Building Resilient Health Infrastructure with ASPR

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MICHAEL ELTRINGHAM: You’re listening to “Building Resilient Health Infrastructure with ASPR,” a podcast from the HHS ASPR Critical Infrastructure Protection Division. If you have any questions about this episode, please email us at [email protected].

Hey everyone! Thanks for listening. I'm Michael Eltringham, a program analyst with the HHS ASPR Critical Infrastructure Protection Division. I'm joined by our division director, Dr. Laura Wolf. How are you, Dr. Wolf?

LW: Great!

ME: We're back. This is part of our three episode series highlighting specific lessons learned from the 2017 hurricane season. In each of these episodes, we're highlighting a specific example of a lesson learned. So today's question: what's the lesson learned from Hurricane Irma? Obviously, Laura, there's a lot of lessons to be learned from all the hurricanes but what's one area or maybe a couple areas that you'd like to highlight specifically from the response to Hurricane Irma?

LW: Sure! I can't help myself I'm going to mention three but we'll just focus on one. So as everyone may remember, this was the second of three major hurricanes to hit and we had just finished responding to Harvey. We threw all of our personnel resources toward this in the CIP Division. And so when Irma came around, something we were dealing with was staff fatigue. So a lesson taken out of this is that we need multiple response teams ready to go if there are overlapping disasters in the future and I think that's important for everyone to think of moving forward. Lots more planning for staff as needed.

The other one was that there was a twist in the weather. The impact was expected to be more on the east coast initially and then it kind of went up central and west coast of Florida. So that changed where the preparedness posture was. It also affected some of the evacuation routes. So that was something to think of -- more of a recognition of the unpredictability of hurricanes.

But onto the infrastructure lesson learned from Hurricane Irma: there was an unfortunate story coming out of Hollywood, Florida. An incident at a nursing home where they did not have power and the temperatures quickly increased within that facility and unfortunately that heat led to the deaths of 12 of their patients over the course of a few days. Now in this story often times I get the questions of, “Well this was critical infrastructure. Why didn't the power come back on sooner rather than later?” There has to be recognition that in any disaster, there's a lot of local critical infrastructure that is a priority of utility companies for restoration.

We have to think of an order of operations of these priorities. Sometimes, you know, other power generation facilities have to be brought online before you can make sure that water systems are restored so that the rest of the infrastructure can be brought back online. Now, in most cases utility companies know to prioritize hospitals. But when we look outside that hospital infrastructure, including nursing homes and other types of residential facilities, behavioral health facilities, that understanding and those agreements are not always in place ahead of time.

So in looking at some of the media articles on this incident, the utility company was contacted several times by staff and family members of those who were in residence at this facility and the utility company after a while seems to have been very honest and saying, “You are not on the prioritization list. We recommend that you evacuate.” Those recommendations were not taken and we see the consequences that happened.

Subsequently, the governor of Florida put forward a law requiring nursing homes and assisted living facilities to have generators that will power their air-conditioning systems. And the lesson learned that I'm taking away from this is the importance of these residential facilities as critical infrastructure and the importance of planning ahead of time for power restoration. But something I think we need to discuss is that generators are not an end-all be-all for power resilience for the community. Of course, generators may be connected to some of the systems in a facility but not all. You're not going to be a hundred percent up and running unless you have a very significant generator system. And it's challenging to fuel air conditioning systems along with other types of patient care systems: emergency lighting, fire detection systems, sewage and waste disposal systems. There's a lot to be powering on a generator and sometimes it - with a quick installation of a generator, you may not get to all those critical functions. So it's really important to be very conscious conscientious when installing a generator and to be very clear of the systems that it supports and those that it doesn't.

Now our listeners are probably familiar with the CMS emergency preparedness rules. They had been released prior to Hurricane Irma but they had not come into full force. Those requirements also require hospitals and long-term care facilities to have emergency and standby power systems similar to what the Florida law required. And so we should be seeing that support across the healthcare sector where there are residential facilities. But again, if it's not done right, it's not going to save the day and I worry that some organizations or some infrastructure may rely on it for something that generator power can't handle.

ME: We also talked about prioritization and I think you know as - not that we're responders, I don't think that's the right term -  but in in responding, you know, we interacted with private sector members who were asking just in the general sense, not in this specific sense necessarily, but were asking about the possibility of assistance with generator power.

So one thing I think it's kind of critical and I don’t know if you want to elaborate on this as well, is sharing with our partners or having our partners share with their partners the protocols in place because there are pretty clear protocols about asking the government for assistance with that, so I think that's a an important piece and do you want to touch on how that works?

LW: Sure, so in most instances those with generators will have contracts for backup fuel. And so in most of the hurricanes that we've experienced over the last few years, most of the disasters we've experienced those contractors have been able to come through and deliver fuel. Now if it's a situation like Hurricane Maria on the island of Puerto Rico there could be challenges with delivery of that fuel and even in larger, maybe long-term power outages on the US mainland we're going to see these issues too. But there were certainly requests for federal assistance with generator fuel deliveries. And so there are a couple different resources if you're a member of our partnership. We'll have frequent calls where you can discuss your need for resources and we will have protocols available on our CIP Connect page that we set up for our partners to use with forms that you could download to be very specific about your resource needs. We're also really connected with FEMA's National Business Emergency Operations Center (NBEOC) and they also have a request for resources process. We're looking to streamline that, so there is a one-stop shop for the US government, but until we do, whichever direction you come in with your request, we're going to be able to help you.

ME: So a key issue, clearly. And something that, you know, obviously had tragic consequences in 2017 unfortunately. But we hope that we can all learn and move on from that and hope that doesn't happen again.

LW: Yeah. I think another key lesson learned certainly for this facility is if the utility company says the power's not coming back on you have to use that information wisely. We often get questions about power restoration prioritization and we've talked with many utilities about the need to restore power quickly. Sometimes even if the intention is there it's physically not possible.

For example, in Maria, when those power lines were down, it sometimes needed to be rebuilt from the ground up. And so even though there's intent to restore quickly, and there may be plans ahead of time the physical restraints of that restoration may be too much to bear. So it's important to be in touch with your utilities ahead of time. Make those plans but recognize that something may get in the way of those plans when the disaster actually happens.

ME: So that's our episode for today! Thank you everyone for listening. If you have any questions about anything you heard, about the HPH sector partnership, or about the HHS ASPR CIP Division, you can email us at [email protected]. Thank you, Dr. Wolf, for joining me, as always!

LW: Thanks Mike!

ME: And thank you all for listening, we'll see you next time!

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