September – October 2009http://pdm.medicine.wisc.eduPrehospital and Disaster MedicineMortelmans,Van Springel,Van Boxstael,
cuits.Indirect damage is the result of induction.The hugeelectromagnetic fields from a lightning strike induce volt-age and currents through conductors (wires and cables)inside of a building.Although these surge currents are lessintense than in direct strike,they are quite capable of dam-aging integrated circuits in computers and other electronicequipment.The stability of software applications,even withintact hardware,is very vulnerable to peak currents.Hospitals have become high tech institutions,dependingon ICT and electronics for diagnosis,treatment,and many aspects of their daily operations,making them extremely vulnerable,even to the indirect effects of a lightning strike.Apart from the physical damage,there also is a financialloss due to the extended suspension of normal activities.Animpact also can directly cause injury or death to patientsand personnel,not only from explosions or fires,but alsofrom side flashes from plumbing fixtures,telephones,andother appliances attached to the outside through conduc-tors.
The greatest risk in hospitals is posed by secondary damage due to malfunction of monitoring or vital supportsystems.Unforeseen interruption of critical interventions,as well as insufficient alarm systems,can cause serious problems.As with other events due to natural hazards,it is diffi-cult to preparefor a lightning impact.Lightning rods canbe used to divert a direct hit.However,even with a light-ning rod,up to 50% of the current willbe spread over dif-ferent conductive elements in the building.These majorenergy transfers create an induction problem on their own,so the lightning rod offers a false idea of security.
Protection against induction is even more difficult. Theoretically,aFarraday’s cage could isolate a buildingfrom external energy transfers.However,in real life,this isnot feasible.Apart from the costs of such a project,thebuilding remains dependent on cabling for power input.Italso would be illegal according to European guidelines thatstate that there should be no potential differences over out-lining walls of a building.
While planning newhospitals,one could use multiple groundings with an equal resistance,simulating a Farraday’s effect.
Ahospital’senergysupply is ideally provided by an underground cable network,reducing the risk for a direct impact.Grounded protectionof the cable willreduce the effects of induction.A high voltage break system can switch off your installations in amillisecond,which in turn can cause damage to criticalfunctions;use of an uninterruptible power supply unit cancope with this.Furthermore,there is no break system thatalways can prevent all energy transfer,certainly not in caseof a direct impact.Allcommunication lines in and out of the hospital should use fiberglass cabling,to prevent surgetransfer.Wireless technology can help in data transmission,but is morevulnerable to induction problems.In a hospital,electrical lines are required for power transfer to all equip-ment.In the case of existing hospitals,the costs will limitthe use of all preventive measures described above.A goodinventory of all connections from outside the building orbetween separate buildings is mandatory.All unused cablesand pipes (also water and heating) should be omitted.Thegrounding of all persistent conductors should be checked,and all conductors should be placed on the same potentiallevel toward the grounding.Surge protective devices can
—A few weeks later,the second hospital,which had436 beds,had a lightning strike on the premises during athunderstorm,causing problems due to induction.Allaffected installations had a copper (co-ax) cable connectionfrom outside in one way or another.The power supplies were not damaged.The surveillance cameras and theentrance control system (badge readers) went out of order,as did the fire alarm system.The patient attendance systemand the “code blue”resuscitation alarm buttons in the wardsceased to function.The CO monitoring system in theunderground parking lot was disrupted,as was the modemthat monitors the main oxygen tanks.The main problem was the failure of different communication systems.One of the two radios used for prehospital communication wentout,although both radios were connected to the sameantenna post and amplifier.A number of analogue tele-phone lines ceased functioning,but the digital linesremained functional.The public address system,the in-hospital radio,and the entrance and parking intercomsceased functioning.Another major problem was with soft- ware.Shortly after the impact,problems with the hospitaladministration system occurred,so no new patients couldbe introduced.Electronic patient files were unavailable andthe automated medication dispenser ceased functioning. These problems were solved by restarting the servers.Afterwards,there still were problems with the digital tele-phone center and failures of the network connections con-trolling technical support systems became apparent.There were no physical damages to patients or personnel.No localdamage from the direct impact on the compound wasfound.Total costs of the lightning strike wereestimated>50,000 Euros.Damage assessments in both hospitals were done by their technical support teams,as well as by their informa-tionand communication technology (ICT) specialists.Theassessments were done immediately after the first problems wereencountered.After inventorying the problems,a triage was done to set priorities for intervention.External con-tacts (suppliers,producers,and maintenance teams) weremobilized and emergency scenarios (e.g.,continuous open-ing of disrupted gates and doors) were activated.Repairs of non-vital structures took up to two months to complete.
Ajoint debriefing lead to the conclusion that we are ratherpowerless when confronted with lightning strikes.Availableprotective resources are limited,very expensive (especially inlowrisk areas),and cannot offer any guarantee regardingdamage control (see discussion).Business continuity plan-ning is mainly focused on the organizational level,includingback-up scenarios and well-prepared contacts/contracts with suppliers,producers,and maintenance teams.Structural damage to buildings,be it a hospital or any other structure,can be direct or indirect.
The direct impactof a bolt of lightning can rip through roofs,explode walls of brick and concrete,or cause fires by igniting combustiblematerials.The lightning current can be carried directly intoand through the building by power and/or data lines,as wellas through all conductive materials.This causes seriousdamage to electrical equipment,especially electronic cir-