Masters of disaster planning approach crises as never events

During the last decade, Healthcare Purchasing News explored the topic of crisis and disaster planning initiatives from a number of perspectives as they pertained to hospitals, integrated delivery networks, group purchasing organizations, manufacturers and distributors.

Specifically, viewpoints included functions and roles played with features spanning a global supply traffic control room deep within the bowels of a leading supplier to how several hospitals and hospital systems dealt with the aftershocks of natural disasters, such as hurricanes, superstorms and tornados, as well as highly contagious disease/pandemic outbreaks.

Last year, HPN highlighted some deep-seeded issues to consider when dealing with crises and disasters – prepping for immediate active response to long-term ongoing operations.

This year, HPN decided to pull back the camera for more of a panoramic perspective. As part of its 40^th anniversary, we strove to profile at least 40 different crises a healthcare organization might experience or face, along with some salient thoughts on how to handle each one – proactively, if not reactively.

Interestingly, one source suffered a crisis of her own during the interview process when her hard drive crashed.

Yet it doesn’t take even a creative mind to conceive a potential crisis or disaster-in-the-making. To wit, ponder these: Sterile Processing’s sterilizers break down first thing in the morning with a full day of surgical procedures looming, but there’s still a backlog of dirty instruments from yesterday’s heavy surgical load that the night shift didn’t finish. The Operating Room has a full surgical schedule for the day after three Ebola-infected patients entered the hospital and required immediate trauma care. Your hospital was scheduled to receive a new batch of loaner instruments today, but the county dam broke and flooded all roads leading to your facility. An SPD tech running sterilizer loads is discovered to be an asymptomatic carrier of Zika. Due to the stress of meeting ever-increasing OR demands and experiencing some personal issues, one SPD tech decides that the best way to catch up is to just wipe the instruments down and send them along.

The possibilities that can interrupt business continuity and interfere with patient care seem endless. They can span hurricanes, tornados, dam breaks, swollen rivers, superstorms, earthquakes and mudslides, power outages, computer hackings, cyber security lapses and information technology data loss, stock-outs due to international trade incidents and product recalls, pandemic disease-infected patients from overseas, active shooters wielding firearms, and even a scarcity of clean air or water.

Even one of the latest pieces of technology making its way into healthcare, a simple 3-D printer, can ignite a crisis or disaster. (Visit https://www.hpnonline.com/a-3-d-printer-can-do-what/ for the sidebar “A 3-D printer can do what?”)

Mayo Clinic delineates disaster planning and preparedness from business continuity, according to Jim Francis, Chair, Supply Chain Management and Chief Supply Chain Officer. In fact, Mayo’s Director of Business Integrity and Continuity and his team had to implement their disaster plans when Hurricane Matthew marched up the eastern seaboard of Florida last October. “It was given a real test,” Francis noted.

“We have been working for about a year on business continuity, which we define as any interruption that could interfere with patient care, postponement or cancellation,” Francis continued. “This could be as simple as a stock-out or backorder. Not many healthcare organizations are even looking at these possibilities.”

Jake Crampton, Founder and CEO, MedSpeed Inc.

A national outbreak of infectious diseases can cause healthcare organizations around the country to go on high alert. The 2014 Ebola outbreak in the U.S. is an example. As patients who tested positive for the illness began to enter hospitals, those systems had to quickly quarantine and treat them and transport the positive tests to the CDC. However, the stigma of delivering infectious disease specimens, and the stringent requirements for moving Category A substances, made it difficult to find an appropriate party to transport the specimens. As a result, some of the tests had to be transported by the doctors and nurses themselves, taking time away from patient care, increasing risk to the staff and those close to them and increasing general liability. Some crises are not as wide spread or planned for but can have still have dramatic impact.

I am sure all healthcare organizations have processes in place for infectious disease outbreaks but not all of them have processes to cover the movement of potentially infected materials outside of the system. More today than ever, the supply chain reaches outside of the four walls of the hospital, and teams need to be prepared to extend its processes as needed. One of the first steps for a Supply Chain team during an infectious disease outbreak should be to work closely with logistics teams or partners to make sure that sensitive protocols are followed to protect the entire community.

Christopher O’Connor, President, GNYHA Services Inc. and Nexera Inc.

A communicable disease outbreak, such as Ebola, requires Supply Chain to be properly informed about the supplies required to protect staff and care for patients effectively. Supply Chain must be in constant communication with Infection Control, clinical, and administrative stakeholders during this situation.

In this scenario, Supply Chain should carefully monitor the growing outbreak in order to anticipate and make early decisions about clinical supplies and personal protective equipment for staff. These decisions have to be made based on the science and guidance available at the moment, recognizing that this will likely change.

