A Controlled Disaster: When the Hospital Loses Power

Responders scrambled to evacuate the vulnerable when a Florida facility blacked out

In the final days of August 2016, the citizens of Pasco County, Fla., were preparing for Hurricane Hermine, the first to make landfall in Florida in over 10 years. Leaders activated the local EOC, canceled school and had already closed some government facilities. These circumstances are fairly common in Florida, as tropical weather happens often and we like to play it safe. Fire departments, law enforcement, EMS and hospitals throughout the area were prepared for the storm as they’d been countless times before.

As the initial rain bands began to make landfall, lightning struck one of the county’s six receiving hospitals, Regional Medical Center Bayonet Point (RMC)—the county’s only trauma center, located in its far west end, just a few miles from the Gulf of Mexico. This triggered a fire and then a sudden and total loss of all power. Due to the unique circumstances of the lightning strike and fire, backup systems failed, and all staff, along with 225 patients, were abruptly left in the dark. Doctors in the middle of procedures suddenly had no light; patients on ventilators were left reliant on backup battery power; elevators ceased to operate. The clock was ticking. 

Pasco County Fire Rescue, the combined system that serves the county’s almost 500,000 citizens, arrived and quickly extinguished the fire. However, it rapidly became apparent that the fire was only one of several problems: Nonambulatory patients on the hospital’s second and third floors were now trapped due to a lack of functioning elevators, and all patients on powered medical equipment were now relying on backup battery power, with various time frames until the batteries were drained. With no power to the hospital, there was no way to recharge the batteries on equipment such as IV pumps, ventilators, cardiac monitors, etc. Suddenly the small fire and power loss became an MCI. 

“The event was the result of a no-notice incident from a lightning strike and power surge resulting in a complete electrical utility loss and forced full-facility evacuation,” says RMC CEO Shayne George. “Through unified command between hospital and emergency services leadership, it resulted in a controlled disaster.”

Additional Resources

As leaders weighed evacuating the hospital, it was apparent they needed more resources immediately. They called numerous other counties to request assistance, and agencies from all over the state answered. 
Among those was Pasco County’s neighbor to the south, Sunstar Paramedics, Pinellas County’s primary EMS agency, operated by Paramedics Plus. As part of its internal policy, Sunstar’s administrator on duty was notified of the developing situation. This resulted in a phone call to John Peterson, Sunstar’s chief administration officer, who immediately responded. 

Sunstar Paramedics was joined by five other departments from Pinellas County, creating a team of 14 transporting units. Among the transport units provided by Sunstar were two specially designed “AmbuBuses” that proved very valuable in the evacuation. AmbuBus 931 and 932 (as well as a third identical bus not involved in this incident) were placed into service two years ago to meet the unique requirements of the region. The constant threat of tropical storms, hurricanes and large-scale incidents such as active-shooter events and fires prompted the Pinellas County EMS & Fire Administration to develop a large-capacity transport solution. Director Craig Hare spearheaded the concept of the AmbuBus, which is a county-owned asset managed and operated by Sunstar Paramedics. The plan was to convert retired school buses already owned by Pinellas County into these ALS transport resources by installing litters and racks like you’d see in a military transport vehicle. The addition of standard ALS equipment, Philips MRx monitors and additional equipment completed the project. The buses are staffed by a paramedic supervisor who drives and, at a minimum, a paramedic and EMT. In addition to the AmbuBuses, Sunstar also brought emergency transport ventilators from a storage facility where they’re kept for events like this. 

When Peterson arrived on the scene, he noted that due to the distance traveled by many of the mutual aid agencies, radios didn’t work. “We had to walk down this huge line of ambulances one at a time to identify who was ALS, who was BLS, who was CCT and then give directions,” he says. Sunstar Paramedics utilizes a tracking system from Genesis PULSE for its vehicles, and it worked flawlessly to track their units. However, with limited to no communication with dispatch, other units or other agencies, it presented significant challenges. 

Peterson ended up coordinating the transport sector by adapting the flow of ambulances into the pickup area: ALS units went to the ER ambulance ramp, and BLS units to the nearby roundabout public entrance. Inside the hospital triage proceeded, and as a patient was ready for transport, the information was relayed to Clearwater District Chief No. 48, who was standing at the doorway. DC48 would use hand signals to Peterson to indicate the number and types of units needed. 

