Professional Documents
Culture Documents
of at-Home Patients
For many of the growing millions who depend on home medical equipment, a power outage goes
way beyond the inconvenience most of us feel. It could be deadly.
It's an issue that snuck up on emergency officials as better medical treatments over the past decade
have helped more critically ill people not only survive but move out of nursing homes.
The Associated Press found emergency planners around the country struggling to find new ways to
identify people at risk before the lights go out, to ensure they will have the aid they need to survive
small outages or big ones.
How serious is the problem?
When ice downed electric lines in Epping, N.H., last month, police found 60-year-old Richard Lapoint
dead, hooked to his powerless oxygen machine. The town's rescue workers hadn't known he was
power-dependent.
In contrast, this is the advice from Idaho's Public Utilities Commission: "If someone has a power
requirement for life and health, the individual is responsible for coming up with their own back-up
plans."
To help people prepare, the Food and Drug Administration this spring plans to issue the first
checklist for device recipients to receive when leaving the hospital.
Emergency workers feel the clock ticking.
"It's incumbent upon us over the next 4 1/2 months, before we get into hurricane season again, to
have a better plan than we had going into Ike," said Terry Moore, Houston's deputy emergency
management coordinator.
Under consideration are mobile "charging stations" that could rotate through Houston
neighborhoods for patients to recharge depleted batteries, or perhaps evacuating the powerdependent.
"This is a huge vulnerability," added Dr. Lewis Rubinson of the University of Washington, who
advises the government on disaster preparations and separately is preparing guidelines for
emergency oxygen supplies. "This is something that patients should demand."
It's a growing population. Roughly 2 million people use home oxygen machines, mostly
"concentrators" that make oxygen on the spot as long as electricity flows. Just a few years ago,
oxygen-gas tanks that don't require home electricity were the norm.
At least another 10,000 people breathe with home ventilators, and thousands more have implanted
heart pumps called VADs, or ventricular assist devices.
There even are a few remaining users of those body-encasing iron lungs infamous from the polio era;
Moore counts 19 in Houston-area homes. Last May, a Tennessee woman who spent nearly 60 years
in an iron lung after childhood polio died when the power went out and her family couldn't get an
emergency generator working.
Millions more use other at-home equipment: dialysis machines, nebulizers, IV and nutrition pumps,
CPAP breathing masks. But power failures bring the most immediate risk for users of ventilators,
heart pumps and oxygen.
Ventilators and heart pumps have internal batteries that last 45 minutes to a few hours, time to put
on longer-lasting batteries or get to help. Some portable oxygen concentrators can run on batteries
for three hours or four hours or be plugged into a car adapter, but patients typically depend on
oxygen suppliers to deliver old-fashioned tanks of the gas for emergency use.
No one knows how often a power outage means death for such patients. Typically, death certificates
note just the underlying disease, said disabilities specialist Lex Frieden of the University of Texas at
Houston, who tried to track down the power-dependent during Ike's prolonged outage to see who
needed help.
Back-ups sometimes fail even in short outages.
Last summer, 15-year-old Fernando Vargas died when a Boston power outage silenced his ventilator
early one morning.
The 2003 Northeast blackout, the nation's largest power failure, was a wake-up call for New York
City's Prezant. In a study published in the journal Critical Care Medicine, Prezant tracked citywide
911 calls plus emergency room visits at his own large hospital, Montefiore Medical Center, during
the nearly 29-hour blackout.
The falls and heart attacks doctors had expected didn't materialize. But paramedics and the ER had
a surge in patients with at-home oxygen, ventilators and other respiratory equipment who needed
help or feared they soon would. Moreover, frail patients often were admitted to the hospital because
doctors couldn't be sure a power failure was the only problem, a huge expense fraught with the risk
of medical errors, said Prezant, a lung specialist.
When it comes to oxygen, many home health-care companies "bend over backward" to race tanks to
customers during power outages, noted Washington's Rubinson. In fact, after Hurricane Katrina, the
American Association for Home Care asked the government to designate oxygen providers as "first
responders" for easier movement in disaster zones.
Medicare requires home oxygen suppliers to have customized emergency back-up plans for
customers.
But if roads are impassable or the disaster's too big, home oxygen may not be delivered.
Yet there are no overarching recommendations on how many back-up tanks patients should keep on
hand. Nor is there agreement about home generators, which have their own risk deadly carbon
monoxide poisoning if operated wrong and can't always adequately power energy-hogging medical
equipment. The FDA isn't advising generators in its patient checklist due out this spring, and the
disabled often can't afford one.
But the AP survey found utilities frequently advise generators, such as Wisconsin utility We
Energies, which also doesn't keep a list of power-dependent customers.
"There's a danger to keep the list and give a false hope you might be able to turn that power on
sooner," said company spokesman Brian Manthey. "We feel more comfortable telling people you
need to have a back-up plan," including generators or batteries.
Whatever a family's back-up plan, Rubinson and Prezant stress that local emergency officials must
know how many power-dependent patients they might have to rescue, and getting utilities and
home-care companies to share customer lists is a good start.
That's happening in northern Arizona. In Coconino County, home of Flagstaff, the emergency office
gets a regularly updated medical-priority list from the state's largest utility, and records GPS
coordinates for those homes so they can be found fast.
"We probably don't have 100 percent of everyone. There are people who slip through those cracks,"
said emergency planner Sherrie Collins.
Federal patient-privacy rules limit sharing, cautioned Bill Desmarais, a co-owner of Home Care
Specialists Inc. in Haverhill, Mass., which had about 800 oxygen-dependent customers using back-up
tanks when last month's Northeast ice storm cut power.
He does a home-safety assessment for new customers and offers a tank in advance, to keep for
emergencies. Such tanks can be over 4 feet tall, weigh 80 pounds, "they're green and they're ugly,"
Desmarais said. "A lot of people don't like it as ornaments in their living room. ... You can't force
them."
Even the federal government was surprised by the demand during Hurricane Gustav, when nearly
1,400 people were housed in special medical shelters in Louisiana and Texas, 20 percent to 40
percent of whom required powered medical equipment. When generators failed in Baton Rouge
shelters, an oxygen supplier hired to refill patients' oxygen tanks couldn't keep up with the
unanticipated need.
"We had some nervous wringing of hands as some of the oxygen tanks started going down to low
levels," said Dr. Allen Dobbs, chief medical officer of the National Disaster Medical System although
enough eventually was found. "We have to have reliable contingency back-up plans for these folks."