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Preparing for Extreme Temperatures


Forrest scene with snow on the ground.

By Angela Murray, MSN, RN, Project Director

Heat is one of the most dangerous weather-related killers in the United States, causing hundreds of deaths every year.

Extreme cold can also cause deaths, especially in areas of the country where buildings and systems are not designed for such temperatures.

To prepare for temperature extremes—heat or cold—as well as storms, health care organizations need to assess the impact of a power outage and how the electrical grid system could affect their facilities.

Mitigation Checklist
With temperature events occurring worldwide, EM teams should start planning for extreme temperatures. A mitigation checklist is a great tool to get started.

Relevant considerations for organizations that have considered temperature extremes in their emergency operations plan include:

  • risk assessment related to extreme temperatures that could affect patients, visitors and staff
  • mitigating strategies related to temperature extremes in a hazard vulnerability analysis (HVA) (explained below in further detail)
  • installation of exterior connectors or adaptors for the attachment of portable emergency utility modules
  • monitoring protocols related to weather forecasts
  • coordinating with local EM or public safety officials to address alternate sources of power
  • pre-identified locations within an organization capable of providing continuous thermal comfort (heating and/or cooling)
  • processes for transfer or relocation of patients to areas capable of providing thermal comfort and, if necessary, evacuation
  • strategies for maintaining essential utilities such as electricity and heating, ventilation and air conditioning (HVAC) during and after the temperature extremes
  • protocols for monitoring air temperature, humidity and air movement during or after the temperature extremes
  • agreements with contractors for equipment such as backup emergency generators, portable air conditioning units, portable heating units, and so on

Hazard Vulnerability Index Analysis
The likelihood and impact of temperature-related power outages should be addressed in The Joint Commission’s required HVA.

Joint Commission accredited organizations must comply with the requirements set forth in state law and regulation as well as in the National Fire Protection Association (NFPA) Health Care Facilities Code (NFPA 99-2012). The requirements related to power outages, summarized and paraphrased here provide a framework for risk assessment and preparedness strategies:—Essential Utilities. Prior to declaring any emergency, an organization must assess whether it has the infrastructure to support electricity and HVAC.—Exterior Connections. For essential utility systems in Category 1 facilities only (and based on a facility’s HVA) an organization must consider the installation of exterior building connectors to allow for the attachment of portable emergency utility modules.—Emergency Generators and Standby Power Systems. Emergency generators and standby power systems, where required for compliance with NFPA 99-2012, must be installed, tested and maintained in accordance with NFPA 110, Standard for Emergency and Standby Power Systems.—Stored Electrical Energy Systems. Stored electrical energy systems must be installed, tested and maintained in accordance with NFPA 111, Standard on Stored Electrical Energy Emergency and Standby Power Systems. 

B.—Power Loss. In getting a facility up and running after a power loss, the first operational priority is clinical care, and the second is infrastructure.
When ordering backup generators, it is important to know the size needed and the method used to connect the generators to the facility. 

B.12.3.4—Activation of Emergency Utility Resources. Planning for a loss of utilities is essential. Organizations should evaluate their ability to be self-sufficient over a period of at least 96 hours, including the fuel they have on hand. An organization that has backup generators must establish how long it can operate on those generators if it loses electricity. Besides the above requirements, organizations should consider guidance (not a regulation) from the Occupational Safety and Health Administration (OSHA). To optimize the comfort of building occupants, OSHA’s Standard 1910.1000 recommends temperature control settings in the range of 68°–76° F and relative humidity control settings in the range of 20%–60%.

Relevant Joint Commission Standards
The Joint Commission’s EM chapter is designed to help our accredited organizations exactly manage these situations. 

Within the chapter, EM standard EM.02.02.09 states: As part of its Emergency Operations Plan, the [organization] identifies alternative means of providing the following: 

  • electricity and lighting 
  • water needed for consumption and essential care activities 
  • water needed for equipment/sanitary purposes 
  • fuel required for building operations, generators, etc.
  • medical gas/vacuum systems 
  • utility systems that the organization defines as essential (for example, heating and cooling systems)

There’s little doubt that more extreme weather events will occur in the coming years, but the right preparation can make all the difference in keeping operations running for your patients and staff.

Angela Murray, MSN, RN, is Project Director-Clinical at The Joint Commission. Prior to this position, she held several nursing roles in trauma and emergency departments at Chicago area hospitals.