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Utility Failure (Code Black)

The Engineering Department maintains detailed Utility Management Plans for a number of scenarios including partial or complete utility failure. The extent of the failure and the time of year will affect the impact on the Health System.

Electrical
CFVMC and HRSH are equipped with primary electrical utility services from Public Works Commission (PWC) that are adequate to meet the electrical needs of the facilities.

MITIGATION:
CFVMC's primary electrical service from the public utility is a dual source system. The primary sub-station is located on Roxie Avenue and the secondary sub-station is located on Ireland Drive. Each sub-station serving the facility is equipped with a dual source supply from the PWC.

PREPAREDNESS:
See “Emergency Generator and Fuel Supply” section.

RESPONSE:
In the event the primary electrical utility is disrupted, the following will occur:

Engineering personnel will respond to the system failure;

Engineering personnel will assess the system to determine the cause of the failure;

Staff will ensure that all emergency generators are operating properly and that all emergency power transfers have been successfully completed;

The Director of Engineering or his/her designee will coordinate with PWC to determine the source and duration of the utility failure;

The Director of Engineering or his/her designee shall assess the situation and contact the Administrator on Call or the Nursing Supervisor;

Engineering personnel will respond in accordance with the Utility Management Plan and the Engineering Department Emergency Response Planning Guide.

RECOVERY:
When the primary service is re-established, the Director of Engineering or his/her designee will notify the HCC.

Food and Nutrition
In the event of a disruption of electrical power, the Food and Nutrition Department will:

Require backup power to operate equipment such as walk-in coolers, freezers, grills, hot boxes, dishwashers, and dietary computers;

Designate an area to dispose of spoiled food;

Utilize coolers with ice, Sternos to heat, disposable containers, shelf-stable food items, and previous day's patient notes to continue dietary operations;

Utilize perishable foods before shelf-stable foods;

Initiate the disaster menu to provide non-select food items to customers;

Contact food and water suppliers from the department's emergency operations plan.

Water
CFVMC and HRSH are equipped with potable water supply systems from PWC that are adequate to meet the domestic water needs of the facilities.

MITIGATION:
CFVMC's primary water supply system from the public utility is a dual source system. There is an eight-inch (8”) water line entering the campus from Owen Drive and an eight-inch (8”) water line entering the campus from Village Drive. The campus water supply system is comprised of an eight-inch (8”) loop that encircles the main facility.

PREPAREDNESS:
Engineering prepares for water system failure by:

Maintaining a stock of potable water by the Food and Nutrition department;

Maintaining two ground water wells located on and adjacent to the main campus for use as a source of non-potable water;

Coordinating with McKesson to warehouse 500 gallons of bottled potable water for emergency use;

Coordinating with Wal-Mar Distribution Center in Fayetteville, North Carolina to assist in emergency water deliveries from their South Carolina Wal-Mart Emergency Distribution network.

RESPONSE:
If the pubic water utility is disrupted, the following will occur:

Engineering personnel will respond to the system failure;

Engineering personnel will assist in water conservation efforts in accordance with the Utility Management Plan;

Staff will assist in transporting non-potable water for non-consumption use;

The Director of Engineering or his/her designee will coordinate with PWC to determine the source and duration of the utility failure;

The Director of Engineering or his/her designee shall assess the situation and contact the Administrator on Call or the Nursing Supervisor;

Engineering personnel will respond in accordance with the Utility Management Plan and the Engineering Department Emergency Response Planning Guide.

RECOVERY:
When the primary water utility service has been re-established, the Director of Engineering or his/her designee will notify the HCC.

Steam Failure
Cape Fear Valley Health System and Highsmith-Rainey Specialty Hospital are equipped with boilers adequate to meet the demands for environmental heating, sterilization, humidification and heating of domestic water for required operations.

MITIGATION:
Steam for CFVMC & HRSH are capable of operating on natural gas and No. 2 fuel oil.

PREPAREDNESS:
Engineering prepares for Steam Failure by:

Maintaining the boiler alarm systems;

Monitoring the alarms through the Building Automation System;

Conducting daily rounds of the boiler plant and logging boiler operations;

Including all boilers and associated equipment in the computerized maintenance management system.

