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A hospital can have a simple or complexemergency power supply
system (EPSS) butensuring that the system continues contributing
tosafe and effective patient care with todayschallenges is rarely
simple. Complexity isintroduced because the EPSS powers other
hospitalsystems such as the clinical, mechanical,
verticaltransportation and fire management systems. Thehospital
engineer must also respond to newrequirements that affect the EPSS,
includingrequirements for utility management, emergencymanagement,
patient safety, continuous qualityimprovement and staff education.
All of theseinterrelationships cause complexity.
An EPSS includes generator sets, generator setauxiliary systems
such as cooling, combustion air,fuel oil and starting systems,
paralleling switchgear,automatic transfer switches, distribution
panels,lighting and power panel boards, feeders and branchcircuits.
Some facilities that do not have EPSSs mayhave a stored-energy EPSS
(SEPSS). Facilities canalso have an uninterruptible power supply
(UPS).
When the normal power fails, all normal loads aredead. All
emergency loads experience a short loss ofpower unless they are
backed up by an SEPSS orUPS. The hospitals clinical staff must know
how todeal with this condition. The monthly load testingsimulates
this experience as illustrated in Figure 1,although the length of
time without voltage during atest is likely to be less than it
would be during anactual outage. A proactive EPSS
managementprogramme will use the lessons learned from themonthly
load testing, along with regular normalpower shutdowns, to train
the clinical staff to expectand then manage this critical element
of theenvironment of care.
Some hospitals have decided that the short period oftime (10
seconds or less) that some clinicalequipment, such as ventilators,
would be withoutpower during a real normal power outage
isunacceptable. Those hospitals have installed UPSsystems to
provide uninterruptible power to theirventilators, and have
identified specially markedoutlets as UPS-backed outlets.
Mana g emen t P r o g r amme S y n op s i s
Managing emergency power systems is more than justmonthly
generator load testing. It should also involve:
knowing the total EPSS demand loading underthe range of
emergency conditions included in thehospitals hazard vulnerability
analysis;
knowing the total demand on major distributionelements of the
EPSS such as transfer switches;
reviewing unexpected occurrences and monthlytest results;
analysing trends of results and problems forcontinuous quality
improvement;
investigating and resolving training and/orsystemic issues
identified by the trend analysis;
co-ordinating the impact of construction/renovation projects and
infrastructure upgradeprojects on the EPSS; and
performing an extended-run EPSS load test atleast once every 36
months.
Eme r g e n c y P owe r D emand L o a d
Hospital engineers need to determine the actualEPSS peak
(demand) load for due diligence and tosatisfy the requirements of
authorities havingjurisdiction in their localities. Many
hospitalengineers believe that the amount of load they recordduring
their monthly EPSS load tests is the realdemand load. This
assumption is flawed and can leadto some negative consequences.
The EPSS test load does not reflect the EPSSdemand load because
the EPSS test loading dependson the day and time of the test.
Correspondingly,real EPSS loading during a utility power failure
alsodepends upon the day and time of the power failure.Many
hospitals test their EPSS at night or early in themorning before
the bulk of the hospitals dailyactivities begin. This test time was
probably chosen
a report by
Da v i d L S t ym i e s t
Voting Member, National Fire Protection Association (NFPA)
Technical Committee on
Emergency Power Supplies and Senior Consultant, Smith Seckman
Reid, Inc.
Manag ing Hosp i ta l Emergency Power Programmes
B U S I N E S S B R I E F I N G : H O S P I T A L E N G I N E E
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Reference Section
David L Stymiest is a votingmember of the National
FireProtection Association (NFPA)Technical Committee on
EmergencyPower Supplies. He is SeniorConsultant at Smith Seckman
Reid,Inc. (SSR), specialising in hospitalfacilities engineering
andmanagement, and is also a CertifiedHealthcare Facility Manager.
Priorto joining SSR, Mr Stymiest wasSenior Electrical Engineer for
morethan 10 years for MassachusettsGeneral Hospital and the other
11hospitals of the Partners HealthCareSystem. He has 30 years
ofexperience in facilities engineering,during which time he
hasdeveloped a comprehensive hospitalelectrical utility
managementprogramme. He has written 13American Society of
HealthcareEngineering (ASHE) papers and fiveHealth Facilities
Managementarticles on hospital facilitiesmanagement and
engineering, andhe co-edited the 1,200-pageMcGraw-Hill Facilities
Engineeringand Management Handbook forCommercial, Industrial,
andInstitutional Buildings. He is amember of ASHE, National
Societyof Professional Engineers (NSPE),NFPA, Illuminating
EngineeringSociety of North America (IESNA),Institute of Electrical
andElectronics Engineers, Inc. (IEEE)and Association of Energy
Engineers(AEE). Mr Stymiest has a Bachelorsdegree and a Master of
Engineeringdegree in Electric PowerEngineering from
RensselaerPolytechnic Institute, a Certificate ofSpecial Studies in
Administrationand Management from HarvardUniversity and is a
RegisteredProfessional Engineer.
