Response to a Health Care Facility Power Outage

By KEVIN PLATT

On January 23, 2013, at 1850 hours, the local utility company for the City of Walnut Creek, California, experienced a transformer fire that caused a large-scale blackout. The Contra Costa County (CA) Fire Protection District, an all-risk agency that serves the majority of Contra Costa County in the San Francisco East Bay area, responded to this incident. Engine 3 (E3), housed in the southern corner of Walnut Creek and consisting of members Captain Matthew dePolo, Engineer Sam Transue, and Firefighter Mike Caraveo, was committed to a call for an elevator that was stuck because of the power outage. After lowering the elevator car to the ground floor by releasing the hydraulic fluid purge valve, the neighboring quint company-Quint 1 (Q1)-was called in to assist in opening the door because E3 didn’t carry the tool required for this incident.

While responding as “available,” Q1 was dispatched to another call for service in E3’s first-due area. Captain 3 (C3) and Captain 1 (C1) quickly agreed over the radio that they would switch calls, directing E3 to the emergency and having Q1 finish with the nonemergent elevator call. E3 was also geographically closer than Q1; E3 was responding to a 180-bed, skilled nursing and rehabilitation facility that had also lost power and was unable to power the ventilators for its critical care wing. Immediately, C3 inquired through the communication center if the local utility company had any information on the expected duration of the power outage. The utility company said that it would be “multiple hours” until power would return.

THE SCENE

On arrival at the single-story health care facility, C3 was confronted by several frantic employees; the entire facility was without power and, specifically, the patients in the ventilator wing were immediately dependent on electric ventilator machines. C3 needed good information; he found a nursing supervisor who informed him that 20 patients were currently dependent on ventilators. C3 then confirmed that the facility was managing the manual mechanical ventilations for these 20 patients. Staff members were using bag valve masks to manually replace the failed ventilators.

C3’s next task was to have the facility staff find out how much oxygen was available to support not only the patients requiring mechanical ventilation but the rest of the facility’s patients needing supplemental oxygen. Once it was determined that the facility had enough oxygen to last until morning and the ventilator-dependent patients were being manually bagged, the next task was to offer a better, more dependable option for ventilating the 20 patients for the next several hours.

SCENE MANAGEMENT

C3 ordered his crew to position the apparatus at one end of the facility and pull the electrical cord from the engine-mounted hydraulic generator down the center hallway. C3 then gathered the facility’s surge protector power strips from every office and he and his crew connected them to the fire engine’s cord reel; this brought power back for the critical ventilator-assisted patients. C3 then paired his firefighter with a respiratory therapist from the facility and had them systematically repower and then reprogram the ventilators one by one. Recognizing the limitations of the engine-mounted generator but not knowing the exact draw of each ventilator, E3 was posted at the engine-mounted generator and a tactical radio channel was requested from the communication center to allow all three crew members to stay in contact now that the operation was spreading out.

SEARCHING FOR BACKUP SUPPORT

While the ventilator patient wing issues were being addressed, C3 and the facility’s maintenance supervisor examined the facility’s backup generator, which was not working. The maintenance supervisor was unsuccessful with troubleshooting efforts. C3 directed the facility staff to contact the emergency repair company regarding the situation. The generator company’s best response was to send a repair technician within one hour and send a replacement generator within two hours.

Battalion 1 (B1) arrived and was informed of the situation’s problems and probabilities and of the actions that needed to be taken. B1 established incident command and declared a tier zero mass-casualty incident (MCI) with the potential for 20 patients. B1 then coordinated with an American Medical Response supervisor for assistance in activating an MCI and the ensuing patient care and transports.

After returning to his crew, C3 found seven patients successfully hooked back up to their ventilators, which were now being powered by the fire engine’s generator. All available extension cords from E3 and from the facility were in use; more were needed. The incident commander requested an additional engine company to respond and bring all the extension cords it could from its station.

MORE RESOURCES NEEDED

Engine 15 (E15) arrived and stretched its power cords through the center hallway from the other end of the facility. With the power cords gathered from the maintenance emergency cache on scene and the cords brought by E15, the remainder of the ventilators were powered, and all patients were returned to their machines. E3 was powering 13 ventilators, and E15 powered the remaining seven (photos 1, 2).

Photos by Mike Caraveo.
Photos by Mike Caraveo.
Photos by Mike Caraveo.

Now, with all the patients hooked up to their ventilators, C3 returned to the facility generator to find the repair technician diligently troubleshooting the generator. The replacement generator had also just arrived and, if the original could not be made operational, the replacement could be hooked up in approximately 45 minutes.

THE UNDERLYING PROBLEM

The utility company restored power after the transformer fire, approximately 2½ hours after power was first lost. Five minutes later, the emergency backup generator was also made operational. With the facility illuminated again, further inspection revealed that an emergency kill switch to the generator was tripped and not reset during a weekly generator test the morning of the incident.

E3 and E15 supplied power until the power was confirmed as steady and the backup generator was confirmed functional (if it was needed). Engine crews then helped the facility staff switch all the patient ventilators back to the house power. The successful mitigation of this incident was possible with the diligent work of the fire crews on scene coordinated with help from the professionals at the health care facility as well as the emergency electrical company.

The success of this unusual call was largely dependent on unconventional thought and the execution of a systematic plan. Often, you are called to scenes similar to other calls to which you have responded. Sometimes, the work you do is familiar and, in some form, that which you have done previously. This call was out of the norm, and the solution was something not familiar to most of us.

The communities we serve call us to help them with situations they can’t manage on their own because we bring a diverse set of tools. Often, we carry these tools on our belt or in compartments on the apparatus, but we back up these tools with the determination to improve the situation with creativity and innovation. Hoselays, aerials, hand tools, and emergency medical services gear are among our most commonly used tools, but what elevates fire departments to a higher level of service is what we carry in our own heads, sharpened by education and training.

KEVIN PLATT is the A-Shift training captain for the Contra Costa County (CA) Fire Protection District, where he has been a member for the past 11 years.

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