Chapter 25 – Power and Light: Impact of Electrical Systems Failure on the Delivery of Anesthetic Care

Abstract

Over the past 50 years, surgery, physiologic monitoring, and the delivery of anesthesia has undergone a high technology revolution. The finger on the pulse, manual blood pressures, and precordial stethoscopes have given way to advances in electrocardiography, automated blood pressure, pulse oximetry, end-tidal capnography, and transesophageal echocardiography, just to name a few of the major advances. As automation has progressed, anesthetic practice and surgery have become extremely dependent upon a reliable power supply for clinical operations. The Joint Commission (TJC) standards require routine testing of the hospital backup power supply (EC.02.05.07.04); 12 times a year, at intervals of not less than 20 days and not more than 40 days, the hospital tests each emergency generator for at least 30 continuous minutes. The completion dates of the tests are documented in the generator and automatic transfer switch (ATS) testing logs by the technicians performing the tests. Additional specifics are addressed in TJC standards on load testing and performance.

Chapter 25 Power and Light: Impact of Electrical Systems Failure on the Delivery of Anesthetic Care

Frederick W. Burgess and Jordan Anderson

In the United States, a routine search of the Internet will generate numerous news articles describing regional and local power outages on a monthly basis. Causes range from lightning strikes to automobile accidents, and even stray bullets from target practice striking a transformer. The most common cause of power failures in the USA and worldwide are attributable to natural disasters, such as weather, earthquakes, and the like. The most recent example was the impact of “Super Storm” Sandy, which produced major coastal flooding and wind damage along the Northeastern USA. Power outages severely impacted several hospitals in the New York City area, prompting the evacuation of patients and transfer to other healthcare facilities. Although standards were met, the severe flooding compromised the backup electrical power systems, resulting in complete electrical failure. However, even in the absence of catastrophic events, power failures have occurred due to small and seemingly inconsequential events. In 1999, the Rhode Island Hospital experienced a major power outage resulting from a child’s helium-filled balloon tangling with power lines and causing a crossed circuit at a power substation, knocking out both feed lines to the hospital complex. The backup electrical systems failed to operate properly, when a transfer switch failed, producing a complete power loss to much of the facility, including life-safety power. Over a span of four years, the facility experienced two more major outages impacting the surgical suite, despite installing additional backup power systems. A systematic literature review on the health impact of power outages produced by extreme events from 2011–2013 was conducted by Klinger et al.² During the interval examined, the USA experienced 14 reported power outages, all related to extreme meteorological events. As the national power grid infrastructure ages, the likelihood of more power and light failures will increase. Add to the weather concerns, the risk of computer glitches and computer virus attacks, as was seen in the massive power failure that blacked out the entire Northeast and portions of Canada in 2003, it is essential that anesthesia providers develop plans, policies, and simulation programs to prevent patient harm in the event of a major power outage.³ This chapter will examine the impact of power and light outages on the delivery of anesthetic care, and recommend steps to avert disastrous consequences.

Impact of Power and Light Outage on Patient Care

In the USA, all hospitals are required to have a backup independent power supply, capable of sensing and responding to external power grid feed-line failures. The backup power supply should assume the workload within 3 minutes, supplying all life-safety essential equipment, which should be plugged into the identified (red) power outlets in critical patient care areas. Most surgical suites should have an ample supply of power lines, but it is important to be aware that not all electrical outlets are powered by the backup generator power lines, and staff should verify that critical equipment, such as monitors, ventilators, anesthesia machines, etc. should be attached to the proper power line circuit. Backup generators should have sufficient fuel to operate for 72 hours at minimal load. Diesel fuel is subject to degradation over time and bacterial growth, and should be subject to monitoring, replacement, or consumption over time to avoid system failures. The National Fire Protection Association (NFPA) has introduced fuel standards to reduce generator failures. As noted above, the NFPA and TJC have specific requirements for regular testing schedules to insure dependability.^1,⁴

Although most surgical suites are capable of continuing to operate with reliable backup power systems, the entire hospital may be seriously impacted by power and light outages (see Box 25.1). Emergency lighting is limited in non-patient care areas, and battery backup lighting is only designed to operate for 30 minutes to aide evacuation. Many areas may not have any emergency lighting at all. Elevators may continue to operate under backup power, but the workload may strain the generator capacity and contribute to the loss of essential power. Non-emergent facility activity should be discontinued, including clinic visits, non-emergent (elective) surgery, and even urgent surgeries should be considered for transfer to unaffected healthcare facilities, if feasible. Ongoing surgical cases should be completed as rapidly and as safely as possible.

Box 25.1 Systems Impacted by Power Outage

Lighting
- Critical systems will function with backup power supply
- Total blackout if backup power system fails
Heating, ventilation, and air conditioning (HVAC)
- Loss of cooling and heating
- Lighting
- Loss of vacuum/suction
- Loss of anesthesia scavenging system
Anesthesia critical equipment
- Ventilators
- Desflurane vaporizer
- Physiologic monitors
- Suction
- Infusion pumps
- Patient warming devices
- Cardiopulmonary bypass pumps and intra-aortic balloon pump
Communication
- Fire and patient bedside alarms
Transportation
Laboratory and blood-banking support
Food (storage and cooking)

Areas likely to be adversely effected by a major power outage within the facility include: food service and storage, HVAC operation, temperature regulation, electronic health records (EHR), communications within and outside the facility, transportation within and outside the facility, medication access and storage, blood-banking activity, and lighting. Additional concerns may arise over the impact of the disaster on the surrounding community, regional hospitals, and broader emergency management. In widespread power outages, most hospitals must anticipate a surge in demand on resources, and many patients who receive extensive medical care in their homes, such as the use of oxygen concentrators, home dialysis, and other critical life-sustaining therapies will seek care in the emergency department. Although, the surgical suite may remain operationally capable, supporting elements may be inadequate, making it important to resist the temptation to sustain normal operation.

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