In the case of the 2014 Ebola outbreak, healthcare organizations experienced major issues finding and stocking supplies. Supply Chain teams were under enormous pressure to evaluate the quantities of supplies that were necessary (based on the probability of an outbreak) and to source and stock extremely hard-to-find protective clothing. GPOs can serve as a valuable resource. In response to the Ebola outbreak, GNYHA Services kept in contact with the supplier community to monitor the availability of the supplies listed on the Centers for Disease Control and Prevention list, and informed the supply chain community about which vendors manufactured these items and the specific stock-keeping units (SKUs) for each. In many cases the supplies that the hospitals required during this outbreak were not available from traditional medical/surgical suppliers. GNYHA Services helped our members locate alternative suppliers and provided training and subject matter expertise for these and other required items.

Staff often require education on how to properly use the supplies required in this type of crisis. For example, education was a major factor in the Ebola outbreak because if staff did not don and doff the protective attire properly when treating a patient, they too could become infected. Supply Chain must work with clinical teams to ensure that proper use recommendations for each supply are available and communicated during infectious disease response.

Based on the level of protection needed, begin the process of moving appropriate supplies in response to the specific pathogen, hopefully from the pre-staged locations. Also, at this time begin to use the Personal Protective Inventory Calculator (Developed by Mercy Hospital Springfield). This calculator gives you the ability to change parameters and you can see the supply needs in the future. This calculator is extremely flexible and gives you the advantage of running several different scenarios. The calculator will supply information on how long the present supplies will last based on the usage parameters that are entered into it.

Al Webb, Director, Integrated Services, ROi

Immediately establish a Supply Chain Command Center led by pre-determined Supply Chain Leaders who will implement the pre-established supply chain disaster plan and coordinate supply needs, with the senior leaders and disaster preparedness leaders at the care site.

Facilitate access to the pre-staged inventories and coordinate delivery of the product to the care site. Immediately communicate with vendor/distributor partners for replenishment of pre-staged supplies and the acquisition of additional supplies as required depending on the length and breadth of the crisis.

Establish routine multiple daily update calls with Supply Chain leaders to keep everyone on the same page regarding the changing situation and related needs.

A few years back, a non-patient walked through the lobby of one of the UPMC Cancer Centers. Upon notification from the Pennsylvania Public Health Department, we learned that the person was confirmed to have an active case of measles. UPMC launched a week-long effort to identify all visitors, staff and patients that may have come in contact with this person in the brief time this person was in the lobby of our facility.

We were notified by the Allegheny County Health Department that there was a possible measles exposure in a non-patient care area at one UPMC facility on a Friday and a second facility on the following Monday. Although the likelihood of exposure is very small, as a precaution we identified employees who were in the vicinity on one of those days and therefore may have been exposed. We worked with Employee Health to see if potentially exposed employees have a titer test on file from their employment physical.  (A titer test is a blood test that will identify if a person’s antibodies are immune to certain disease agents; in this case, measles.)

Health authorities also said the exposed individual rode Port Authority bus leaving Fifth Avenue and South Highland Avenue going toward Shadyside and Lawrenceville at 9:12 a.m. on Friday, February 14. Anyone who rode this bus between 9 a.m. and 11 a.m. on that day may have been exposed. We knew patients and families may ask questions if they have heard this on the news so we prepared talking points:

1. We have identified patients who may have been exposed and we have reached out to them for testing and treatment.
2. If you are susceptible to measles and become ill with symptoms of measles between now and 14 days, please contact your primary care physician immediately.
3. Measles are caused by a virus and is highly contagious. Most people are vaccinated against the disease as children and exposures are very rare.
4. Symptoms of the disease can develop about 10 days after exposure and include a high fever, cough, pink eye and a rash.

We had a multidisciplinary team develop a Measles Exposure Plan and then held calls several times a day for multiple days to work the plan.

1. Allegheny Health Department Update
2. Document review
3. Physician letter
4. Script for phone calls
5. Treatment algorithm
6. Draft letter for patient exposure
7. Media communication plan
8. List of patients, staff or visitors from all UPMC facilities. Focus on exposure to infants (as they have partial or no vaccination coverage).
9. Phone call updates to contact every one exposed to ask them to be seen in one of five UPMC EDs. We called hundreds of patients.
10. Tracking tools – each patient was tracked from call through ED testing and treatment.
11. ED update – keeping track of all of the exposure patients and still providing ED care was important. Triage was added to address the exposure patients separately from normal triage. Staffing was increased during peak times.
12. Pharmacy update- immune globulin was required. We normally stocked the IV formulation. This formulation is infused over six hours. With so many patients presenting to the ED, HC Pharmacy had the IM formulation of immune globulin air shipped so that we could reduce the administration time.
13. Registration/charging – Since this was a public health issue, patients were not charged for the service or medication. We had a family with a 9-month old infant that would not come to the hospital because they could not afford to pay. After a few days or calls, the city police assisted in getting the infant to the ED for treatment.