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Reference Section
to be one of low clinical activity, and that avoidedclinical
load will not be reflected in the EPSS testloading. Many hospitals
do not test their EPSSwhenever their operating theatres are in use.
Also,the mechanical (see Figure 2), building, radiology (see
Figure 3) and other clinical processes all vary during atypical
hospital day. Finally, some equipment, such assmoke control systems
and fire pumps, will notoperate except during internal
emergencies.
The amount of load through a piece of distributionequipment such
as a transfer switch can be measuredas a function of time of day.
This does not includesampling in short intervals. Repeated
recordings forseveral days with portable or permanently
installedpower monitors will provide the raw data fromwhich EPSS
load profiles can be generated.
During an internal emergency situation such as aworking fire,
the EPSS loading may include extra firealarm system load (see
Figure 4), may include theextra load of smoke control systems such
as stairwellpressurisation fans or atrium exhaust fans and
mayinclude a fire pump. If the emergency is external,then the EPSS
load may also include extra clinicalactivity, which some medical
personnel callemergency department surge.
The authors experience reviewing thousands ofhospital load
profiles has indicated that daily loadprofiles taken in the same
hospital building over timetend to show similar characteristics and
values. Theload profiles are most likely to change due to
loadgrowth (over time), space utilisation changes anddensification
of occupancy or equipment. Thefollowing is a strategy for
determining the peak loadthat provides good repeatable values:
obtain typical day load profile for each automatictransfer
switch (ATS);
add seasonal adjustments;
adjust loading for the internal emergencycondition considered
(such as a fire);
adjust loading for the external emergencycondition considered;
and
adjust loading for lessons learned from plannednormal power
shutdowns.
Each ATS and adjustment factor is consideredindividually. Once
all input data has been measured,calculated or analysed, Figure 5
can be turned into theoverall EPSS stacked area chart (see Figure
6) with a
Fair Better Best
Sample with hand-held ammeter Record 23 days per ATS with Use
remote power management systems
does not result in load profile portable recording
instrumentation
Sample with ATS-mounted ammeter Use power quality meter Use
central data recording and storage
does not result in load profile Use data loggers
Table 1: Methods for Measuring Typical ATS Loads and Load
Profiles
Figure 1: Impact of an EPSS Test on ATS Current
0
50
100
150
200
250
300
350
400
450
500
7:00 am 7:30 amATS current 5 min/div horiz.
8:00 am
Amps
Figure 2: Sample Mechanical Equipment System ATS One-minute Load
Profile
0
50
100
150
200
250
300
Equipment system, no smoke control or fire wire
Two days, 6:30 am start time
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Reference Section
simple spreadsheet command. It is important to ensurethat all
measurements and adjustments are in the sameunits. The author
prefers kilovolt-amperes since it is adirect calculation from
amperes, is independent of ATSvoltage and does not require power
factor assumptions.
Eme r g e n c y P owe r T e s t i n g P r o g r amme
The primary goal of a hospitals emergency powertesting programme
is to comply with regulatoryrequirements without adversely
affecting theoperation of the hospital or the wellbeing of
thepatients. Additionally, the programme needs to verifythe
infrastructures ability to withstand those powertransfers that will
occur when utility power is lost. Asthese power transfers usually
involve power qualityissues, it is also necessary to educate
clinical care-givers so that patient care is not put at risk in
theevent of power outages or transfers.
A comprehensive, proactive approach to emergencypower testing
should incorporate the following.
Test the functionality of all equipment related togeneration and
distribution of emergency power.
Train both maintenance and clinical personnel inhow to deal with
the loss of utility power andpower system transfers.
Test clinical equipment response to power systemtransfers.
Test the mechanical and building system responsesto power system
transfers.
Ascertain the causes of unexpected occurrencescaused by the EPSS
testing and take correctiveaction to preclude future failures.
Avoid conditions that compromise patienttreatment and
safety.
