Impacts / Primary Users
(Who is Affected) / Key Actions
(What Do You Need to Do) / Primary Partners

Overview of System Failures —

A Guidance for Incident Commander/Hospital Command Center

Impacts / Primary Users
(Who is Affected) / Key Actions
(What Do You Need to Do) / Primary Partners
Normal Power Failure
Lighting /
  • All facility
/
  • Assess critical areas affected
  • Use flash lights/lanterns as needed
  • Caution for trip hazards
  • Minimal lighting on generators
/ POM
Medical Devices /
  • Clinical areas
  • Laboratory
  • Surgery,
    Cath Lab, L&D
/
  • Critical devices in Red Plugs
  • Delay/cancel elective procedures
  • Consider relocating services to unaffected areas
/ Bio Med
Equipment /
  • All facility
/
  • Critical equipment in Red Plugs
  • May need to unlock Pyxis/medication delivery
  • Manual activities
/ POM
Pharmacy
Computers /
  • All facility
/
  • Use Downtime Procedures as needed
  • # computer is on generator
/ IT
Elevators /
  • All facility
/
  • Check for trapped persons in elevators
  • Limit unnecessary elevator use
  • # 1&2 elevators are on generator
/ POM
Communications
  • Fax
  • DOD Lines
  • Nurse Call
  • Telephone Server
  • Pagers
/
  • All facility
/
  • Notification of failure
  • Inform of alternate plans
  • Cell phones, HAM, other backups
  • Runners
  • See Communication Failure below
/ POM
Telecom
Insert Additional Items as Needed
Emergency Power Failure
Generator
  • Parts
  • Maintenance Issues
/
  • All facility
/
  • Maintain life safety activities
  • Potential of cancelling procedures
  • Medical equipment batteries back-up
  • Small portable generators
/ POM
Nursing
Electrical Distribution Components
  • Transfer Switches
  • Breakers
/
  • Isolated areas or all facility
/
  • Maintain life safety activities
  • Potential of cancelling procedures
  • Medical equipment batteries back-up
  • Small portable generators
/ POM
Nursing
Fuel
  • Above ground
  • Underground
  • Day Tanks
/
  • Part of facility serviced by the tank
/
  • Generator time may be lessened
  • Conservation of power
  • Medical equipment batteries back-up
  • Small portable generators
  • Fuel tankers
/ POM
Nursing
Chiller Failure
Building Cooling /
  • Isolated areas or all facility
/
  • Refer to Chiller Failure Policy/Procedures
  • Assess current and expected temperatures and impact
  • Promote cooling activities (closing curtains)
  • Portable Fans
  • Portable air conditioners
  • Determine transfer/evacuation plan as needed, notify CDPH L&C
/ POM
Nursing
  • Surgery
/
  • Consider cancelling surgeries