Erich Heneke, Director, Business Integrity & Continuity, Supply Chain Management, Mayo Clinic

On Monday, February 20, the FDA shuts down the production line of a vendor producing a significant commodity item to the organization. This vendor is a sole supplier to our organization, and the FDA maneuver creates a large hiccup/disruption in the entire market. The products are critical to patient care and timeframe for availability of the items is unknown/uncertain.

Response should include: 1. Readily available list of substitute vendors/items for business critical items. 2. Pre-established internal escalation system to respond to shortage, both proposed practice changes as well as procedures to locate alternative items.

Terri Nelson, R.N., Director, Supply Chain Operations, CQVA, Mayo Clinic

On March 3, the Chinese government announces all manufacturing will halt on April 1 to allow for air quality to improve prior to the start of the Summer Olympic Games. This shutdown will affect products manufactured only in China. Mayo will need a list of affected products and suppliers and determine what alternatives are available.

Mayo Clinic will need to scope out the details of the situation including with is the duration of this shut down, identify effected products and suppliers and determine what alternatives are currently available. These items can be identified in advance. We had an idea what items were manufactured in China or Asia, such as anything with latex and latex-like material, which included gloves, some IV tubing and dressing. We also asked our med/surg and medical device manufacturers where their products were manufactured and what plans they had in place to maintain inventory. Since this event, we have standard questions to ask manufacturers during requests for information (RFI) specific to where products are manufactured, how much inventory is kept in the U.S., where the storage facility is located and what are their contingency plans for any interruption in product availability.

Jake Crampton, Founder and CEO, MedSpeed Inc.

About a year ago, a Mid-Atlantic health system with busy patient volume experienced an IV solution shortage over a weekend. Its manufacturer notified the system that it was unexpectedly unable to deliver IV solution to several of its facilities, due to production shortages. Without the IV solution, the affected hospitals would not have been able to provide care to patients. This could have translated into poor patient outcomes, negative patient experiences, lost revenue and negative brand reputation within the community.

Any pharmaceutical shortage can come with great risk. Supply Chain’s first response should be to assess current supply throughout its entire system and implement a sharing process that can move the pharmaceutical in question around quickly to meet demand. At the Mid-Atlantic organization, the system had a logistical framework in place that allowed for this seamless redistribution and supply sharing.

Courtney Winstead, Marketing Manager,
Instrument Management Services (IMS), STERIS Inc.

A local hospital system recently had three of its facilities shut down due to repeated compliance issues. As the only other system in the immediate area, your facility sees an immediate increase for surgery requests. While you do have the OR space and doctors available to meet the needs, your Sterile Processing department cannot reprocess quickly enough to satisfy the increased case load.

STERIS Instrument Management Services (IMS) has fully trained Sterile Processing technicians that can be deployed to the facility to offer support and alleviate the demands of the increase case load. These additional technicians have a heightened sense of awareness of industry best practices allowing them to help staff identify concerns and improve approaches of areas that might be brought up by a Joint Commission audit.

Recalls affect all healthcare provider facilities and their many patients. There is little to no traceability to the actual patients who received product. Although we may not think of this as a disaster, it is. Recall notifications have increased over the past few years. To complete a recall within each facility is time consuming, anywhere from a few minutes to days. I received a recall sent out by a manufacturer for implantable products used in OR and Cath Lab. The recall was 30 pages long with 25 lines per page. The administrative assistant spent 8 hours looking up each item to determine if it was a product ordered by the facility. For those items purchased, she added the stock location to the page. The inventory tech then spent 2 hours looking for each product/serial number in each location. We had no way of knowing what had been purchased and used on a patient. With any recall, much effort is put into locating the recalled supply, most often, we don’t know what of the recalled product has been used on a patient.

The first response is to ensure all recalls are processed in a timely manner. The next response is to develop a robust item master which includes the unique device identifier (UDI) and work with clinical areas to capture that information in their systems. This is the first step in tracing the product use to the patient which will allow for the tracking of recalled products. Information for orthopedic and cardiac devices is being captured in registries today. Is Supply Chain aware and involved? If not, get involved. Meaningful Use Stage 3 takes effect January 2018. The requirements are for information in the Common Clinical Data Set (CCDS), which includes the UDI for implantables, to be included in the patient’s electronic health record. This is one of the first steps in bringing the organizations together to endure all of this data is captured. This is a patient safety issue and a disaster to continue to work in the manner we have for many years. It is time to become proactive rather than reactive.

