Author(s): Scott Sutherland. Published on March 2, 2015.

IN 2012, SHORTLY AFTER Hurricane Sandy forced the emergency evacuation of three hospitals in the New York City area, Eric Cote and Cara Klein began work on Powered for Patients, a public–private effort to protect patient health by ensuring proper backup power and expedited power restoration for critical healthcare facilities. Cote and Klein are the founders of Disaster Safety Strategies, a communications and policy consultancy based in Providence, Rhode Island, that works with disaster safety organizations. Powered for Patients held its first wide-ranging meeting in Washington, D.C. last August to determine issues critical to stakeholders and to discuss next steps for addressing those issues. NFPA Journal recently spoke with Cote about the mission of Powered for Patients and what he hopes to accomplish with the initiative.

Was there a particular Sandy story that illustrated the need to tackle healthcare facility power issues?
I saw a CNN story where the interviewer kept asking a doctor at one of the affected hospitals, “Sir, what happened to your generators? Why didn’t they work as expected?” The doctor couldn’t answer the question. It wasn’t good for the backup power industry, and it wasn’t good for the hospital to have these questions out there without answers.

What are the most urgent issues you’re addressing with Powered for Patients?
We identified a lot of low-hanging fruit at our initial stakeholders meeting in August. One of the greatest opportunities is to help utilities and hospitals build closer working relationships—to avoid outages when possible and, when they can’t be avoided, to enable faster restoration of power. We’ve spoken to generator service companies that were unable to service their hospital clients because they couldn’t get through restricted areas during Hurricane Sandy, or they couldn’t get fuel for their service trucks. Another issue is a growing concern about what happens to at-risk citizens who are using in-home dialysis machines or relying on ventilators or oxygen concentrators in their homes—what happens when the power goes out and there is a prolonged outage? That’s a serious question that the federal government and other organizations, including Powered for Patients, are putting a lot of resources into.

What are the biggest challenges you face in effectively addressing those issues?
A problem after disasters is that those at-risk citizens flood hospital emergency rooms because they need dialysis or their electrically powered medical devices are running low on battery back-up and they need to get to a facility where they can recharge them. This places additional strain on a hospital that is already under enormous stress due to the disaster. A lot of work is being done to help communities understand how many of their citizens are actually in this category. The U.S. Department of Health and Human Services (HHS), along with the National Association of County and City Health Officials (NACCHO), are doing a lot of work in this area, which Powered for Patients plans to support.

Is it fair to say we don’t have a very good handle on this issue?
There hasn’t been much work done to identify the different sources or organizations that maintain information on at-risk residents in communities, or to bring them together to collaborate. HHS has been working to develop an online map that would show how many citizens in a community are getting Medicare payments for medical equipment—it’s expected to come out sometime this year. And utilities often maintain registries of at-risk citizens so that if they need to turn off the power to a neighborhood they can be in touch with those people. But there is a lot more that can be done to coordinate this information.

Eric Cote, a project director for Powered for Patient

Eric Cote, a project director for Powered for Patients.

PHOTO: Jesse Burke

What is the scope of Powered for Patients, as far as the kinds of facilities you’re targeting?
Primarily critical healthcare facilities, including hospitals, nursing homes, and dialysis facilities. But we also realize that if other parts of a community’s infrastructure aren’t working properly, that can have an adverse impact on healthcare facilities, too—like wastewater treatment facilities. We recently began working with the Water Environment Federation, a national organization that represents many of the country’s wastewater treatment facility operators. Those facilities need to protect their back-up power sources, too, to stay online.

You created Powered for Patients because there was no one who had brought all the stakeholders together on these issues—was that really not happening?
As far as we could tell, no—we saw a real opportunity for Powered for Patients to improve public health by bringing the players together for an important conversation that I don’t think had really taken place in a meaningful way.

You held your first big conversation in August. Who was there?
All kinds of stakeholders: emergency managers, public health officials, utility industry leaders, private-sector healthcare representatives, and more.

