In recent years, and assortment of natural disasters have offered reminders of what can happen to vital emergency power when the weather turns heavy. From tropical Storm Allison in 2001 to Hurricane Katrina in 2005 to the EF5 tornado that struck Joplin, Missouri, in 2011, and most recently, to hurricane sandy, we’ve seen a steady procession of events that have overwhelmed emergency power systems at health care facilities across the county.

Flooding, the failure of antiquated equipment, and the destruction of supporting infrastructure such as fuel pumps have led to disruption of the essential electrical system, or emergency power that allows facilities to remain in operation and provide an appropriate level of care and safety to both patients and staff. Among the enduring images of Hurricane Sandy and those of doctors, nurses, and emergency responders evacuating patients down unlit hospital stairwells in New York City, as ambulances lined up for blocks to take them to other facilities. Some climate experts predict that our future will be filled with more storms and bigger storms, but that doesn’t mean hospitals and other health care facilities need to endure the problems associated with the loss of emergency power. Two NFPA documents-NFPA 99, Health Care Facilities, and NFPA 110, Emergency and Standby Power Systems-address the primary issues related to emergency power for hospitals. NFPA 99 requires the emergency power, typically provided by generators, and dictates which areas of the health care facility or functions, system, and equipment must be connected for automatic restoration from the emergency power system.

Certain functions must be restored within 10 seconds of loss of normal power, including those intended for life safety functions, such as illumination of means of egress and exit signs. They also include critical areas and equipment, such as fixed equipment in operating rooms, where the electrical failure can have serious negative consequences on patient care.

Other important, though less critical building features such as heating equipment and elevators must be connected to the emergency power but are permitted to be restored at appropriate intervals once the energy has been restored to the most vital areas. This power can only be provided when the source of emergency power is properly operating.

NFPA 110, a portion of which is extracted into NFPA 99, addresses this source of emergency power, the emergency power supply (EPS), and, along with its supplementary components, the emergency power supply system (ESPP). (For more on emergency power supply system, see this issue’s “Electrical Safety” column on page 40.)

One of the requirements for locating the EPSS states that the room, shelter, or separate building in which the equipment is housed must be designed and located to minimize the damage from flooding. The associated annex material recommends that the EPSS equipment be located above known flooding elevations where possible.

Both NFPA 99 and NFPA 110 address the maintenance and testing of the emergency power systems for health care facilities. Routine maintenance, detailed in NFPA 110, must be performed to ensure that the emergency power can meet the requirement for 10-second  power restoration. Monthly testing (at least 12 times per year at intervals between 220-40 days) of the emergency power source is required under load for 30 minutes. At least once every three years, the entire EPSS must be tested continuously for four hours.

Hurricane Sandy and the resulting emergency power failures have raised critical questions about the adequacy of these requirements. Why, for example does NFPA 99 not require more areas or functions within hospitals to be connected to emergency power? Why does NFPA 110 not require that emergency power equipment be located above the known previous flooding levels rather than just minimizing damage from flooding? Are the testing requirements for generators enough to ensure that they will operate over the long durations-days at a time, rather than hours-needed in some disasters? These are all the reasonable questions, and the responsible technical committees will most likely address them for the 2015 edition of NFPA 99 and the 2016 edition on NFPA 110.

It is important to keep in mind that these documents are written as minimum standards for the performance, installation, and testing of emergency power systems. Each facility, designer, enforcing authority or other entity can go above and beyond these minimum requirements at their discretion. When the codes and standards are followed, it is expected that an adequate level of life safety and reliability will be provided. Guidance is available from different groups on going “above and beyond” the minimal requirements, such as The Joint Commission’s Sentinel Event Alert, Issue 37, which specifically offers guidance for health care facilities to reduce risk of emergency power failure. (For more information, visit jointcommission.org and enter 37 in the search box.)

When failures do occur, requirements in NFPA 99 for emergency management can help reduce the impact (see “Prepping for the Worst,” page 52). Ensuring the reliability of the electrical system is the preferred approach, but proper planning, training, and execution of an emergency operations plan can also make a difficult situation easier to manage. Emergency management includes identifying hazards, developing strategies to mitigate the effects of these hazards, and creating plans for prepping for, responding to, and recovering from the emergency.

The power failures that unfolded in the wake Hurricane Sandy are being analyzed for lessons we can use to help manage future natural disasters. They remind us how vital the essential electrical system and their integrity are to the health care facilities. While the failures raise critical questions about the requirements of current codes and standards, it is also worth noting that many health care facilities did not require evacuation and that their emergency power operated properly for the duration of the power outage, allowing them to withstand the influx of patients from those health care facilities that did require evacuation.

Hart, J. (2013). Emergency Power+NFPA 99 and NFPA 110 . NFPA Journal , 49-49.