Physicians meet blackout challenges great and small

Last month's massive outage left office-based doctors working in the dark and hospital physicians guessing just how much their backup systems could handle.

By Victoria Stagg Elliott, amednews staff. Sept. 8, 2003.

The Aug. 14 power outage affecting eight states and one Canadian province disrupted the lives of more than 50 million people -- and physicians were no exception.

When the lights went out for G. Brian Bechill, DO, a family physician at Bedford Family Physicians in Lambertville, Ohio, he examined patients already in the office using various penlights, flashlights and whatever light was coming through the windows. Office staff tried to contact other patients who had yet to come in to tell them the office would be closing because of a lack of power, a task made difficult by the fact that the phones were out. Patients were anxious because of fears that this was another incident like the attacks of Sept. 11, 2001.

Tales from the dark
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When Dr. Bechill was finally able to leave, he took with him $3,000 worth of vaccines and other perishables because the power was still on at his home in Toledo.

"It was a little frustrating, but it was fun to go around with flashlights. It seemed to make things almost more cozy with patients," said Dr. Bechill. But he said his wife was a bit upset when he showed up with "this bag of stuff" when the refrigerator was already full of food.

Meanwhile, hundreds of miles away in New York City, Elliott Friedman, MD, director of pediatric emergency services at Jamaica Hospital Medical Center, was also struggling to work in the midst of the largest blackout in U.S. history. One of the biggest challenges was guessing how much the hospital's backup generators could handle.

It took constant juggling. To use the CT scanner, air conditioning had to be turned off, and even when the air conditioning was on, it could not be turned on for all floors at the same time.

"A few hours into the blackout, one of the two generators blew up," said Dr. Friedman. "There was a lot of hustling by engineering, and there were a couple minutes there when babies in the neonatal ICU had to be hand-ventilated. We had our fingers crossed, and we continued to plug on." Eventually, engineers ran extension cords to a generator attached to a neighboring building just in case the one remaining generator blew. It never did.

Patient flow was heavy. Some came because of heat exhaustion from a lack of air conditioning and because of minor injuries occurring in streets jammed with large crowds trying to make their way home. Others were nursing home residents and homebound patients who needed power for their life-support appliances.

But for the most part, many of the problems caused by the outage were inconveniences. Doctors and their staffs couldn't access online medical records, and pregnant women scheduled to have their labor induced were told to wait a little while longer.

There were some tragedies, though. The blackout has been implicated in a handful of deaths, and a liver meant for a New York patient was reallocated to a patient in Pittsburgh because of fears that the power supply was too unstable to undertake the transplant operation.

And some problems didn't end when the power came back on. Detroit residents were warned to boil their water for a couple of days, and the New York City Dept. of Health and Mental Hygiene noted an increase in gastrointestinal illness possibly linked to eating spoiled food, although some physicians suspect that the problems may have been more a result of nerves.

"There wasn't enough time for food to spoil to then be eaten by people to then develop symptoms," said Michael Carius, MD, chair of the emergency department at Norwalk Hospital in Connecticut. "I just wonder if it wasn't more anxiety."

The outage also left the fragile blood supply, already at low levels, struggling to make up the loss of one day of blood drives. And many physicians were left scrambling to squeeze in people who missed their appointments.

A vote for planning

This incident was exceptional in the number of people it affected rather than the actual impact on the individual. The experience, however, did highlight the importance of disaster planning and of not taking the electrical supply for granted. Hospitals have such plans in place and backup power, but office-based physicians rarely do.

"We had no elevator and had to guide some patients down the stairs," said Jill Braverman-Panza, MD, an internist in private practice in Albany, N.Y. "The front doors wouldn't open, short of pushing the emergency piece, because we have electronic front doors. We're definitely talking to people about getting a generator for this building."

But many maintain that the outage wasn't so bad and gave them the opportunity to catch up on long-neglected tasks, do other things or just relax.

Dr. Braverman-Panza closed her clinic early and lent a hand at her husband's restaurant, one of only four buildings in town with its own generator. In Toledo, Dr. Bechill also closed early and saw a few patients the following day. He was on call over the weekend and stayed close to home because of fears that cell phones and pagers would be unreliable.

Other doctors took the time to conquer the ever-present stack of papers.

"It was one of those rare times when I had time to do my paperwork, and I worked by candlelight," said Marc Siegel, MD, associate professor of medicine at New York University. "I'm caught up. I can't believe it. I can see my desk."

ADDITIONAL INFORMATION:

Tales from the dark

A family physician in Toledo, Ohio, stored $3,000 worth of vaccines in his home refrigerator. His residence had electricity but his office did not.
A liver promised to a New York woman was rerouted to a man in Pittsburgh. She was being prepped for surgery when the hospital lights flickered.
The New York City Dept. of Health and Mental Hygiene noted a slight increase in stomach trouble and warned residents to throw out possibly spoiled food.
Hospitals in blackout areas had to switch to backup generators, but some didn't sustain power. At Jamaica Hospital Medical Center in New York, one of two generators died. An extension cord was used to connect to another generator in a neighboring building -- just in case the second one also failed.
Blood drives scheduled for a day after the blackout, Aug. 15, were canceled, adding pressure to an already strapped blood supply.

Weblink

The Blackout History Project at George Mason University, Fairfax, Va. (blackout.gmu.edu)

Information on the power outage from the U.S. Dept. of Energy (www.energy.gov/engine/content.do?PUBLIC_ID=11860&BT_CODE=DOEHOME&TT_CODE=SPOTLIGHTDOCUMENT)

Advisory on the increase in diarrheal illness from the City of New York Dept. of Mental Health and Hygiene, in pdf (www.nyc.gov/html/doh/pdf/cd/03md25.pdf)