OCTOBER 2001, VOL 74, NO 4

CL I N I C A L I N N O V A T I ON S

Emergency- total power outage in the OR

n Tuesday, March 28, 2000, at 1:35 PM, staff members c at the Miami Veterans

Affairs Medical Center experi- enced a total blackout in the OR. The power loss resulted from a fire in the electrical vault on the first floor of the hospital. Lighting and air conditioning systems were shut down in almost every area of the main building. The fire melted the cir- cuit breaker panel and complete- ly halted electrical distribution throughout the hospital. Although the electrical meter continued to have power, elec- tricity could not be transferred throughout the building. The sur- gical suite, postoperative anes- thesia care unit, spinal cord unit, critical care units, and other patient care areas were affected. This article describes how staff members at our facility initiated our disaster plan and the improvements we later made to this plan to better maintain quali- ty patient care.

POWER OUT-EMERGENCY Our surgical suite comprises

nine general ORs and two cys- toscopy rooms. The suite is located on the third floor of the main building in an area known as the tower. At the time of the power outage, three patients were undergoing procedures-an ante- rior ankle fusion, a bilateral radi- cal neck dissection, and a total pelvic exenteration.

Continuing patient care. The patients undergoing anterior ankle

fusion and pelvic exenteration procedures were in the final stages of incision closure. Surgeons performing the bilateral neck dissection procedure were near completion and were verify- ing hemostasis. Emergency light- ing was not sufficient to illumi- nate the surgical suite; therefore, OR staff members immediately obtained the flashlights that had been issued to each OR to be used in the event of an emergency. This allowed sufficient lighting of the surgical field and anesthesia equipment so that all three proce- dures could be resumed. Surgeons performing the bilateral neck dis- section were able to insert drains and close the incision. Staff mem- bers in the remaining ORs had completed their procedures and had no others scheduled.

time of the power outage, anesthe- sia machines were switched auto- matically to emergency back-up

Alternate equipment. At the

ANA PAGAN. RN, MSN, is nurse managel; Owpostanesthesia recov- ery/ambulatory sutgery, Miami Veterans Affairs Medical Center

ROSEMARIE CURTY, RN, is assistant nurse manager; OR, Miami Veterans Affairs Medical Centex

MARiA I. RODRIGUEZ, RN, BSN, CNOR, is a cardiothoracic service team leadel; Miami Veterans Afsairs Medical Center

FLAVIA PRYOR, RN, BSN, CNOR, is nurse researcher; Miami Veterans Aflairs Medical Center

battery power that lasts approxi- mately two hours. Electrosurgery equipment no longer functioned. During the three procedures that were in progress, the battery-oper- ated eye electrosurgery unit was used immediately to provide hemostasis; however, it was not effective for cauterizing large ves- sels. As a result, patients’ bleed- ing vessels had to be ligated to prevent hemorrhaging. Suction devices also failed, so surgeons had to use portable suction equip- ment. They completed their pro- cedures expeditiously using this alternate equipment and prepared patients for immediate transport to local hospitals.

Evacuating patients. By early evening, facility administrators decided to evacuate all patients remaining in the medical center. At this time, it was impossible to predict how long it would be before elevators and air condition- ing systems could be restored. The evacuation process proceeded with the support of the Miami Veterans Affairs Employee Manpower Pool, City of Miami Fire Department, and Dade County Fire Rescue.

At the time of the blackout, there were nine patients in the sur- gical intensive care unit located on the west side of the main building on the third floor. Ten patients were in the medical inten- sive care unit (MICU), and 10 patients were in the cardiac care unit (CCU). Both MICU and CCU are located on the east side of the main building on the third

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floor. Using a secured path creat- ed by engineering department staff members, nurses evacuated patients from these specialized areas across the roof and into the ambulatory care building, which is adjacent to the main building. Based on the close proximity of both buildings and the fact that the elevators were working in the ambulatory care building, it was prudent for staff members to move patients to the adjacent building and then transport them to the first floor, where ambu- lances were waiting to transfer them to the nearest hospitals.

The remaining patients in the main building were transported down numerous flights of stairs on “battlefield-type” stretchers. Emergency room staff members prepared these patients for trans- port to nearby hospitals, and pharmacy services staff members diligently filled their prescrip- tions. Ninety-eight patients were transferred to the Veterans Affairs Nursing Home Care Unit located on the grounds of the hospital. We received excellent support from our affiliates (ie, Jackson Memorial Hospital, Miami; Cedars Medical Center, Miami; University of Miami School of Medicine; Veterans Affairs Medical Center, West Palm Beach, Fla; Veterans Affairs Medical Center, Tampa).

Determining staff member responsibilities. Some hospital staff members (eg, social workers, medical records personnel, nurses, physicians) received patient care assignments, and others were given administrative assignments. Some individuals were assigned to serve as security and informa- tion officers at each hospital entrance. Three OR staff members (ie, one nurse and two surgical

technologists) were assigned to drive official Veterans Affairs vans to transport nursing staff members for each working shift during the blackout. Drivers trans- ported nursing staff members from the Miami Veterans Affairs

Critical decisions must be made

with a great deal of expediency, and

being prepared is crucial.

