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Author Topic: Bellevue hospital staff says they wish they had walkie-talkies  (Read 12608 times)
KD8CGF
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Posts: 39




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« on: November 01, 2012, 08:34:31 PM »

http://www.nytimes.com/2012/11/02/nyregion/at-bellevue-a-desperate-fight-to-ensure-the-patients-safety.html?hp&pagewanted=all
At Bellevue, a Desperate Fight to Ensure the Patients’ Safety - read the whole thing, this part was puzzling:
  From the moment the water lapped above street level in Lower Manhattan, the doctors and nurses of Bellevue Hospital Center began a desperate struggle to keep patients safe. By 9 p.m. Monday, the hospital was on backup power, and an hour later, the basement was flooded...“All hospitals are required to do disaster planning and disaster drills,” Pamela Brier, the chief executive of Maimonides, noted. “All hospitals are required as a condition of being accredited, to have generators, backup generators.”

City health department and emergency officials have been particularly fervent about citywide disaster drills, she added, but “as prepared as we think we are we’ve never had a mock disaster drill where we carried patients downstairs. I’m shocked that we didn’t do that. Now we’re going to.”...Despite the power problems, Bellevue was able to print out some medical records or get summaries from doctors to send with patients. But landlines and cellphones were affected, and doctors and nurses said they wished some other form of communication, like walkie-talkies, had been available.
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W2RWJ
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« Reply #1 on: November 05, 2012, 04:26:20 AM »

Doctors and nurses said they wished some other form of communication, like walkie-talkies, had been available.

I manage the communications needs for a Hospital.  I can tell you that our site has two independent repeaters, with significant battery backup.

We also have a large cache of commercial HT's for situations like this.  However, putting them into the hands of people who are used to cellphones would be instant mayhem and make the channel useless.

73 Martin Flynn
Disclaimer - Not speaking for my employer or the facility I am stationed at.

PS - Evacuating a hospital is going to negatively impact the most fragile (neonates, ventilator dependent, and post surgery cases).  I would bet the hospital administrators were holding out to the last minute hoping that power would be restored and they would not have to evacuate.






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KD0REQ
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Posts: 857




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« Reply #2 on: November 06, 2012, 09:13:31 AM »

number one... put the suits in the basement, and put the generators a couple floors above ground.  put the fuel tanks a floor above that.  if you can't do it in the hospital, dump a floor of parking, and put the generators one floor below top of the parking ramp.

number two... there needs to be at least one elevator that runs on emergency power, no matter what The Book says.

number three... main power distribution should not be below ground at all.

number four... the power transfer switches to emergency buss need to be the good ol' type with a huge manual lever for the task.

when I worked through the second college degree as a maintenance assistant in a hospital in North Dakota, we had half of it... #1 and #4.

now that we've had Katrina and Sandy, it's time for the accreditation folks to dust off their mimeographed sheets fading with age, and upgrade the requirements with, say, a 10-year maximum window to upgrade facilities.
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WA4D
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« Reply #3 on: November 16, 2012, 03:52:17 PM »

I find the post "Sandy" bellowing ridiculous.  "We need hand helds" they shouted.  "We need better communications!".
"Put the Generators on the Parking deck."  Now that we've done "Katrina and Sandy" we'll ready with a whole new set of "best practices".  The rhetoric is  pathetic (though amusing)>

Gov. Cuomo wants $30 Billion for Post Sandy infrastructure repairs. That's $23 Billion more than the Feds were ready to give out. Still to be determined.    The good news is that New York and New Jersey are both states with deficits. (Yet, small timers compared to Calif.!)  They have not spent significant sums on "infrastructure" in  years.  And in the current fiscal climate they will not. New Jersey citizens are among the most heavily taxed in the nation. Yet their emergency response appeared to have been mediocre at best. What do they spend their money on? Like most states (Pensions for overpaid State retirees)

Government does not do anything very well. From FEMA to the Post Office. Or the IRS to the Military.  Ham Radio Emcomm enthusiasts love to embrace government and parrot their behavior.  They deserve each other!

Most hams don't waste their time on EmComm.  Nor shoud they.


mike wa4d.net
« Last Edit: November 16, 2012, 04:09:29 PM by WA4D » Logged
KD0REQ
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Posts: 857




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« Reply #4 on: November 17, 2012, 12:22:27 PM »

I presume WA4D doesn't have circuit breakers or fuses because they're a hokey government mandate, and his wires work just fine.  or sewer pipes, because they need inspection and occasionally gunk up.

fact is, stuff outside your control happens, like posts on these here interwebbie pipe things.  you can whine, panic, prepare some alternatives if it looks like a rough period is coming soon, or try to hide.  this thread is about options for #3.  you don't have to participate if you don't like it.

have fun on the air
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W2RWJ
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Posts: 176




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« Reply #5 on: November 17, 2012, 01:16:40 PM »

now that we've had Katrina and Sandy, it's time for the accreditation folks to dust off their mimeographed sheets fading with age, and upgrade the requirements with, say, a 10-year maximum window to upgrade facilities.