A Hurricane Warning was in effect for most of Northeast Florida on Oct. 7, 2016. Hurricane Matthew was a Category 4 hurricane with maximum sustained winds of 140 m.p.h. The anticipated track of Matthew was projected to impact Jacksonville during the evening of October 7.

Mayo Clinic Florida enacted the Healthcare Incident Command System (HICS) and the Planned Emergency Response Team (PERT). PERT is a dedicated group of employees that agree in advance to staff the hospital in the event of a hurricane or other multiple-day disaster. The Mayo Supply Chain PERT Team consisted of 13 individuals that were part of nearly 600 individuals campus-wide deployed to execute the various phases of the Hurricane plan. The Hurricane Plan consists of four distinct phases that become enacted during a Hurricane Watch (Phase 1, which occurs from 48 hours to 2 hours to landfall, to Phase 4, which is initiated when severe weather conditions have diminished). Supply Chain executed our plan in Phase 1 by activating our PERT Team and the initial components of our Hurricane plan that largely consists of coordinating with our team members, suppliers and internal customers preparations for an anticipated Category 4 hurricane. In addition, downtime procedures are reviewed.

In subsequent phases (2 and 3) Supply Chain coordinated the procurement and delivery of all supplies that are part of our Hurricane formulary. These supplies are predetermined through interactions with staff and based on anticipated patient populations that would be encountered in a disaster of this type. Supply Chain updates our formulary every spring and works with our distributors and suppliers on the needed disaster supplies as well as accessibility of these supplies based on the various phases of our plan. Unique formularies exist at Mayo Clinic for other disasters, depending on their nature, such as mass casualty, chemical burns, pandemics. etc.

Supply Chain is an integral part of the HICS Command Center and also supports Vertical Relocation plans that would relocate ground floor operations to higher locations in the event of flooding. Finally, in Phase 4 when operations for Mayo Clinic Florida returned to normal (October 9th) Supply Chain also coordinated normal operations and continuity of supplies for our patients. All of these preceding activities occurred in a 72-hour time frame.

Mayo Clinic Florida was fortunate that Matthew diverted from our coast at the last minute sparing a direct impact. As a Supply Chain leader you never want to be in a situation where you must execute on a disaster plan. However, we were fortunate in that we were able to execute and determine that our plan worked without major impact from the storm.

Christopher O’Connor, President, GNYHA Services Inc. and Nexera Inc.

Hurricane Sandy is an example of an event where procuring supplies was a leading request coming out of emergency response efforts. GPOs, such as GNYHA Services, worked closely with Supply Chain departments at area hospitals and long-term care facilities to procure the supplies essential to remaining open and continuing to serve patients and residents as well as meeting staff needs during and after the storm.

A major issue experienced during weather-related events is large-scale patient evacuation and relocation. There are two organizations and Supply Chain teams involved in this scenario: The sending facility and the receiving facility.

In preparation, Supply Chain should evaluate evacuation aid supplies and clearly document their location. If in a position to receive patients from other facilities, the hospital should estimate what their patient census might be and the maximum number of evacuating patients they would be able to accept. With this number in mind, Supply Chain must ensure that they think beyond a 72-hour supply during preparedness efforts in order to estimate what would be needed for surge patients and staff, such as bedding (for staff as well as patients) and food (including meals for those with a restricted diet). Supply Chain should also develop a process for tracking supplies that would need to go with the patient to the receiving facility (e.g., wheelchairs, IV poles, etc.). In these cases, it is important to track all expenses for reimbursement and submit them to federal and state governments after the crisis.

Patient transfer was a huge challenge during Hurricane Sandy. One hundred and fifty staff members from GNYHA Services, Nexera, and our parent organization, the Greater New York Hospital Association, helped area hospitals and long-term care facilities source a number of essential supplies, including generators and fuel to prevent avoidable additional patient evacuations; critical air gas to support patient transfers; and cots, mattresses, wheelchairs and food for the receiving facilities.

In these scenarios, Supply Chain teams must also consider how these last-minute supplies will be paid for should vendors request immediate payment. GPOs are an excellent resource for Supply Chain during these crises. Our relationships, on-staff expertise, and sourcing experience make us particularly well-suited to orchestrate essential connections and coordinate a successful response.

Russ Conroy RRT, Director, Safety and Emergency Preparedness, Mercy Hospital Springfield

What if you experience a direct hit on your facility by a category F-5 tornado? (Editor’s Note: Search HPN Online for coverage of Mercy Hospital Joplin, May 2011.)

