Is your hospital safe when disaster strikes?

Emergency backup generators don't always work when they are needed most, a Consumer Reports investigation finds

Published: October 29, 2014 06:00 AM
After Superstorm Sandy, patients at NYU Langone Medical Center were evacuated in the dark.

When Superstorm Sandy knocked out power throughout coastal New Jersey and New York on Oct. 29, 2012, nowhere was the terror more palpable than in the darkened hallways and stairways of NYU Langone Medical Center and Bellevue Hospital. As both Manhattan hospitals lost power and their backup systems failed, nearly 1,000 patients had to be evacuated to other facilities.

Most of us assume our local hospital will be a safe haven when disaster strikes. But that isn’t necessarily the case. In fact, hospital generators were known to be vulnerable long before Sandy. In 2005, after Hurricane Katrina struck New Orleans, about 215 patients died in hospitals and nursing homes, partly because generators stopped working. In 2011, a Connecticut hospital evacuated more than 40 patients when its generator failed during Hurricane Irene.

Though steps were taken after those hurricanes to bolster hospital emergency preparedness, what happened during Sandy showed that they weren’t enough. And while no one knows for certain whether storms, floods, and tornadoes are on the rise, it’s clear that the health care community has been given a wake-up call.

“Whoever thought that invincible Manhattan, which withstood the 9/11 attacks, would go down under a storm surge?” said Dan Hanfling, M.D., a consultant on emergency preparedness and former vice-chairman of the Institute of Medicine’s committee on establishing standards of care in disaster situations. “We have to prepare for worst case scenarios.”

But have we? A Consumer Reports investigation finds that while extended power outages in hospitals are uncommon, there are reasons for concern:

  • Many generators are 50 or more years old.
  • Many are housed in basements, and need to be protected from floods.
  • Most hospitals can’t afford to move generators to safer locations, and federal and state governments aren’t likely to pick up the tab.
  • There is no national standard for the installation of backup generators.
  • Information about hospitals that fail generator tests isn’t available to the public.

A hospital’s lifeblood

When a hospital’s backup generator fails, the repercussions can be life threatening. After all, electricity powers not just heating, cooling, lighting, and alarms but also services critical to patient care: life-support systems, blood, bone and tissue storage systems, operating rooms, and neonatal intensive care units.

The Joint Commission, which accredits hospitals, says hospitals should test backup diesel generators 12 times a year for 30 minutes at a minimum of 30 percent of their maximum output (or nameplate load). The generator must also be tested once every three years for four consecutive hours at a minimum of 30 percent of its maximum. The center must also test automatic transfer switches, which transfer power from the electrical grid to the generator, monthly.

If either the generator or the switch fail, it must be repaired and retested. Finally, generators must supply power within 10 seconds to critical parts of the hospital’s electrical grid, which includes ventilators, infant nurseries, and coronary care units as well as communication systems, elevators, alarms, and exit signs.

See Consumer Reports Storm & Emergency Guide for information on backup generators and other supplies you need when the power goes out.  

Since 9/11 and Hurricane Katrina, hospitals have had to step up their emergency planning.

Why generators stop working

Despite all that, there’s no guarantee that a generator will do what it’s supposed to during an emergency. “You do the test to check that it is as reliable as you can make it,” said George Mills, director of engineering for the Joint Commission. But it’s like having maintenance done on your car, he continued: “Your vehicle may get the all clear from the auto mechanic, but a week later, it could have a problem.”  

Generators can stop working for several reasons. Among them:

Their age. “A lot of hospitals were built in the 40s, 50s and 60s,” Mills said. “Many still have their original equipment.” Nonetheless, old generators can still do their job. “Life expectancy is a function of how well a generator has been treated,” said Bill Burke, division manager of electrical engineering at the National Fire Protection Association, which establishes standards for the installation of electrical equipment and generator integrity.

Their location. Hospital generators and their fuel supply are usually in the basement, where they’re at risk for water damage. Why there? “The power company runs all the major electrical feeds into the basement,” Mills said. What’s more, because the “generator is a big noisy engine,” he says, putting it on the roof may not sit well with neighbors. It will also be at the mercy of high winds. Plus, the generator’s weight—typically several tons—coupled with the machine’s vibrations could damage a building.  

Their fuel source. Local fire departments typically require that fuel tanks be on a building’s lowest level or underground. That reduces risks in case of a fire or if a tank leaked. But that also means the tanks face flooding risks. “The biggest source of generator failure during Sandy was fuel contamination,” Burke said.

Hospitals must have an emergency plan

Since 9/11 and Katrina, the Joint Commission, the Federal Emergency Management Agency (FEMA), NFPA, and other agencies have said that hospitals should establish comprehensive emergency plans that address multiple potential crises. But because a hospital near the San Andreas fault in California is likely to face different risks than a hospital in the Midwest's tornado alley or on the hurricane-prone Eastern seaboard, each facility should also develop plans for its specific situation.

But there’s a limit to how prepared a hospital can be. There’s no way to know exactly where a tornado will touch down, a hurricane will come ashore, or an earthquake will strike. Nor can a hospital predict how devastating a natural disaster will be. “There are always surprises,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. “We do everything we can to understand what vulnerabilities are in our system and put in place mitigating strategies to address them. Then we have to be creative.”