Conducting preventative maintenance on a monthly, quarterly and annual basis with an annual internal inspection and certification by the State of North Carolina;

Training Heating and Air Conditioning technicians on competencies related to the boilers and associated steam systems.

RESPONSE:
If all boilers fail at the same time the following will occur:

Engineering personnel will respond to all system alarms;

Engineering personnel will make the necessary corrections. If in-house staff cannot make the necessary repairs and emergency services are required, the responding technician will contact outside vendors in accordance with the Engineering Department Emergency Response Planning Guide. Responding personnel will follow department specific notification procedures as outlined in the Guide.

The Director of Engineering or his/her designee shall assess the situation and contact the Administrator on Call or the Nursing Supervisor;

Director of Engineering will recommend a Code Black, Code Triage, or both.

Upon hearing the code or being appraised of the situation, clinical staff will:

Verify that items undergoing sterilization are safe for patient use. (Items being sterilized at the time of a steam failure should be re-sterilized).

Ensure that blankets are distributed to patients, if necessary

Conserve hot water; using it only for critical needs

Engineering personnel shall make the necessary repairs or contact an outside vendor and notify the HCC of the anticipated down time.

RECOVERY:
Once boilers and steam supplying systems return to normal operations, the Director of Engineering will notify the HCC.

Medical Gas Failure
The Health System is equipped with systems to provide all the medical gases necessary for the services we provide.  These include Oxygen, Nitrous Oxide, Nitrogen, Medical Air, and Medical Vacuum. Systems are in place to assure that gas is delivered in a safe manner.  Medical gas system alarms are located in Security and Engineering.  All medical gas systems are equipped with redundant supplies and emergency power.

MITIGATION:
Each of the gas systems has integrated alarms that sound in both Security Base Operations and the Central Energy Plant of Engineering.

PREPAREDNESS:

Staff is trained in appropriate actions to take in the event of a medical gas failure;

Departments maintain a roster of personnel required to respond to med gas failure;

Engineering staff conduct scheduled inspections of bulk storage areas;

Central Supply maintains Portable Vacuum Pumps;

RESPONSE:
1. If any of the gases fail hospital wide, alarms sound in Security and the Central Energy Plant. The responding technician will have the Switchboard notify the following personnel, as necessary:

Administrator on Call

Nursing Administrator or his/her designee, i.e. Administrative Supervisor

Director of Engineering or his/her designee

Respiratory Therapy or his/her designee

In-house staff will assess the problem and make arrangement for repairs.

For Oxygen Failure:  The Respiratory Therapy (RT) Department will coordinate the use of portable oxygen cylinders if necessary. RT will provide oxygen cylinders to the most oxygen sensitive patients and determine the need for portable oxygen throughout the hospital.

The Director of Respiratory Therapy, along with the Materials Management Department, shall be responsible for ordering additional oxygen cylinders, until the failure has been corrected.

Alarms on the primary system will initiate automatically at both the Security Base and the Central Energy Plant.  The Oxygen flow will transfer to the secondary source.  Responding Engineering personnel will identify the source of the failure.  If emergency deliver of liquid oxygen is required, the responding technician will notify Aire Gas National Cryogenics for emergency delivery.  Responding Engineering personnel will follow department specific notification procedures as outlined in the Engineering Department Emergency Response Planning Guide.

For Nitrous Oxide or Nitrogen Failure: Alarms on the primary system will initiate automatically at both the Security Base and the Central Energy Plant.  The gas flow will transfer to the secondary (redundant) source.  Responding Engineering personnel will identify the source of the failure.  If the tanks are empty, they will be replaced and staff will verify that the system has been returned to normal operations.  If emergency services are required, the responding technician will notify Medical Gas Technology (MGT) for emergency response.  Responding Engineering personnel will follow department specific notification procedures as outlined in the Engineering Department Emergency Response Planning Guide.

For a Medical Air Failure:  Respiratory Therapy will provide compressors for the most oxygen sensitive patients and determine the need for portable compressors throughout the hospital.  Place all respiratory therapy care requirements on a priority basis.