Provide immediate additional medical supplies to the triage/alternative care site.  At the same time begin the process of increasing the flow of all supplies – both medical and support supplies – to the site, hopefully from the pre-staged locations. Begin the process of finding alternative space for storage of supplies.

Al Webb, Director, Integrated Services, ROi

It’s important to already have a well-documented and practiced disaster plan in place so that leaders and co-workers are already familiar with the next steps. The plan must remain fresh and active in leader and co-worker minds and should be routinely reviewed, practiced and updated as resources and needs change.

Pre-plan in phases: How to meet needs during the first 72 hours, the next two weeks, the months ahead.

Establish pre-selected alternative locations, with a couple of backup location options in place, to immediately establish a Supply Chain Command Center. Have a plan in place to help quickly secure alternative space for supply chain operations and storage for the varied phases of the disaster. Proactively negotiate agreements with critical suppliers/distributors on how and what level of support they can and will provide in the event of such a crisis. Proactively identify and activate predetermined supply lists that would be needed in this type of disaster. Consider establishing and coordinating a predetermined order at primary vendors/distributors that they can quickly ship to the care site in case communications and ERP systems are hindered.

Pre-plan and establish alternative communication plans if phones and computers are unavailable. The Supply Chain Command Center Leader(s) should lead in and direct the communication and coordination with senior leaders and local emergency preparedness leaders at the impacted site, Supply Chain co-workers, local community disaster coalition partners, county, state and federal agencies, vendor partners, people and organizations for assistance with immediate supply needs.

Many well-meaning people and organizations are anxious to help out, but without a plan and direction for what supplies are actually needed, how much is needed, when they’re needed and where they should be delivered and stored, local resources can easily become overwhelmed.   They can quickly lose visibility to available undocumented supplies which then may go unused, result in wasted time and resources to replenish supply needs that have unknowingly already been met. And it can create a storage challenge for local limited resources. (Visit https://www.hpnonline.com/competition-crises-disasters/ for the sidebar “What about competition during crises, disasters?”)

Once phone communication is available establish routine check-in conference calls with the Supply Chain Command Center and supply chain leaders at the care site to keep current on the situation and to coordinate supply needs at the site.

In October 2012, the impact from Hurricane Sandy devastated the New York metropolitan area. All transportation infrastructure – except the Lincoln Tunnel – leading to Manhattan was closed. Power outages impacted over 2.2 million people. A major research and acute-care health system located in Manhattan experienced heavy flooding and failure of a backup generator. The hospital was forced to divert patients to surrounding hospitals and evacuate its medical buildings.

With limited access to communication, the hospital had difficulty contacting suppliers to divert all orders to a temporary warehouse in New Jersey. As the health system’s supply chain partner, TRIOSE stepped in and engaged all suppliers and carriers with updated shipping instructions and served as the proxy between hospital and vendors. Ultimately, TRIOSE was able to help the hospital keep its supplies in the New York metro area so patients could have access to much-needed healthcare resources.

Supply chain should immediately notify carriers and suppliers about contingency plans that may impact procurement and delivery. In the case of the major healthcare organization in the New York City metro area, being unable to divert shipments to the temporary warehouse in New Jersey would’ve resulted in products returning to the supplier. This would have directly impacted the ability to provide patient care in a time of crisis or disaster.

Dave Gossett, Product Manager, Mobile Solutions, STERIS Inc.

A sewer line leak was identified and needed to be addressed immediately. Repairs to this line involve jackhammering through the floor of the SPD and making the area inaccessible during the month-long planned downtime for this and other repairs to the area. The hospital wants to maintain case load during this time while continuing to provide on-site sterile processing to maintain a high level of productivity and profitability.

Russ Conroy RRT, Director, Safety and Emergency Preparedness, Mercy Hospital Springfield

What if you experience catastrophic loss of utilities to the supply chain location? Every Supply Chain location should have two plans. First: How you are going to support your facilities? Second: How you are going to support yourself if your location experiences a catastrophic event? With this second thought each location initiates their Continuity of Operation Plan (COOP) or some individuals refer to as a Business Continuity Plan (BCP). This lays out the response to any significant event that interrupts the day-to-day operation of supply chain location.

Al Webb, Director, Integrated Services, ROi

It’s important to already have a well-documented and practiced COOP/BCP in place so that leaders and co-workers are already familiar with the next steps. The plan must remain fresh and active in leader and co-worker minds and should be routinely reviewed, practiced and updated as resources and needs change.

