NOTE: This blog was originally posted on NFPA Today in October, 2019, and has been edited. As spring and summer months approach, the topics of durable medical equipment, patient safety, and their relationship to natural disasters is once again, a timely one.
As so often is the case when you work in building and life safety, and strive to bring attention to potential hazards, a tragic incident has occurred to underscore the concerns and opportunities noted in this blog. Newsweek reports that, a 67-year old, oxygen-dependent Northern California man with COPD and congestive heart failure, died when a utility company cut power to his home. His medical equipment required power to deliver the needed oxygen. Within 15 minutes of PG&E turning off electrical service in the area due to the threat of wildfire, local first responders received and responded to an emergency call from someone on life-saving medical equipment. Despite their rescue attempts – while using flashlights - the man died.
Durable medical equipment (DME) is the term used for medical equipment that patients use in the home to maintain optimal health. In recent years, there has been a paradigm shift in health care placing a greater emphasis on controlling patient health and the transitioning of health care from hospitals and doctors’ offices to patients' homes and mobile devices. Given this shift, it is safe to say that the use of DME will increase in the future.
The use of DME makes sense for health care organizations looking to reduce overhead and operational responsibilities; insurance industries interested in paying less in premiums; and patients hoping to save some money on medical expenses. Some studies show that patient healing is also enhanced while being treated or recovering in familiar surroundings. The thing is, those that use DME including oxygen concentrators, Continuous Positive Airway Pressure (CPAP) machines, ventilators, IV infusion pumps, suction pumps, electric beds, and various other pieces of equipment, rely significantly on a dependable power source to ensure their safety and well-being. Most DME is electrically-powered, therefore if there is a loss of primary power to the home, patients could be at grave risk if there are no alternate power plans in place.
Power loss can stem from a natural disaster, power grid issues, or intentional controlled power outages (sometimes referred to as a “public safety power shutdown”), like those being considered in areas of Northern California by Pacific Gas & Electric (PG&E). PG&E power lines have been responsible for some recent wildfires in their market, including the 2018 Camp Fire that killed 86 people, so the company is hoping to reduce or eliminate potential ignitions from its power lines by initiating controlled power outages in areas where there might be a high risk of a wildfire occurring.
According to the Office of the Assistant Secretary for Preparedness & Response, approximately 2.5 million people covered under Medicare in the United States use some form of DME, thus the reason it is essential that we have a resilient power supply infrastructure in place to ensure that DME is fully powered for proper use. The number of DME users covered by other programs such as Medicaid, private pay insurance and VA programs are unknown. Some DME may be equipped with back-up battery power, but that source will typically only last a few hours.
Ensuring the safety of patients reliant on DME should be a priority among emergency managers and those responsible for policy planning too. Jurisdictional emergency plans should include a way to identify the most vulnerable residents who rely on DME. The U.S. Department of Health and Human Services (HHS) program, emPOWER, which uses the Medicare claims database to identify patients that utilize DME, can help with that effort. Emergency plans, for example, might call for the evacuation of the patient, if possible, and relocation to a health care facility that has a back up power system in place. Other plans may call for the patient to be checked on, if they have a generator or other means that enable them to defend in place. The latter option may be a better strategy, in some cases, if relocating the patient is impractical due to the patient’s condition, environmental conditions, resources available at the time, and logistics associated with moving the patient and multiple pieces of DME. Beyond evacuating and defending in place, the emPOWER database can also be used to help utility companies prioritize power restoration efforts and emergency managers to focus their response resources.
In June, NFPA staff members joined representatives from the Meridian Institute, Clean Energy Group, the health care industry, energy sector, U.S. Department of Veterans Affairs, and several other organizations at MIT in Cambridge, Massachusetts to discuss today’s resilient power supply system and potential issues for patients that use DME. Two common methods of supplying back up power – generators, and combination solar/energy storage systems (ESS) – were considered.
Generators, it was noted, have their limitations as the equipment must be maintained, refueled, can be noisy, and are likely to produce pollutants. Solar and battery storage systems may be a good option, it was determined, but the cost can be prohibitive, especially for low-income patients. Key findings were shared in the Meridian Institute report, including recommendations that solar and ESS options be further researched to see how patients can affordably access and pay for potentially life-saving alternative energy solutions.
NFPA recognizes there is also a need to address resilient power for DME in its codes and standards. To that end, the National Electrical Code (NEC) Correlating Committee is currently forming a task group to examine how the current requirements in the NEC should be managed for DME. The objective will be to determine if changes need to be made to the code to address the interface criteria between alternate power sources and the distribution system for the DME. Additionally, the new NFPA 855, Standard for the Installation of Stationary Energy Storage Systems and NFPA 110, Standard for Emergency and Standby Power Systems may also play a role in addressing DME resiliency; those documents will need to be reviewed to see how their requirements can further support the infrastructure for DME.
NFPA 99, Health Care Facilities Code already contains requirements for patient care, electrical appliances, and equipment, however, the current application of NFPA 99 excludes home health care. Therefore, there are currently no requirements for DME in NFPA 99. The correlating committee on Health Care Facilities is meeting in Phoenix, Arizona next month to complete their work on the 2020 edition of NFPA 99. The topic of DME will be on the agenda and dialogue about whether DME should be factored into the standard in the future is expected.
Addressing the resiliency aspect of DME in emergency management protocol, via forward-thinking collaborations and in the codes and standards that provide benchmarks for safety, will help to ensure that the most vulnerable members of our community are safe the next time power is compromised by weather events, power outages, and forced shutdowns.