The Director of Respiratory Therapy, along with the Materials Management Department, shall be responsible for ordering additional Medical Air supplies, until the failure has been corrected, and purity tests made (if required).

Nursing will closely monitor and support patients during the interim period.  Be prepared to assist in relocating patients.

Alarms on medical air compressor will initiate automatically at both the Security Base and the Central Energy Plant.  The Medical Air compressor will transfer to a series of the secondary compressors.  Responding Engineering personnel will identify the source of the failure.  Engineering personnel will correct the problem or notify Pattons for emergency response. Responding Engineering personnel will follow department specific notification procedures as outlined in the Engineering Department Emergency Response Planning Guide.

For a Medical Vacuum Failure – If a patient requires a vacuum, clinical staff obtains a portable vacuum from Central Supply or the patient is moved to an area where vacuum is operational.

Alarms on the vacuum pump will initiate automatically at both the Security Base and the Central Energy Plant.  Responding Engineering personnel will transfer the medical vacuum to the backup pumps and identify the source of the failure.  Engineering personnel will correct the problem or notify Pattons for emergency response. Responding Engineering personnel will follow department specific notification procedures as outlined in the Engineering Department Emergency Response Planning Guide.

RECOVERY:
Once the medical gas system is repaired and tested, operations will return to normal.

Lab Services – In the event of a Utility Failure in which the laboratory facility is deemed inoperable, the following alternate testing sites would be utilized:

HRSH

HPN

Womack Army Hospital

Veterans Administration Hospital

FirstHealth Moore Regional Hospital

UNC Hospitals

Rex Healthcare

WakeMed Medical Center

LabCorp

Environmental Services

Follow procedures listed in “Unit Activities”

Assist in moving patients and clean/sterile supplies out of the area.

Assist with closing doors and isolating that area(s)

Prepare supplies for cleaning – chemicals, mops, cleaning cloths

Wait for sewage system repair and proper function.

Flush/drain waste, then clean with a bleach solution and/or cleanser to remove soiling.

Food & Nutrition
Maintenance staff would need to be notified to assist with issues such as moving equipment and power;

During the incident the department will need backup power to operate electrical equipment such as walk-in coolers and freezers, grills, hot boxes, dishwasher, computers in the diet office to obtain diet orders for patients, and a designated area to dispose of trash would need to be utilized

Coolers with ice to keep potentially hazardous foods cold, sternos to heat food, disposable containers, shelf-stable food items, and notes from previous day would need to be used to obtain patient information for diet orders as well as paper and writing utensils to document patient information

Potentially hazardous foods are items that cannot be maintained between temperatures of 40 to 140 degrees Fahrenheit.  These items would include cheese, deli meats, fresh meats, and milk which would need to be prepared before shelf-stable foods are distributed.

Normal operations would be impacted during a power outage that would effect walk-in coolers and freezers, grills, hot boxes, and dishwasher; short staffed would need to combine staff to feed patients first, dependants, and CFVMC staff; and computer system to obtain information about patients diet orders.

If backup generators fail and/or food and water is in short supply individuals would need to contact food and water suppliers from the department's emergency operations plan and use the disaster menu to provide non-select food items to patients, dependants, and CFVMC staff.

Cancer Center
For any incident or emergency situation with some degree of notice, the Cancer Center will contact patients to inform them of appointment status or any changes to operating  hours.

Downtime procedures will be used until power/IST is restored.

In the event that power or IST is not restored within 2 days, patient conditions and treatment course assessments will be evaluated with physicians with alternative recommendations for treatment at Health Pavilion North Cancer Center if operational. Likewise, the same scenario would apply to Health Pavilion North Cancer Center if power or IST were not restored to this facility.

In the event that Cancer Center operations at both locations were unable to resume within 4 days, alternatives for patient treatments would be assessed.  Alternatives could include sending patients and treatment records to nearby treatment facilities until operations could resume at Cape Fear Valley Cancer Center.

US Patent Numbers 7,720,998 B2, 7,836,207