Table 2
Some types of EPSS failures Possible result if not found and
fixed
before the next normal power outage
Starting battery or cable problems No emergency power when
needed
Engine fuel oil contamination Poor operation, possible engine
failure
Faulty safety shutdown switches May shut off the generator set
unnecessarily
Engine fluid leaks Possible engine failure
Engine mechanical failures Possible engine failure
Transfer switch failures Failure to transfer to emergency
power
Blown control power fuses ATS fail to transfer, paralleling
switchgear
failure, generator set fail to start
Tripped or open emergency power ATS will not transfer to a dead
source
circuit breakers
Figure 3: Sample Radiology ATS Load Profile
0kw
5.0kw
10.0kw
15.0kw
20.0kw
25.0kw
30.0kw
35.0kw
40.0kw
45.0kw
50.0kwkw
Noon 12:30 pm
Instantaneous Power 5 min/div horiz.
1:pm
Figure 4: Sample Hospital Emergency Power System Life Safety ATS
Load Profile Using 15-minute Demands
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Monthly emergency power testing may also causeEPSS failures to
occur during the test because theequipment is operating. Failures
that do occur duringa test probably would have occurred anyway
duringthe next normal power outage. Their impact on thehospital is
lessened because plant operators arefocusing on the test and normal
power is stillavailable. Experienced hospital engineers wouldprefer
to have the next failure during the next testinstead of during the
next outage.
S e c o nd - o r d e r C o n s e q u e n c e s a n dL e s s o n
s L e a r n e d f r om E P S S T e s t s
EPSS testing can have second-order consequences,which are
wide-ranging consequences beyond theprimary intent of the testing.
The second-orderconsequences of the testing may signify a
potentialproblem with the next power outage as well. For
thisreason, hospital engineers should always follow up on
thelessons learned from the monthly load testing, determine
Figure 5: Sample Hospital Emergency Power System ATS Load
Profiles Using 15-minute Demands
Figure 6: Sample Hospital Emergency Power Supply System Load
Profile Using 15-minute Demands on
800kW/1,000kVA Generator Set
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5
the causes and effects of the second-order consequencesand take
corrective action as soon as possible. Examplesof some types of
second-order consequences are:unnecessary mechanical system
tripping; UPSs thattransfer to battery during the test; clinical
equipmentfailures; circuit-breaker tripping; unwanted
mechanicalsystem responses; and variable-speed drive failures.
Everysystem failure that coincides with or follows an EPSS
testshould be analysed for its generic relevance, consideringit as
a potential:
human error; problem system interaction; test procedure
inadequacy; equipment malfunction; or simple coincidence
(unlikely).
Hospital engineers should proactively assess andreduce the risk
of EPSS failure. The programmediscussed here offers this. The
following list providesa set of tools for quality improvement.
Rotate testing personnel. Supervisors proactively review test
results and all
surprises. Analyse test results, look for trends:
do not just record generator parameters. Review second-order
consequences:
look for interactions between EPSS and thesystems it powers.
Use a testing event database: unexpected events; failures EPSS,
other systems and equipment;
and other unexplained occurrences.
Mana g emen t o fP owe r S y s t em F a i l u r e s
Some hospitals consider power system failures as thefailure of
the incoming utility lines, maintransformer, main switchboard, etc.
This can takedown the entire normal power system. In this case,the
emergency power system is assumed to beavailable. As illustrated in
Table 3, hospital engineersshould consider different failure
points, not just at themains. The responses will be different for
each typeof failure and, as people sometimes find out much totheir
dismay, it is too late to formulate a responseafter the failure has
occurred.
Poorly considered emergency responses can degradepatient safety
if they neglect to consider allramifications of emergency
operation. Sometimesbad decisions are made by well-meaning
personnelwho are under a lot of pressure to act immediately.This
situation can also compromise worker safety.
Hospital departments can plan and work together todeliver safe
patient care, not just in the infection
Types of failures that usually have written failure procedures
Types of failures that often do not have written failure
procedures
Normal power Normal power
Incoming utility line(s) Large feeder or riser (busway or
Main utility transformer cable/conduit)
Main service entrance Large transformers and switchboards
switchboard Motor control centres, large distribution
panels
Emergency power Emergency power
One generator of a Paralleling switchgear most critical
multiple generator system common mode EPSS failure
Single generator
Normal/emergency power (still part of the EPSS but downstream
of
the transfer switch or other transfer device)
Critical branch ATS or riser
Critical branch feeder or panel Hard-wired equipment is very
problematic
Life safety ATS or riser Will take out all hard-wired loads
(fire
Life safety feeder or panel alarms, emergency lights, exit
signs, etc.)
Equipment system ATS or feeder Will take down many important
mechanical
loads serving critical care areas
Will take down all loads on the UPS, Uninterruptible power
supply
usually the most electrically critical.