Scott,
The "accreditation folks" for most hospitals in the US is the Joint Commission or DNV.   They are preparing to adopt NFPA 99, Health Care Facilities Code (2012 edition)  This document has had a complete rewrite and addition of many things not previously addressed (IT and Communications as examples).  It also has changed from a "standard" to a "code"

Noncompliance means that you are not reimbursed by CMS (Medicare / Medicade ) and insurance.

My question is:  what if the hospital or system can't afford to relocate switchgear, generators, and other critical infrastructure?   Remember - Most hospitals are nonprofit organizations

Martin

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KD0REQ
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« Reply #6 on: November 19, 2012, 07:08:47 AM »

Martin, sounds like they either start a fundraising program or close up, based on the uprating of the standards.  and both are occurring as the standards of care and diagnostic costs are rising.  no insurance company pays for facilities costs now.

the basic method of upgrading at this point is fundraisers.  big parties for big money are becoming a necessary evil.  born and raised in Fargo, and the primary hospital/clinic system there was just taken over by a Sioux Falls operation, which is expanding rapidly on the benevolence of a regional multi-millionnaire.  they just had their first white-tie private event up there, and it raised a lot of eyebrows, something like that never happened when it was St. Luke's.  your best HSM suit was fine.

my preferred hospital/clinic complex here in the Twin Cities, downtown, has a very very active social net of the hoi polloi, which has resulted in five major facility additions in 10 years.  to get a "leaf" with your name on it in the lobby starts at 5 grand, and many are considerably over 100 grand.  these are the supporting players who don't get a wing named after them.

used to be different.  before the MRIs and dual-isotope cardiac stress tests that have saved my bacon several times, for instance.  I'd have been dust in the wind at 43 back in the simpler times.

ps -- around the house, I am referred to as the "safety nazi."  when I first read code books, it was when working part-time at a hospital to pay for the second college education, after all my TV hair fell out and the first career went fallow.  I see stuff around my projects from the "life safety" regulations.  so shoot me.
« Last Edit: November 19, 2012, 07:13:06 AM by KD0REQ » Logged
W2RWJ
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Posts: 176




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« Reply #7 on: November 19, 2012, 02:13:54 PM »

Martin, sounds like they either start a fundraising program or close up, based on the uprating of the standards.  and both are occurring as the standards of care and diagnostic costs are rising.  no insurance company pays for facilities costs now.

That's part of the problem:  Government says you need to meet standard XYZ or we are not paying you.  Government says you must provide care regardless of the ability of the patient to pay.   Government says that Dr. Smith can do the same procedure in his office, and not have to jump through the regulatory hoops that a hospital does.   And by the way, the patients that Dr. Smith won't see because they don't have insurance, you need to treat them as well.  

Two issues:
*   The flaw in reimbursement is that they (CMS and Insurance)  only cover the cost of the procedure itself, not the 1 million dollar operating room it was done in.  (Did you know that there are different ventilation requirements for certain procedures. Negative pressure vs. positive pressure operating rooms)
*   Fundraising gets harder every day as there are more charities with their hand out.  The local businesses who used to make a profit and give the local hospital a generous donation are gone.  

In the end, you are going to have no hospital in your community, or if you are lucky, one operated by a system with a dozen hospitals.   Look at the hospitals are insolvent, or teetering on closing.

Martin.

PS - NFPA member since 2004

« Last Edit: November 19, 2012, 02:19:28 PM by W2RWJ » Logged
KD0REQ
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Posts: 857




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« Reply #8 on: November 19, 2012, 03:50:31 PM »

heh, the insurance companies don't care if nobody provides services, as long as they have their annual contract check in hand from the corporations insuring workers.  this is one pre-existing condition that Obamacare doesn't cover Wink

answer?  uh, hmmm, ahhhh... testing 1 2 3... ah! -- St. Oopsie sends the CFO out twice a week for lottery tickets?
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KD0REQ
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« Reply #9 on: November 19, 2012, 04:11:36 PM »

consider halfway steps... what can you absolutely, positively NOT afford to lose?  what can you hack around to stay operational in a disaster, no matter how ugly it is to fix later?

take a common example, we'll call it St. Oopsie, 400-500 bed hospital building on a busy thoroughfare that gets flood scares but really only has experienced a couple flooded elevator pits historically.  there is a parking ramp across the street.  there is almost always a cage for maintenance stuff inside these tied-building ramps... couple tanks of gas, lawn mowers, one or two four-wheelers, assorted personal cruft that is not supposed to be in there but nobody growls because it's behind the uniform lockers.

let's be generous and say the HVAC plant is above ground someplace close, has the main power switchgear in there as well as boilers and pumps.