Make sure to pre-plan alternative communication options and immediately communicate the situation to customer facilities, with ongoing follow up communications as the situation continues and/or changes. Local Supply Chain leaders can then implement their local COOP/BCP plans for Supply Chain.

Immediately communicate with co-workers and have pre-selected alternative locations, with a couple of backup location options in place, to immediately establish a Supply Chain Command Center and supply chain operations. This includes pre-established plans with IT and Telecom for equipment and system needs. Implement pre-established supply plan with vendor/distribution partners as needed.

Christopher O’Connor, President, GNYHA Services Inc. and Nexera Inc.

The New York City blackout of 2003 is an interesting example of a crisis that made a strong case for emergency preparedness planning. Many organizations had never anticipated a widespread loss of utilities across a large geographic area for an extended amount of time. Supply Chain is a major part of this response, as particular supplies are needed to keep healthcare facilities operating.

During New York City’s 2003 blackout, issues that at first appeared minor ended up having a significant impact on hospitals. Supply Chain intervention was a major part of the solution.

Many of the city’s healthcare organizations had to run on backup generators for several days. It turned out that several hospitals only had 24–36 hours of fuel on hand, leading to the question of how they could remain in operation and prevent patient evacuations. There was not an easy solution as the local fuel suppliers were also impacted by the loss of power. This meant that they were limited in their ability to pump fuel as well as to communicate with the hospital representatives who were trying to reach them.

A similar situation arose related to foodservice. Nursing units found themselves needing dry ice to preserve food and drinks. In both cases, hospital representatives’ normal method for accessing phone numbers and connecting with vendors (and vice versa) was not an option. Supply Chain played a major role in researching and securing delivery of these supplies. However, once the contacts were made, hospital Supply Chain teams ran into the issue of payment. Many hospitals had little cash on hand and found themselves needing to establish on-demand payment controls.

Supply Chain teams must ensure that they have agreed-upon processes in place. This includes a backup method for contacting required vendors as well as established payment and inventory controls to ensure that the limited resources they have are protected and used appropriately.

The hospital data center is where information comes together – integrating patient data information, the latest clinical protocols and departmental systems into actionable information along with backup, network activity, communications and security systems. Because these systems are so vital, even extremely short power outages of a few seconds can compromise massive amounts of data – not to mention the health of individual patients via electronic health records – and cause costly damage to sensitive medical equipment and IT systems.

Assure data and system integrity by utilizing a power management system that has the capabilities to mitigate any damage to IT and medical equipment. To avoid any possibility of unplanned downtime, hospitals need a reliable uninterruptible power system (UPS) solution to protect and monitoring support systems against a full range of problems from spikes and sags to full power interruptions.

Power distribution units (PDU) also provide reliable data center power distribution for healthcare IT environments. To deliver effective power management and monitoring, a PDU will optimize both utilization and availability down to the branch circuit level, while providing proactive warning if any circuits are approaching overload. Virtualization software can integrate with the datacenter UPS system to initiate the automatic transfer of data and computing functions to another facility, or to a disaster recovery backup datacenter.

The nurses’ station is at the heart of patient care, and quick access to reliable patient information is paramount. Hospital staffs rely on IT and telecommunications networks, so an unexpected power event can interference with the ability to enter, view, store and exchange patient data.

Utilize power monitoring software in conjunction with UPS’ and other power backup equipment to ensure your network remains up-and-running. Supply Chain can help by ensuring that replacement batteries for small UPS’ are available in-house. These can be quickly swapped out by the user if needed. From monitoring event history, notifying you of alerts in case of a power event and delivering real-time status, power monitoring software can provide the tools needed to keep critical equipment running at all times. Many software solutions are easy to use and maintain business continuity which saves time, saves money and reduces risk.

Innovative power monitoring solutions will allow users to monitor and manage multiple power and environmental devices across their network from a single interface. A customizable software interface can also provide key information at a glance, with centralized measurement and alarm information to ensure system uptime and data integrity. On notification of a power outage, nurses’ station personnel should initially determine what non-critical equipment (like printers, redundant monitors, etc.) can be manually shut down to extend the battery backup time of the UPS.

An unexpected power outage can cause lab equipment, imaging systems and analytical instrumentation to malfunction. This results in unstable patient samples, wasted lab materials, delays for re-testing and other unforeseen events. It can prove extremely costly for both hospitals and their patients. Similarly, pharmacy data, communication and auto-dispensing equipment is another critical function that must be available and reliable at all times.

A UPS (uninterruptible power system) in conjunction with the generator solves this critical issue. Supply Chain can provide valuable assistance by arranging for timely UPS maintenance, and negotiating a contract with the supplier for extra diesel fuel to be delivered during extended outages. Fuel providers should be notified immediately when a power outage occurs, so they can dispatch a fuel truck if needed.