What were the takeaways?
Probably the biggest one was that we succeeded in bringing people together who should have been working together already. We also determined that hospitals and utilities could do more together before a disaster to help avoid a loss of power, and also to expedite the restoration of power. The meeting included a representative from Con Edison in New York, which obviously saw an enormous impact from Sandy, including the flooding of system elements. He said that when a hospital is down, they can’t put it back online until they know that the hospital’s generator isn’t putting electricity back into the grid that could harm utility workers. That was a good example to me of the benefits of better communication between hospitals and utilities.

How would you describe that communication now?
Utilities typically have key account managers who interface with the largest customers, such as hospitals, in emergencies. But there are other people on both the hospital and the utility sides who need to engage, too, and they need to know each other before disaster strikes. One of the people attending the meeting told me a story about when he worked for a utility in New Hampshire, and how he established relationships with the hospitals inside the utility’s coverage area. There was a major weather event that knocked out power to the area, and he called his hospital customers to check on them. A hospital administrator told him they were fine, that they had two days of generator fuel remaining, and that he should go ahead and take care of somebody else. That kind of information helped the utility prioritize—it could get some other facility that didn’t have as much generator fuel back online quicker. That’s the kind of enhanced situational awareness that can help not only the utility, but also government officials who are standing by ready to deploy federal resources to hospitals after a disaster.

That’s a great example. What is NFPA’s involvement in Powered for Patients?
Robert Solomon, division manager of Building & Life Safety at NFPA, has been extremely valuable in helping us understand the technical aspects of backup power in terms of codes and standards and accreditation guidelines.

Do you see opportunities to use the resources in NFPA’s codes and standards as part of your Powered for Patients work?
Yes. For example, a lot of hospitals still have generator fuel sources located below flood grade. We saw in Hurricane Sandy and in other instances that that can be a recipe for disaster. Newer versions of the code require new construction to elevate fuel sources above flood levels. But there are many existing hospitals out there that don’t face that requirement. So obviously the role of the code is very important in providing a standard that healthcare facilities need to achieve. Addressing the challenge presented by older facilities is an issue we’ll be looking at. A key recommendation from the initial stakeholder meeting was to address the codes and standards that relate to backup power for healthcare facilities.

Are you a code guy by trade?
I’m not a technical person, but I’ve worked on code-related projects in the past, including requirements for impact-resistant windows and a post-Katrina effort to encourage Mississippi to adopt a statewide building code. I have a lot of public policy experience, along with communications work and an understanding of how policy is crafted. I worked for a number of years as a press secretary to members of Congress, and I served as the Washington director for Lincoln Almond, the governor of Rhode Island, before becoming his press secretary. I’ve used those skills over the last 16 years, since I left the governor’s office and started my own firm, to address public health issues and other challenges.

How did you end up in the disaster space?
I left the governor’s office to co-found a company called Cote & D’Ambrosio, a communications, marketing, and public relations firm. One of our first clients was in the protective glazing industry, which protected windows in high-risk federal buildings from terrorist attacks. That work got us involved in public safety activities, which led us into disaster safety work. At the start of 2014, Cara Klein and I created Disaster Safety Strategies because we wanted a company specifically dedicated to these areas. Powered for Patients is one of our projects.

What are the next steps for Powered for Patients?
We’ll be working closely with NACCHO and the Association of State and Territorial Health Officials to bring together all of the interested parties—utilities, healthcare facilities, emergency management agencies, public health officials, governors’ offices—for discussions about power restoration for healthcare facilities after a disaster. We’ll also focus on providing support for the efforts of NACCHO and HHS to better meet the needs of at-risk citizens in communities during extended power outages. We will launch the codes and standards work group to take a closer look at the issues that impact backup power. We’ll also work in specific states to have stakeholder conversations about power restoration and about addressing local gaps that could undermine the reliability of backup power and delay the restoration of utility power.

That’s some list.
It is, but it’s very exciting. This is one of the most exciting initiatives I’ve ever been involved in.

SCOTT SUTHERLAND is the executive editor of NFPA Journal.