how does the power get to the upper floors? -- distribution frames, generally, copper buss separated with high-temp insulation, in protective covers.  some of it may come in large conduits.  there may or may not be safe switchgear, the master distribution for the hospital building itself may be in the basement, as will be air handlers that provide the pressure behind the heating/cooling coils for rooms and common areas.

you flood it, you lose the air handlers.  you can fake it with fans for a period.

you lose the basement, you lose the building master power.  but you can knock a hole or crack a window and put aerial cable into a floor, take apart the panelbus, and bolt the wires onto the lugs.

you lose water pressure, you can hack it for a while with a tanker truck and a fire pump, or with 5-gallon water jugs and a bunch of staffers' kids using hand trucks.

you can run on oxygen tanks, and most hospitals have backup tank service on 2500 psi manifolds backing up the big liquid tank system.

you are Stuck Outta Luck without electricity, even for evacuation.

nobody is going to put a drone into your lobby if you have the generators on the ramp instead of in the basement, and run a pair of 3 or 4 way drop lines into the building for a couple days, until everybody is out of there.

IMPHO, as long as pharmacy and power is above water, and you can put heat into the pipes in winter, you should be able to keep folks alive until you can evacuate them.  you live to collect your facility insurance and business-interruption insurance and fix the place.  and since it's all new stuff on another guy's dime, do it above water this time.

you COULD even install a parallel emergency set of lines ready to reterminate if you think ahead for relative chump change, a million or so.  this you can build into your next required upgrade with two or three former well-heeled patients' help.
« Last Edit: November 19, 2012, 04:15:19 PM by KD0REQ » Logged
W2RWJ
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Posts: 176




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« Reply #10 on: November 19, 2012, 05:46:00 PM »

It's not just flooding a hospital has to plan for.  Take a look at http://www.njha.com/ep/pdf/627200834041PM.pdf , pages 4-6.
 
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KO3D
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« Reply #11 on: March 01, 2013, 06:43:23 AM »

I totally agree. Part 97 says that amateur radio shouldn't be used to replace another radio service, such as public safety. Police, Fire, EMS, hospitals have huge budgets and can buy their own commo gear.

I remember the New Hampshire State Police buying a new multi-million dollar Motorola 800 MHz trunked radio system back in the 90s to replace their old VHF low system. Everything worked great, until the leaves came out in the spring. It was never used and they had to buy another multi-million dollar trunked VHF system a few years later. So much for the communications experts in government...




Government does not do anything very well. From FEMA to the Post Office. Or the IRS to the Military.  Ham Radio Emcomm enthusiasts love to embrace government and parrot their behavior.  They deserve each other!

Most hams don't waste their time on EmComm.  Nor shoud they.


mike wa4d.net
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LA9XSA
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Posts: 376




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« Reply #12 on: March 02, 2013, 01:59:37 PM »

That post contradicted itself something awful. On the one hand you don't want amateur radio operators to serve as backup communications, and that commercial band gear should be used instead, since government can supposdely afford that; but on the other hand you cite an example of commercial non-amateur gear failing, and the government is incompetent in its purchasing.

You realize that these are contradictory positions, when you hold them both categorically at the same time, right? There is much to be said about the sometimes lacking competence of government aquisitions, but that's a separate issue from whether or not amateur radio should be used as a fallback when all the other systems fail.
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K1CJS
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« Reply #13 on: March 03, 2013, 08:17:20 AM »

The issue was never IF ham radio should be used to replace comms when other systems fail--it is, rather, how much the users of 'other systems' should be relying on ham radio as a replacement/fallback system.  Ham radio has traditionally been a fallback, but the US government (pushed, no doubt by some ham radio organizations that shall remain nameless here) has taken on the position that ham radio should be incorporated into the actual communications infrastructure planning instead of remaining in the background as it traditionally was.

Now, instead of being a standby method, ham radio has got to fulfill certain goals and be rigidified and set into place with set training and methods.  It has stopped being a standby for "when all else fails" and now is being depended on for certain uses--but still as a volunteer communications method.

The disconnect between the planners who are mandating the changes and uses--and the doers who have to make the system work or lose funding, co-operation of federal agencies, or even more--is the root cause of all the arguing and disagreement.  What may look good on paper seldom works as well in practice, and that goes even when ham radio isn't even in the loop--just like the New Hampshire State Police found out with their UHF system.

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W2RWJ
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« Reply #14 on: March 04, 2013, 04:24:06 PM »

Now, instead of being a standby method, ham radio has got to fulfill certain goals and be rigidified and set into place with set training and methods.  It has stopped being a standby for "when all else fails" and now is being depended on for certain uses--but still as a volunteer communications method.

Just as a personal observation:  Some hospitals have chosen not to utilize Amateur Radio in their EP model, instead hardening their public safety communications equipment and other infrastructure. Both options meet the requirement of the AHJ.

73 Martin Flynn
W2RWJ
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