The UPS/generator combination will ensure timely access to vital equipment and the completion of vital medical testing procedures. Additionally, [operational expenditures] can be reduced by procuring and deploying an energy-efficient UPS that delivers power conditioning and long runtimes to ride through power disturbances.  In a power emergency, this allows imaging processes to be completed, and even delicate surgical procedures like cardiac catheterization to continue at least until a safe “stopping point” is reached.

When selecting a UPS with power conditioning function, be sure it has been tested and certified for use in medical imaging system applications by all major suppliers of X-ray, MRI and CT machines. There are a number of UPS’ available that are specifically designed to protect these critical machines during their operation, and a typical ER will depend heavily on instant access to imaging to make urgent diagnoses and decisions on patient care.

Christopher O’Connor, President, GNYHA Services Inc. and Nexera Inc.

A terrorist attack, with the potential for mass casualties, such as the Pulse nightclub shooting in Orlando or the World Trade Center attacks, are fast-moving events that call for a high level of preparation and an immediate Supply Chain response. It is critical that the necessary supplies are on hand to treat the wounded. This is especially critical for rural and community emergency departments as they do not always have immediate access to the additional supplies, drugs, or staff needed to care for a sudden spike in patients. A contingency plan must be in place.

Supply Chain should create and maintain a list of high-demand supplies and drugs, their locations, and how to receive additional inventory in the event of a terrorist attack. The emergency preparedness plan should include an analysis of previous mass casualty incidents experienced locally or in other areas of the country. This analysis provides the Supply Chain department with an idea of the type and quantity of supplies needed to take care of a single critical patient. They can then estimate how many critical patients would deplete the inventory they keep on hand. If the facility is part of a larger health system, it should plan resource coordination.

At the onset of the event, immediate considerations must be made for the transfer of patients and staff, and the necessary supplies and drugs needed at the new location. These details should be considered in advance through emergency preparedness planning. This process can change depending on access to the location of the receiving facility.

The Supply Chain response can include communicating with their group purchasing organization and related vendors and distributors for support. As we are based in New York City, GNYHA Services and our parent organization, the Greater New York Hospital Association, were heavily involved in the 9/11 response. Providers were dealing with the expectation of mass trauma, a massive power outage, and a city under lockdown at the onset of the attack. In coordination with government agencies, we helped transfer necessary supplies from the city’s hospitals to Ground Zero, triage locations, and the medical examiner’s office. Even though they had lost power, the hospitals within the vicinity of the attacks needed to keep running and caring for first responders. This was achieved through the unique coordination of police, city officials and hospitals that held contracted relationships with fuel companies, medical/surgical distributors, protective equipment suppliers, and many others to get the necessary items where they were needed in order to remain in operation.

The reaction to 9/11 was also an example of how good intentions can create unexpected and unintended supply chain issues during a crisis. Hospitals often receive huge donations during a crisis. In the case of the World Trade Center attacks, Supply Chain departments were struggling to keep up with the supplies that appeared unexpectedly as they had no way to catalog, inventory or store them. Hospital Supply Chain departments would be well-served to include a plan for dealing with this issue as part of their crisis planning.

Mary Beth Lang, R.Ph., MPM, DSc, CMRP, Executive Vice President, Cognitive Analytics, Pensiamo Inc. and HC Pharmacy Central Inc.

As a regional site for CDC declared emergencies, medications are stocked and inspected by the CDC at locations across the country. Regional centers wait for notification and instruction by the CDC.

The CHEMPACK program is an ongoing initiative of CDC’s Division of Strategic National Stockpile (SNS) launched in 2003, which provides antidotes (three countermeasures used concomitantly) to nerve agents for pre-positioning by State, local, and/or tribal officials throughout the U.S. (See https://chemm.nlm.nih.gov/chempack.htm.) CHEMPACK Program is envisioned as a comprehensive capability for the effective use of medical countermeasures in the event of an attack on civilians with nerve agents. The Enterprise CHEMPACK program would build upon the existing system, improving it by adding an education, training, and exercise component and by optimizing the pre-positioning of antidotes. (See https://chemm.nlm.nih.gov/chempack.htm#sec1.)