Due to the issues with radio communication, the use of the hand signals and face-to-face communication was crucial to coordinating transport. “Everyone was trying to do the right thing,” Peterson says. “We provided standard mutual aid and adapted to the situation we were presented with. Basically it was hand signals and cell phones.” 

The AmbuBuses and a similar bus provided by Alachua County handled the most critical patients. AmbuBus 931 made the first transport of six critical patients not long after the evacuation began and returned to transport four more, with additional Sunstar personnel added to staff the bus. AmbuBus 932 added help from Pasco County Fire Rescue and transported eight critical patients. Most of the patients transported by the AmbuBuses were on ventilators and complex IV medications. 

‘Like a Routine Transfer’

I was notified of the incident by the AMR on-duty supervisor and immediately made my way to our headquarters to help coordinate our response. Several phone calls produced 22 employees who volunteered to come in and assist. AMR West Florida is the contracted transportation provider for RMC and maintains a substation on hospital property, so its response was immediate. AMR provided 14 total units (5 critical care, 5 ALS, 2 BLS, a wheelchair van and a command unit) that completed 25 total transports. AMR units in Florida are managed by a system called Logis, provided by Logis Solutions of Denmark, which allows simultaneous tracking, system status management and real-time voice and text communication between dispatch, field units, supervisors and management. This is achieved over a cellular connection, and though it allowed flawless communication within AMR, AMR was unable to communicate with command or any other responding units via radio. 

Upon arriving on scene, I met with the AMR operations manager, Brian Haff, and Commander David Akers, who reported to the staging officer for all AMR units. There was a lot of time being spent by a very long line of ambulances with limited information waiting for further instructions. Once the treatment, transportation and staging officers were all on the same page, things started to move smoothly. The flow of ambulances was adjusted a few times until a system was developed that allowed units to pick up patients and leave without interfering with other units. 

As my partner and I entered the hospital through the emergency department, we encountered a very controlled environment. The hospital had posted someone with a clipboard at the exit, and no patient could leave the facility without accountability. It was clear who was in charge inside the emergency department, and our instructions were clearly communicated. The hallway was full of stable patients on hospital beds, nurses and doctors attending to patients and directing the massive flow of EMS and stretchers coming and going. My partner and I were directed to our patient, who had just had a significant cardiac procedure that day. We were met by a very professional nurse who gave us a full report. She knew exactly where the patient was going and was unusually calm and collected despite all she and her team had dealt with. We transferred the patient to our stretcher, placed them on the monitor, IV pump and equipment, and left to return to our ambulance. 

As we wheeled the patient down the hall, my partner and I both noted how the situation was so well controlled, it felt like a routine transfer. It was obvious it wasn’t as we passed groups of firefighters carrying patients with stair chairs; at what seemed like every turn, there were firefighters in stairwells bringing patients down. These firefighters had performed this repetitive and grueling task over and over for hours, in a hospital with no air conditioning in South Florida in August. There was amazing teamwork, a great sense of unity and mutual respect between everyone from nurses to medics to doctors to janitors. Everyone knew what needed to be done, and title and rank no longer mattered—it was just a group of like-minded people working to accomplish a task. 

My partner and I completed our transport and returned to the hospital staging line, but before we made it to the front again, the evacuation was complete. 

Conclusion

The largest challenge for us was the lack of ability to communicate with command, staging or anyone else not a part of AMR. This was overcome by having a designated representative from our agency literally stand close to the staging officer and relay information. 

The overall cooperation and teamwork between all agencies made this MCI run so smoothly that many personnel felt like it was a routine event. “We have the deepest appreciation for our staff, first responders, HCA and the other community and government resources that supported the successful total evacuation of 225 patients,” says George. “This occurred without incident within a six-hour time frame. Working as a united team, Regional Medical Center Bayonet Point was able to recover and reopen within five days at 100% capacity.” 

The No. 1 thing I’ve taken away is that a cool, calm and collected approach with mutual respect, flexibility and a bit of planning turned this potential disaster into a success. If the same approach is taken on all incidents, no matter how small or large, you can expect similar positive results.  

Richard Montgomery, Jr., AAS, NREMT-P, CCT-P, is the clinical education and safety and risk manager for AMR – West Florida. He has 18 years of experience and is a critical care paramedic instructor and author on EMS-related topics. He served in the United States Army as a paratrooper and medic, worked offshore in the oil and gas industry as a medic, worked as a street medic and maintains his skills by running critical care calls in the West Florida region with AMR. Contact him at Richard.Montgomery@amr.net.