Medical Center to the West Palm Beach Veterans Affairs Medical Center-an 80-mile trip. The remaining perioperative staff members were assigned to work in the OR at the Veterans Affairs Medical Center in West Palm Beach.

Power was restored on May 8, 2000, and patients gradually were transferred back to our facility. The power outage lasted 42 days. Never before had we experienced an electrical disaster of this mag- nitude. Electrical failures generally affect the main power generators, and emergency generators are acti- vated immediately to restore some electrical power. In our case, the electrical fire not only burned the main power generator but also completely destroyed the emer- gency generator.

EMERGENCY PREPAREDNESS Hospital staff members should

be prepared to handle unanticipat- ed electrical failures. During a

total power outage, the primary objective is to transfer patients safely to an area or facility where they can continue to receive med- ical attention. All staff members should act quickly and diligently. Critical decisions must be made with a great deal of expediency. Being prepared is crucial.

Patient safety. When the blackout occurred at our facility, we first had to ensure that our patients were safe. Hospital-wide evacuation procedures were initi- ated immediately. Some staff members were assigned to be runners, and they completed a variety of tasks, including coordi- nating the activities of pharmacy and central supply services staff members in preparation for patient transfer. Our collaborative efforts were critically important in the successful relocation of our patients.

Medication system. Pharmacy services staff members at our hos- pital use an electronic medication dispensing system that does not function without power. As a result, we were unable to retrieve medications from these devices and had to assign staff members to maintain a separate supply of medications. Pharmacy services representatives were immediately contacted to send specially trained staff members to manually oper- ate these medication dispensing units, which can be opened with- out any source of power in the event of an emergency.

Equipment and supplies. Having flashlights available is imperative in the event of an emergency. In the surgical suite, additional precautions also are needed. For example, battery- operated equipment (eg, electro- surgical units, suction devices) should be available. A method of

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transporting patients also is important. Facilities should be equipped with enough stretchers and wheelchairs to prevent unnec- essary delays in patient transport.

Documentation. Surgical pro- cedures at our hospital are docu- mented using electronic charting. The intraoperative record usually is entered in the computer during the procedure and printed only after the procedure is completed. As a result, at the time of the power outage, not all intraopera- tive records had been printed. In addition, because all intraopera- tive records were done electroni- cally, we had no blank copies for written documentation. This resulted in significant delays.

EMERGENCY DISASTER PLA NNlNG As a result of this experience,

we have revised our facility’s emergency disaster plan to include the following components.

An emergency staffing plan will be created that identifies specific designated staff mem- ber responsibilities in the

event of an emergency, including assessing the affect- ed area (eg, patients, situation, staff members), contacting departments for information, transfemng and evacuating patients, and supporting criti- cal needs (eg, obtaining blood or supplies). Battery-operated electrosurgi- cal units and suction devices will be available in all areas, and batteries will be tested daily to ensure the devices are fully functional. Emergency spotlights (ie, bat- tery-operated lights that can be placed directly over the surgi- cal field) will be available in the O h . Batteries will be test- ed daily to ensure the devices are fully functional. Mock disaster drills will be rehearsed quarterly, and staff members in all patient care areas will participate.

a Pharmacy services staff mem- bers will ensure that OR staff members have adequate access to medications in the

event of an emergency. Each OR will have flashlights available. Flashlights will be checked quarterly to ensure batteries remain charged. Blank copies of intraoperative records will be available in each OR.

CONCLUSION During a complete power out-

age of this magnitude, there is no time for preparation. Hospital administrators should collaborate with OR directors and staff members to formulate a disaster plan that addresses this type of catastrophic event. Emergency disaster plans should be intro- duced during hospital orientation and reviewed regularly to ensure personnel are adequately pre- pared for power outages. A

The opinions or assertions contained in this article are the private views of the authors and are not to be con- strued as oficial or as reflecting the views of the Department of Veterans Affairs.

Researchers Discover Honey is Good for Muscles Researchers at the University of Memphis have dis- covered that honey may be beneficial to muscles, according to a news story from bshealthwatch.med- scape.com. Previous studies found that a combina- tion of carbohydrates and protein supplements boosts muscle recovery, but these studies did not examine what type of carbohydrates were most beneficial. Researchers at the University of Memphis used honey as a carbohydrate source and combined it with a protein supplement. They found that athletes maintained better glucose levels with this combination, which is important to postwork- out recovery.

Thirty-nine weight-trained athletes participated in the study. They completed an intensive weight- lifting workout then immediately consumed a protein supplement blended with sugar, maltodextrin, or honey. Only those subjects in the honey group main- tained optimal blood sugar levels two hours after the workout, and they also showed favorabfe changes in hormone ratio, indicating positive muscle recupera- tive status.

Honey May Help Muscles Recuperate After Workouts (news stow June 23, 200 I ) hilp://lvww.cbshealthwatch .medscape.com (accessed 19 July 200 I ) .

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