• CHEMPACK mission
  • Provide, monitor and maintain a nationwide program for the forward placement of nerve agent antidotes.
  • To provide state and local governments a sustainable resource; and improve their capability to respond quickly to a nerve agent incident.
• Why CHEMPACK?
  • Strategic National Stockpile (SNS) has a 12-hour response time, too long in the event of a chemical attack
  • State and local governments have limited or no chemical/nerve agent antidote stocks
  • Hospitals carry very limited supplies of treatments for nerve agent exposures
  • Nerve agent antidotes are costly and have variable shelf lives (not an easily sustainable resource)
• Background
  • The CHEMPACK Program pilot was established in September 2002.
    • Three Project Areas participated (South Dakota, Washington State and New York City)
    • Tested the concept of forward placement of SNS-owned chemical/nerve agent antidotes
    • Determined feasibility of the tested strategy
    • Lessons learned used to refine processes for the nationwide program

Effective disaster preparedness needs to address natural events such as earthquakes or tornados, large-scale accidents like plane or train crashes, cases of spontaneous and planned mass violence, and emergent failure of core infrastructure. While all of these may present as discrete events, many present as a secondary effect of the first. The need to mindfully assess the critical to operations categories is essential if a healthcare organization is to maintain and expand its services to its service region in any disaster situation. There are many such categories, but it’s important to focus on a foundational category that is all too easy to overlook: Water.

Water is, in many ways, the quintessential and irreplaceable product for healthcare facilities. Electricity is typically highlighted, given the size and sophistication of the technology footprint in a modern hospital. While there are many internal fail-overs for emergent loss of electricity, including generators and analog work processes, there is no replacement for water.  Water is essential for both people and major infrastructure systems like sanitary and HVAC. Neither system nor person can be without water for an extended period. Outside of the municipal water systems, you must focus on the variables that need to be assessed and are contractually controllable.

The first assessment is to understand the vectors and limitations for water delivery and understand the ordering of events that emerge post-disruption in the water supply. In healthcare, a primary problem is the immediate need for water is decentralized and follows the location of the patient. Simply put, when water is suddenly not available from a central source, that is not the time to replace the central source as a single or first-phase response. The immediate need is to quickly interpose a nimble and decentralized logistical plan to get water to the patients, wherever the patients are at the time of the disruption. In light of this reality, UPMC focused on a dual strategy that utilizes both deployment of portable water buffalos and a heavy focus on the use of bottled water.  Bottled water is essential to the quick and pervasive intra-facility response required.

UPMC covers the large needs for an extended water disruption by contracting for emergent access to water buffalos across its service region. The contracts in question permit UPMC to exercise a priority override in order to insure appropriate levels of support. While this is essential, the first and stabilizing response is the use of bottled water. UPMC is self-distributed and maintains three weeks of inventory within its Central Distribution facility. It is important to note that this inventory level is based on normal demand across the enterprise. A water disruption is not a normal event. In one such situation less than one month ago, the municipal water source within the City of Pittsburgh was off-line for a few hours. In this time period and for a small sub-set of its facilities, over 80,000 bottles of water were deployed over four hours. In order to support this kind of sudden demand, UPMC utilizes a priority replacement contract with its bottled water suppliers. The inclusion of the priority access to immediate inventory replenishment is a necessary component in order to insure there are no operational gaps when a disaster occurs. In addition to the contracts, UPMC maintains a list of critical contacts with pre-established phone access for key suppliers with the ability to support UPMC’s need for bottled water.

Bottled water is just one of the day-to-day things that average people take for granted that a 21^st century healthcare organization would be ill-advised to ignore. Sometimes it is the simple things that are anything but simple in a disaster.

We organize our crises/vulnerabilities into the following five categories: Supplier-related events, geopolitical events, local natural events, local technological events, local human events. All of these can negatively impact the flow of supply for a short period of time to an extended period of time.

For supplier-related events, such as regulatory failure: Change to alternative product and quarantine regular product. Work with supplier to resolve failure. If the supplier cannot meet the requirement then move to a new product supplier. We would treat this similar to a recall or defective product.

For geopolitical events, such as energy costs: Changes and increases in oil, gas or electricity impact the supply chain locally or globally as they impact production or transportation. Assess financial impact to supply continuity and expenses. Work with suppliers to determine ways to create more efficiency distribution and order aggregation solutions. Assess transportation cost versus inventory cost to determine if increased inventory is appropriate.

For local natural events, such as high winds: Localized high winds result in damage to infrastructure, halts trucking traffic, impacts power supply, etc. Assess damage and impact to supply continuity. Implement alternative supply method, including routes and vehicle types.

For local technological events, such as an explosion: Local manufacturing and industrial plants, including oil refinery explosions, could impact and close highways, nearby healthcare facilities and lead to possible mass casualties. Implement alternative supply methods, including routes and secondary sources of supply.       

For local human events, such as an active shooter at a hospital, clinic, support facility or even a local third-party service provider, we implement our active shooter protocol (Emergency response & Run-Hide-Fight training).

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