Even if your generator works like a charm, your fuel tank could run dry if there’s a sustained loss of power. And there is a limit to how much fuel hospitals can store. “Hospitals, and particularly urban hospitals, are already fighting for space,” Hanfling said. “Fuel storage can be unwieldy and unrealistic.”

Read more about hospital safety, including our Ratings of more than 4,000 hospitals nationwide on infections, complications, and more.

No national code

The good news is that sustained generator failures are rare. The American Society for Healthcare Engineering recently surveyed 1,558 members about utility failures from July 1, 2011, to June 30, 2014. The 258 respondents reported an average of one power outage per year. During power failures, the emergency electrical system was successful 98.65 percent of the time.

Still, there are concerns. For one, while there is a national electrical code, most safety and building standards are state to state, Burke says. “There is no mandatory national standard for how each hospital has to address emergency loads,” he said.

In addition, the Centers for Medicare and Medicaid Services recently proposed updating national requirements for the testing of emergency backup systems. (CMS will issue its final rule no later than December 2016.) Among the changes being considered is requiring that generators be tested for four hours at least once every 12 months under the full electrical load expected to be needed during a failure rather than the current protocol.

Some experts think the yearly four-hour test is needed only in certain circumstances. “For hospitals with complex multi-generator systems, it may make sense to run a generator system more often than the NFPA standards,” said Dale Woodin, senior executive director of ASHE.

Relocating generators and fuel tanks might help in emergencies, but most hospitals don’t have the money. While the government allocated financing to hospitals for emergency planning, “These funds were not intended to relocate generators,” Foster said.

That’s as it should be, Hanfling says. “Backup electricity is part of the core business responsibility of any organization,” he said. “Emergency preparedness doesn’t come on the cheap, but it’s your best investment for ensuring that your doors remain open.”

Not only should electricity be reliable, but hospitals should also have a redundancy plan. “Patients need to be assured that their care will be delivered in a seamless fashion,” he said. “If it can’t—because sometimes events overtake even the best planning—there should be contingency plans in place. Right now we are doing it in a piecemeal fashion.”

Another important piece of the generator puzzle is transparency. “Despite a hospital’s best efforts, backup generators will occasionally fail,” Lisa McGiffert, director of Consumer Reports Safe Patient Project, said. “But the public has a right to know what happened and why and what plans are in place to prevent it from happening again. That’s not the case now.”

The Joint Commission encourages hospitals to report utility failures when it leads to a patient’s death or loss of function. But the reporting is confidential and usually voluntary.

NYU-Langone plans to produce its own power in a new plant scheduled to open in 2016.
Photo: Ennead Architects

Future storm protection

Ultimately, it may take a brand new hospital to solve the generator problem. NYU Langone Medical Center was in the midst of redesigning when Sandy struck, and is using millions of dollars from FEMA to repair Sandy-related damage and protect against future storms, says Paul Schwabacher, senior vice president of facilities management. Included in that effort will be a state-of-the-art 71,000-square-foot Energy Building.

The hospital will have three sources of power. One will be its local supplier, Con Edison. The second will be the hospital’s cogeneration plant, which will generate electricity and heat. In the event of a local power failure or if most of the Northeast is blacked out—as was the case in August 2003—the hospital’s plant can power the medical center using either natural gas or diesel. Finally, generators will be available to power the hospital during an emergency, and more than 150,000 gallons of diesel will be stored on site.

To protect equipment and fuel, the new energy building will have flood barriers 7 feet higher than the Sandy storm surge, and the generators will be 20 feet above the storm surge level. Though fuel tanks will be at ground level, they will be in a reinforced concrete waterproof containment vault with an access point that’s more than 10 feet higher than the Sandy storm surge.

“We sustained a lot of damage during Sandy and that was tough,” Schwabacher said. “Now we’re able to rebuild in a way that ensures we won’t have future damage.”

—Catherine Winters

A backup generator can help you weather a storm at home.

What you can do

Hospitals are supposed to train medical staff to deal with emergencies and to have vital supplies on hand should the power fail and the generator not work. But if you are entering the hospital during hurricane or tornado season, experts recommend the following.

Plan for an early discharge. Hospitals often try to discharge patients early if a natural disaster is looming, provided they are well enough. Ask a family member or friend to be on call in case you need a ride home. And before leaving the hospital, get clear discharge instructions and fill any prescriptions you will need, says Dan Hanfling, M.D., former vice chairman of the Institute of Medicine’s committee on establishing standards of care in disasters.

Have a communication plan. “Be sure you can contact your family if you need to be evacuated, ahead of the event or afterward,” Hanfling said. That works both ways. Your family should know the best way to contact you, especially if cell phone service is disrupted.

Know evacuation plans. If there’s a chance your loved ones may have to evacuate, find out where the nearest local shelter is. And if you are concerned about an impending storm, ask the hospital where it is likely to move patients if it’s necessary to evacuate the hospital.

Prepare your home. If you are discharged early, you won’t have time to shop for flashlight batteries or fill the propane tank that fuels your home generator, so do this prep work before you’re admitted.

Read more about what you should do at home to plan for an emergency.

E-mail Newsletters

FREE e-mail Newsletters! Choose from cars, safety, health, and more!
Already signed-up?
Manage your newsletters here too.

Health News


Cars Build & Buy Car Buying Service
Save thousands off MSRP with upfront dealer pricing information and a transparent car buying experience.

See your savings


Mobile Get Ratings on the go and compare
while you shop

Learn more