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, I'm a program analyst within the HHS ASPR Critical Infrastructure Protection or CIP Division. Alongside me is our division director, Dr. Laura Wolf. How are you, Dr. Wolf?

DR. LAURA WOLF: Great! How are you Mike?

ME: I'm great we're back again for another episode. This is the last in our three-part series on lessons learned from the 2017 hurricane season. The question for today's episode, “What is a lesson learned from Hurricane Maria?” and I think we're going to cheat a little bit because I think we have two kind of topic areas.

LW: I might bring up three.

ME: Oh boy, now they're going to cancel the podcast! We can't do that! So I think we have three different lessons we’d like to talk about but did you want to just dive into the first one then that you wanted to talk about?

LW: Absolutely. So it's a follow-on from the previous podcast of Hurricane Irma. So I had flagged that Irma was our second in a series of major hurricanes and we were feeling some staff fatigue. I promise you by the time we hit Hurricane Maria we were completely exhausted. But for Maria, for the first time, we deployed one of our CIP staffers down to Puerto Rico to make those connections between business and the federal response that was happening and provide some health expertise to that process. So we powered through thanks to the dedication of our staff, also because our partners were powering through. Many of our national organizations were impacted by all three and so it was a challenge on both the government and private sector sides.

But the two that we really wanted to talk about today were the fact that this was a one of the first examples we've seen of a regional long term power outage. And that had many of its own challenges. It was also an island which created a lot of transportation issues. So it was a long-term power outage because the infrastructure for the electrical grid on the island of Puerto Rico was not incredibly strong before the hurricane. We saw decimation of it really by the hurricane. One of the tell-tale signs from one of my colleagues in the energy sector was that the utility poles were down across the island and within days of seeing that on TV he shared with us that this is going to be a long-term recovery because you're going to have to send in lots of of poles and those are in short supply across the country.

ME: And who would have thought that that's one of those unexpected things. Like who would have thought that would even be an issue right?

LW: Exactly, exactly. So that's also why the recovery is still happening. There's a lot of decisions to be made about how to restore systems and how to potentially make them more resilient to the next hurricane which hopefully doesn't come anytime soon.

But one of those impacts of a long term power outage was a surprise to us and it has to do with infrastructure that we may not always think about first. We're frequently thinking about hospitals, how to bring hospitals back up and running, the supply chain, how to make sure drugs and devices are being produced and distributed. And I think we've covered a lot about the impact on supply chain from the footprint that we have on Puerto Rico in the medical device and pharmaceutical manufacturing sector, but one that I want to talk about was challenges with providing medical gases on the island, particularly oxygen, but also other gases. Normally these gases are produced within 200 miles of where they're needed because it's very difficult to transport them. You don't want to fly them in an airplane because it's basically flying a large bomb with you, so they're usually produced within 200 miles where they're needed, driven to where they're needed. These are large quantities of oxygen and other gases. The production of them requires so much energy that it can't be done on generator power, so when we got reports after Hurricane Maria that the two - the two - manufacturers of gases on the island were off of grid power and could not produce any materials, and they needed help with a strategy of how to get oxygen on the island, we were very concerned.

I mean there there's not only requirements at hospitals and other residential health care facilities for oxygen within those facilities but there's a large population of home health patients who require oxygen to survive. We wanted to make sure that that there was no disruption to that community. So it was a challenge for us to figure out how to get oxygen from the mainland down to Puerto Rico because it's an island we couldn't fly it in. We had to send it over via the sea, so via ships, and that took a long time. And there were some tense periods where we weren't sure that the existing supply on the island would last until we were able to get it there on a ship.

We also had instances where the cargo was temporarily lost in the port because of how much was coming through those ports at that time.

So we had some very tense challenges but as far as we were able to ascertain there was not disruption in the delivery, weren’t major disruptions in the delivery of oxygen to hospitals, and those distributors who serve the home health population. We heard from our partners in manufacturing through our connections at FDA that some gases were also required for production of critical goods. Nitrogen was a key gas required for that and our challenge was making sure there was enough for patients to breathe so we really made a prioritization decision of who received shipments of gases based on the human survival needs so patients were prioritized and we as part of our partnership we were very honest with the manufacturing community, with our partners at FDA, about the great potential for there not being enough for manufacturing.

That I think was helpful to our partners: knowing not only what we can do but what we can't do and in ensuring that delivery of those gases. And so several of our partners in manufacturing were able to figure out their own system of finding the conveyance and the containers for the gases that they needed. So recently we were at a conference and shared a session with Medtronic which was a medical device manufacturer in Puerto Rico. They worked with some of their colleagues in the industry and also with our partners at FEMA to ensure that once they figured out how to procure their own gases on the US mainland and got it onto a ship that we could make sure it was prioritized for removal from that ship, when it got to the port that we would keep track of it, and that we would get it on to their trucks so that they could bring it where it was needed.

And I think that's an example, like from one of our previous episodes, you know, using duck boats that these are things you normally wouldn't plan for. You assume that these providers are going to be able to continue providing the product. And so it's a surprise and it requires all hands on deck to come up with a solution. So this is a great example of the self-reliance of these companies and the way that the government was able to provide a hand in making sure we could prioritize offloading of that product. That was what we were able to do we were able to coordinate with them through honest communication and make sure that this this worked out for all parties.

ME: This is obviously a situation where the location of the disaster was a huge complicating factor but what's the likelihood, or maybe not the likelihood, but is this something that like when we talk about the medical gas issue, is this something that could have an impact on the continental United States?

LW: Absolutely. So we've had some regional power outages in the past. I know in the New York area, the east coast has seen some large-scale power outages they weren't necessarily long-term power outages and they didn't impact transportation. So you're probably not going to see it even in those regional responses.

But there are a couple of fault lines that we keep looking at so we look at the Cascadia’s up on the west coast and the New Madrid fault line across the Midwest, that one impacts eight states. And that's likely to disrupt transportation by causing damage on some major transportation arteries. So I can see it becoming an issue in some of those major earthquake incidents that that might separate a community and make it its own island, if you will, after a disaster.

ME: So critical issues to consider for the future and that that's the one kind of silver lining of obviously tragic situations is that there's always lessons learned in ways we can hopefully improve our responses to help save more lives in the future.

That's our episode and thank you everyone for listening! As always you can email us at [email protected]. Please send any questions about anything heard on the podcast, about the HPH Sector partnership or if you have any feedback on the podcast, please send that as well.

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