Emergency system is still available
major impact on hospital but
expectations are lower
Emergency system is still available lesser
impact on hospital but expectations are
much higher than total outage. Could be
accompanied by fire/smoke.
Remaining generators are still
available
Normal power is still available, may
arrange for spare or rental unit
Will take out all connected generators
must rewire all ATSs.
Normal power is still available but clinicians
must be trained so that normal power can be
the back-up
or
motor
control
centre
Table 3: Managing Hospital Power System Failures
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Reference Section
control and clinical arenas, but in the utilitymanagement arena
as well. Basic what if thinking byinnovative professionals working
together will improvethe overall ability of the hospital to deliver
safe patientcare under all electrical failure eventualities.
When utility failures do occur and they will incident reports
should be completed. Whenincident reports are generated, proactive
utilitymanagers will fix the immediate cause of the failure(as well
as the failed equipment itself), consider thegeneric relevance of
the failure, improve policies andprocedures where warranted and
make other changesto avoid similar future failures and improve
overallutility reliability. Finally, all of these lessons
learnedshould be used to improve the emergencymanagement plan.
P l a n n e d S h u t d own s
Hospital new construction and renovation projectsoften require
carefully planned electrical shutdowns.If the critical branch
panels or risers are to be shutdown, then the temporary wiring and
proceduresthat are used should be included in future
emergencymanagement documentation.
It is often necessary to power more equipmentduring a planned
power shutdown than just code-required equipment. This is
necessitated by thehospitals operating needs and if the extra
equipmentis not already on emergency power it must betemporarily
wired for the shutdown. Many of theseissues were learned for the
first time when hospitalsprepared themselves for Y2K.
Finally, planned shutdowns also include whatemergency management
policies call recovery -getting back to normal. This can be a
burdensomeprocess if a lot of temporary wiring or back-feeds
wereused to get through the shutdown. It may be necessaryto have
detailed procedures for switching back to thenormal operation in
order to minimise the potentialfor accidents. Equipment that had
remained de-energised during the outage should also be shut
offbefore recovery begins to minimise the possibility ofdamage to
sensitive electronics from power surges(voltage fluctuations)
during the initial power-up.
Edu c a t i o n
Since modern hospitals are evolving, constantlychanging
entities, on-going staff education is necessary.This includes
highlighting and keeping current theinterdependencies between each
of the departments -facilities, clinical, support services, etc.
The plannedmaintenance shutdowns and construction/renovation
shutdowns provide excellent opportunities to highlightthese
interdependencies.
R e f e r e n c e s
NFPA 110, Standard for Emergency and StandbyPower Systems, 2002
Edition, Quincy, MA: National FireProtection Association (NFPA),
2002.
David Stymiest, Managing Hospital Emergency PowerTesting
Programs, American Society of HealthcareEngineering (ASHE)
Management Monograph, July 2003.
Environment of Care, Essentials for Health Care,Oakbrook
Terrace, IL: Joint Commission Resources, 2ndEdition, 2002.
Environment of Care, Essentials for Health Care,Oakbrook
Terrace, IL: Joint Commission Resources, 3rdEdition, 2003.
David Stymiest, Joining Forces Integrating Utility andEmergency
Management for Better Patient Safety, HealthFacilities Management
Magazine, April 2003.
David Stymiest, All Things Considered An EmergencyPower
Management Program Has Many Variables, HealthFacilities Management
Magazine, June 2003.
Scott Wallask, What To Do When The Lights Go Out A Guide to
Handling Power Outages in Health Care,Marblehead, MA: Opus
Communications, Inc., June 2001.
Hugh O Nash, Jr and Dan Chisholm, EssentialDistribution System
Disaster Preparedness GuaranteeingPerformance of Your On-site
Electric Utility, slides 5-6,Proceedings of the 39th Annual
Conference of theAmerican Society of Healthcare Engineering,
Chicago:ASHE, 2002.
David Stymiest, Anand Seth and Jack Dean, Managing theCost and
Impact of Emergency Power Testing Programs onHospital Operations A
Case Study, Proceedings of the35th Annual Conference of the
American Society ofHealthcare Engineering, Chicago: ASHE, 1998.
D i s c l a ime r
Although the author is a member of the National FireProtection
Association (NFPA) Technical Committee onEmergency Power Supplies,
which is responsible for NFPA110 and NFPA 111, the views and
opinions expressed inthis article are purely those of the author
and shall not beconsidered the official position of NFPA or any of
its TechnicalCommittees and shall not be considered to be, nor be
reliedupon as, a formal interpretation. Readers are encouraged
torefer to the entire text of all referenced documents.
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