  • IT/data center
/
  • Notify IT managers
  • Monitor temperatures of data rooms
  • Consider activating back up plans
/ IT Dept
Steam Failure
Steam System /
  • POM
/
  • Refer to Boiler Failure Policy/Procedures
/ POM
Building Heating /
  • Patient care areas
/
  • Assess current and expected temperatures and impact
  • Promote warming measures
  • Determine transfer/evacuation plan as needed, notify CDPH L&C
/ POM
Nursing
Cooking /
  • Food preparation
/
  • Use alternate cooking methods
/ Dietary
Sterilization /
  • Sterile processing (instrument sterilization)
  • Surgery (flash sterilization)
/
  • Alternate methods of sterilizing
  • Considering cancelling surgeries
  • Chemical Sterilization
  • Outsourcing
/ Surgery
SaniPak /
  • EVS
  • Patient care areas
/
  • Prepare for additional storage area of
    Red Bags
  • Increased use of waste haulers
/ EVS
Water Failure
Domestic Cold Water /
  • All facility
/
  • Refer to Water System Failure Policy/Procedures
  • Fire Watch for loss of sprinklers
  • Alternate hand hygiene methods
  • Alternate drinking water plans
/ POM
Dietary
Infection
Control
Security
Nursing
Domestic
Hot Water /
  • All facility
/
  • Alternate hand hygiene methods
  • Alternate patient hygiene methods
/ Nursing
Facility Heating /
  • See loss of steam
/
  • Alternate heating sources
/ POM
Facility Cooling /
  • See loss of chillers
/
  • Plan for use of portable fans
/ POM
Equipment /
  • Ice machines
  • Vacuum pumps
  • Dialysis machines
  • Linear Accelerators (Rad Therapy)
  • Laundry
  • Water cooled equipment
  • Water sealed equipment
  • Lab water filter
  • Water softener
/
  • Access and prioritize needs for equipment
  • Determine alternate methods
  • Prioritize for recovery of equipment when water restored
/ POM
Bio Med
Vendors
Nursing
Sanitation Failure
Toilets /
  • All facility
/
  • Refer to Sewer Failure Policy/Procedures
  • Designate limited toilets for use
  • Red bag or liners in toilets
  • Designate waste storage areas
  • Porta-pots
  • Increased use of waste haulers
/ POM
EVS
Waste Management /
  • All facility
/
  • Alternate methods of waste management
  • Designate additional waste storage areas
  • Increased use of waste haulers
/ EVS
VentilationSystems Failure
Building Airflow /
  • All facility
/
  • Refer to HVAC Failure Policy/Procedures
/ POM
Positive & Negative Pressure /
  • Surgery
  • Bone marrow
  • Isolation rooms
/
  • Identify affected patients and areas
  • Implement alternate isolation procedures, portable units, face masks
  • Consider need to cancel surgeries/procedures
/ Nursing
Infection
Control
Communications Failure
IT, Desk Top, Servers, Data Center /
  • All facility
/
  • Identify which applications are affected
  • Notify users
  • Activate downtime procedures
  • Plan for recovery and entry of downtime information
/ IT
Desk Top
Data Center
Telecom /
  • All facility
  • External contacts
/
  • Refer to Communications Failure Policy/ Procedures
  • Establish alternate methods of receiving incoming calls
  • Notify staff and external partners of communication failure and provide alternate means of contact
  • Establish alternate means of pager notifications
  • Establish alternate means of facility notifications
/ Telecom
PBX
Nursing
Vendors
PBX
Pagers
Overhead Paging
Fire Protection Systems Failure
Detection /
  • All facility
/
  • Implement Interim Life Safety Measures (ILSM)
  • Notify staff to be extra vigilant
  • Establish Fire Watch
/ POM
Notification /
  • PBX
  • All facility
/
  • Implement Interim Life Safety Measures (ILSM)
  • Notify Fire Department of failure
  • Establish manual means of Fire Department and facility notification
/ POM
PBX
Extinguishing /
  • All facility
  • POM
/
  • Implement Interim Life Safety Measures (ILSM)
  • Notify staff of failure
  • Determine need for extra fire extinguishers in high risk areas
/ POM
Fuel Systems Failure
Natural Gas /
  • Kitchen
  • POM
/
  • Notify Dietary
  • Identify potential loss of services due to loss of power
/ POM
Propane /
  • Kitchen
  • POM
/
  • Notify Dietary
  • Identify potential loss of services due to loss of power
/ POM
Diesel /
  • POM
/
  • Notify Dietary
  • Identify potential loss of services due to loss of power
/ POM
Tanks or piped /
  • POM
/
  • Notify Dietary
  • Identify potential loss of services due to loss of power
/ POM
Access Control and Surveillance Systems Failure
Interior /
  • Identify security sensitive areas that may need monitoring
  • Inform staff of need for increased vigilance
  • Are security cameras functioning
/ Security
Exterior /
  • Determine access to parking structures
  • Identify security sensitive areas that may need monitoring
  • Are security cameras functioning
/ Security
Card readers/Key
  • C- Cure
/
  • All facility
/
  • Identify area of failure
  • Notify staff
  • Alternate time clock methods
  • Parking Lot access
  • Identify which secure areas to unlock –
    does it have to be all or nothing
/ POM
Security
IT
Human
Resources
Piped Medical Gases Failure
Oxygen /
  • Patient care areas
  • Surgery
/
  • Refer to Med Gas Failure Policy/Procedures
  • Prioritize needs – NICU, ICU, OR
  • Transport Portable cylinders to areas needed
  • Consider need to cancel/reschedule procedures
  • Consider relocating patients with highest need to one area and back feed the area
/ Respiratory
Vendors
POM
Nitrous Oxide /
  • Surgery
/
  • Transport Portable cylinders to areas needed
/ Respiratory
Vendors
POM
Nitrogen /
  • Surgery
/
  • Loss of surgical power tools
/ Respiratory
Vendors
POM
Vacuum /
  • Patient care areas
  • Surgery
/
  • Use portable Vacuum Pumps
/ Respiratory
Vendors
POM
Medical Air /
  • Patient care areas
  • Surgery
/
  • Transport Portable cylinders to areas needed
/ Respiratory
Vendors
POM
Conveyance Systems Failure
Elevators /
  • All facility
/
  • Refer to Elevator Failure Policy/Procedures
  • Determine if any elevators are functioning
  • Prioritize use of elevators
  • Assign monitors to functioning elevators
  • Consider cancellation of procedures or admissions
/ Nursing
Security
POM
Vendor
Dumb Waiters /
  • All facility
/
  • Refer to Dumb Waiter Failure Policy /Procedures
  • Notify staff
  • Establish alternate means of providing courier services (runners)
/ Nursing
POM
Vendor
Pneumatic Tube System /
  • All facility
/
  • Refer to Pneumatic Tube System Failure Policy/Procedures
  • Notify staff
  • Establish alternate means of providing courier services (runners)
/ POM
Vendor
Insert Additional Items as Needed

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