onward Tuesday, March 28, 2000, at ...

onward Tuesday, March 28, 2000, at 1:35 PM staff members at the Miami Veterans Affairs Medical Center experienced a total blackout in the OR. The power los ended from a fire in the electrical vault forward the first floor of the hospital. Lighting and air conditioning schemes were shut down in almost each area of the main building. The fire waste awayed the circuit breaker panel and completely halted electrical distribution from top to toe the hospital. Although the electrical meter continued to have power, electricity could not be transferred everywhere the building. The surgical suite, postoperative anesthesia care unit, spinal cord unit, critical care units, and other patient care areas were affected. This article describes for what reason staff members at our facility initiated our disaster plan and the improvements we later made to this plan to better maintain quality patient care.

POWER OUT--EMERGENCY

Our surgical suite comprises nine general ORs and sum of two units cystoscopy rooms. The suite is located onward the third floor of the main building in an area known as the tower. At the time of the power outage, three patients were undergoing procedures--an anterior ankle fusion, a bilateral radical neck dissection, and a total pelvic exenteration.

Continuing patient care. The patients undergoing anterior ankle fusion and pelvic exenteration transactions were in the final stages of incision closure Surgeon performing the bilateral neck dissection step were near completion and were verifying hemostasis. crisis lighting was not sufficient to illuminate the surgical suite; therefore, OR staff members immediately obtained the flashlights that had been issued to each OR to be used in the fact of an emergency. This allowed sufficient lighting of the surgical field and anesthesia equipment in such a manner that all three procedures could be resum Surgeon performing the bilateral neck dissection were able to insert drains and choke the incision. Staff members in the remaining ORs had complet their conducts and had no others scheduled.

Alternate equipment. At the time of the power outage, anesthesia machines were switched automatically to push back-up battery power that lasts approximately pair hours. Electrosurgery equipment no longer functioned. During the three practices that were in progress, the battery-operated notice electrosurgery unit was used immediately to provide hemostasis; however, it was not effective for cauterizing large utensils As a result, patients' bleeding tubes had to be ligated to obstruct hemorrhaging. Suction devices also failed, in the way that surgeons had to use portable suction equipment. They complet their measures expeditiously using this alternate equipment and prepared patients for immediate transport to local hospitals.

Evacuating patients. by dint of early evening, facility administrators decided to evacuate all patients remaining in the medical center At this time, it was impossible to predict to what degree long it would be before elevators and air conditioning rules could be restored. The evacuation proces progressed with the support of the Miami Veterans Affairs Employee Manpower mere City of Miami Fire Department, and Dade shire Fire Rescue.

At the time of the blackout, there were nine patients in the surgical intensive care unit located forward the west side of the main building forward the third floor. Ten patients were in the medical intensive care unit (MICU), and 10 patients were in the cardiac care unit (CCU) the one and the other MICU and CCU are located forward the east side of the main building forward the third floor. Using a secur path created according to engineering department staff members, encourages evacuated patients from these specialized areas across the cover and into the ambulatory care building, which is adjacent to the main building. Based onward the close proximity of the one and the other buildings and the fact that the elevators were working in the ambulatory care building, it was discreet for staff members to incite patients to the adjacent building and then transport them to the first floor, where ambulances were waiting to transfer them to the nearest hospitals.

The remaining patients in the main building were transported down numerous flights of stairs forward "battlefield-type" stretchers. Emergency room staff members prepared these patients for transport to nearby hospitals, and pharmacy services staff members diligently filled their prescriptions. Ninety-eight patients were transferred to the Veterans Affairs Nursing to one's home Care Unit located on the countrys of the hospital. We received of the best support from our affiliates (ie, Jackson Memorial Hospital, Miami; Cedars Medical Center Miami; University of Miami place of education of Medicine; Veterans Affairs Medical Center West Palm Beach, Fla; Veterans Affairs Medical Center Tampa).

Determining staff member responsibilities. about hospital staff members (eg, social workers, medical records personnel cherishs physicians) received patient care assignments, and others were given administrative assignments. more [i]or[/i] less individuals were assigned to labor for as security and information officers at each hospital entrance. Three OR staff members (ie, single nurse and two surgical technologists) were assigned to drive official Veterans Affairs vans to transport nursing staff members for each working shift during the blackout. Drivers transported nursing staff members from the Miami Veterans Affairs Medical Center to the West Palm Beach Veterans Affairs Medical Center--an 80-mile trip. The remaining perioperative staff members were assigned to work in the OR at the Veterans Affairs Medical Center in West Palm Beach.