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Table 5: A typology of health impacts of power outages

CategoryImpact
Hospital Direct clinical care:
  • Malfunctioning critical care devices led to decision to evacuate a hospital13
  • Patients on ventilators had to be evacuated12 , 14 , 16
  • A Ventricular Assist Device was not functioning and ran on battery power and a backup generator ‘nursed by the National Guard.’ The heart surgery team stayed with the patient until he could be moved to a hospital with power12
  • Intra-venous drips were converted to subcutaneous drips where possible to save on electricity14
  • Lifts were not working and patients had to be evacuated down the stairs10 , 12 , 14
Patient records and identification:
  • Accessing clinical records was difficult10 , 17 e.g. patients’ viral status10
  • Generating patient identifications was compromised, leading to difficulties tracking patients and patient results16
Increased demand on services:
  • Emergency Department (ED) was short staffed whilst volumes of patients doubled12
  • Patients on home oxygen had to seek oxygen at hospital as their oxygen concentrators were not working9 , 19
  • Influx of patients needing
    • electricity to recharge equipment 9
    • respiratory treatments9
    • dialysis. For example, 27 patients were waiting for dialysis in one ED at one point during Super Storm Sandy10 , 12
    • insulin19
  • Elderly patients with no access to home nursing10
Communication systems Patients communicating with hospital:
  • Patients unable to dial 911 to get emergency help due to loss of telephony (landlines and mobiles)10
Within the hospital:
  • Runners were used to relay messages14
  • Inability to charge phones17
  • Doctors downloaded and used a telephony app as the wi-fi system continued to not function10
Hospitals communicating with the outside world:
  • Communications systems were ‘overloaded and not working’ – therefore staff were unable to judge the extent of the event and prepare16. Once power was restored, medical students were sent to watch TV news and bring back updates on the situation.
  • Inability to charge phone17
  • Staff spelled “SOS” with bed sheets on a hospital roof in an effort to get outside help17
Hospital infrastructure dependent on electricity:
  • Heating, cooling, gas and air handling, washing linen and dishes, cooking. For example, one hospital used disposable utensils and plates, reduced the changing of bed linen and changed the menus to reduce power usage17
  • Blood bank had no power16
  • Radiology department had no power16
Transport to and from the hospital:
  • No public transport (no buses, subways) for patients and staff to use10,12
Healthcare Loss of home oxygen supply 9 , 10 , 15 , 19
Nebulisations failed leading to ‘asthma exacerbations and shortness of breath’10
Loss of functioning ventilators9 , 10
Dialysis sessions missed leading to ‘life threatening hyperkalaemia’10
  • Drug storage compromised9 , 10 . For example:
  • Biological therapy for rheumatic conditions20
  • Insulin19
  • Vaccine11
Lifts and Hoists not working leading to difficulties in caring for vulnerable patients in the community10 , 15
Transport:
  • Patients getting to hospital10 , 12
  • Patients calling emergency services for help10
  • Staff accessing patients in the community10 , 15
Communication:
  • Mobile phone service and landlines not working10 , 12
Community health effects Carbon monoxide poisoning caused by the unsafe use of generators for electricity, and grills and gas-powered heaters for cooking and heat generation10 , 21 , 22 , 23 , 24 , 25 , 29
Electrocution19
Adverse mental health- loss of services (including electricity) was significantly related to depression, anxiety and Post Traumatic Stress Disorder26
Loss of public health infrastructure Clean water:
  • Loss of water monitoring and pumping mechanisms19
  • Water boil notices and water restrictions were issued18
Sewage treatment:
  • Sewage treatment failure could lead to untreated/ undertreated sewage being added directly to streams19
  • Water treatment is reliant on power18
Food storage and safety17 , 18
Meal providers had to provide shelf stored food as fridges didn’t work19
Loss of safety mechanisms – national parks were shut due to loss of fire suppression systems. Traffic lights were not working19
Temperature control:
  • Inability to ‘get relief from the heat’18
  • Lack of heating is a problem for “elderly, homebound patients and small children, especially in low income housing projects”13
  • People tried to ‘heat their homes with kitchen stoves’10