Emergency Water Supply Planning

Hospital Water Quality Management

According to the American Hospital Association, about 36.3 million people are  admitted to U.S. hospitals each year. We don’t typically think a lot about the  availability of a resource as basic as water in medical institutions. But when there is  a natural disaster or an unexpected man-made event, the dedicated staff of these  institutions have it top of mind. Most hospitals keep back-up generators to handle  the power outages usually caused by hurricanes. They don’t necessarily maintain  an alternative water supply in case a water main suddenly breaks, or the power  outage from a hurricane lasts longer than their generator capacity. 

The risk to hospital patients during catastrophic events can be dire when the usable water supply is interrupted. A study on water sector resilience showed that “water  capabilities [for hospitals] are degraded 67% – 99% within two hours of water  service loss.” Water stagnation can spur the development of cyanobacterial toxins  that make the water undrinkable. Dialysis patients, who require large volumes of  water in the preparation of their hemodialysis fluids, risk being infused with harmful  microbiological contaminants. 

When the water supply to a major North Carolina medical facility was disrupted for  four days by Hurricane Floyd, the hospital lost use of its air conditioner, sprinkler system, and drinking water. Despite its external hook-up for an emergency water  supply, it still required the fire department to develop three 2,000-gallon dump  pools so it had water to pump. Even with this, the hospital was still unable to meet  its 300 gallon per minute demand. Toilets could not be flushed, patients could not  bathe, hands could not be washed, and food could not be prepared. Only  emergency surgeries could be performed.  

Emergency Water Supply Planning 

Source: Emergency Water Supply Planning Guide for Hospitals and Healthcare Facilities, p 22 

Both poor water quality and the lack of water pose serious threats to the lives of  hospital patients whose health is already compromised. With natural disasters  increasing in frequency and intensity in recent years, concerns across the country  have grown about hospital preparedness regarding water supply. In collaboration with the CDC and the FDA, the Centers for Medicare and Medicaid Services (CMS)  prepared an extensive document outlining mandates for emergency water supply  planning in hospitals and other healthcare facilities. 

In order to maintain daily operations and patient care services, healthcare  facilities need to develop an Emergency Water Supply Plan (EWSP) to  prepare for, respond to, and recover from a total or partial interruption of  the facility’s normal water supply. (CMS) 

The plan must account for consumption and critical care activities as well as  sanitary needs and equipment maintenance. In other words, it must explicitly lay  out the hospital’s procedures for maintaining potable water, meaning the water  must be drinkable and suitable for washing hands, preparing food, bathing, and  mixing fluids for dialysis and other medical treatments. It must also account for  water needed for sanitation, such as flushing toilets and cleaning floors. Finally, it  must ensure medical equipment, HVAC, hazmat, fire suppressors, sprinkler systems, etcetera continue to operate properly.  

This is a tall order for hospitals because it requires them to expand their in-house  staff with a team that has expertise in water quality management. Initial steps for  the team include conducting a water use audit plan per CMS guidelines, identifying  and isolating an emergency water supply source, and finally, formally drafting the  EWSP.  

While all of these require a serious commitment of time and energy, the analysis of  an emergency water supply alternative is perhaps the most demanding. To  accomplish this, the CMS recommends the team consult with the water utility  company and other authorities about the anticipated nature of the water outage,  and to be able to anticipate its duration. Scouting of nearby storage tanks, water  sources, water tanks, and water storage locations are also part of this crucial phase  of the plan’s development. The time commitment can be shortened with the help of  experts who already have extensive experience and deep knowledge of water  quality management and emergency water supply alternatives. 

Other EWSP Considerations

When, not if, a water main rupture or a strong hurricane disrupts the water supply,  the hospital must be ready to execute on the plan. Details of other activities and  considerations are below. Every EWSP team should build these into their plan and  keep them top of mind even during the emergency event.  

1. During an event, continuously monitor the hospital’s water quality to ensure  it does not become contaminated with bacteria.
2. During an event, apply the right products to the water needed to ensure it  remains potable.  
3. On a regular basis, ensure there is a sufficient inventory of chemicals and  other supplies onsite to treat water in order to avoid any water-borne  pathogens.
4. If you do not store onsite, consider your delivery capability for getting  supplies and chemicals onsite quickly.

Summary 

Hospitals are 24-7, 7-day a week, critical services operations. Missteps can mean  the loss of lives. Preparing an EWSP is daunting and executing on it is serious  business. Garratt-Callahan has been doing water quality management for over 100  years. We are an approved vendor for facility compliance with all CMS mandates  and we are ISO 9000 compliant. Please call us if you need help developing your  EWSP.