An emergency power (EP) sys-tem’s role in patient safety iscritical to hospitals and regula-tors. Each hospital EP system

must power what the health care facilityneeds, when and for as long as it needs it.That is a tall order and one that likely

will become more complicated as newrequirements and technologies increasethe demands on these systems.So, how can hospitals prepare for

these challenges? What measures shouldthey take? Of what dangers should theybe aware? These questions can beanswered by exploring and analyzing six critical areas of emergency powermanagement.

1 System reliabilityReliability continues to be one of themost important challenges in health carefacility EP systems. Needs are growing asbudgets continue to shrink. How do facili-ty professionals inspect, test and main-tain more with less operating funds? Howdo they meet more restrictive codes andstandards with smaller capital budgets? Tightening construction budgets results

in a focus on “Is it code-required or not?”Facility professionals often see the dispar-ity between code-required minimums andwhat it really takes to keep a hospitaloperating effectively. Some wish for tighter codes so they

will be able to argue for features theywant in their new EP systems, such astransfer switch bypass/isolation functionsand larger generator sets. Others argueagainst tighter codes because of highercapital cost, and because their operationalbudgets simply cannot afford the increas-ing emphasis on testing and maintenance.A strong groundswell also is buildingwithin the health care industry againstany code changes that are not supportedby sufficient empirical proof of value.Many concerns with EP reliability par-

allel the requirements found in the newcritical operations power systems (COPS)requirements that first appeared in the2008 version of the National Fire Protec-tion Association’s NFPA 70, National Elec-trical Code®.While many hospital power systems are

not necessarily classified as COPS, theCOPS requirements cover many issuesthat are important to EP reliability. Theyinclude: risk assessments; identifying haz-ards and undertaking hazard mitigationstrategies; performing documented loadtesting and documented maintenance;

commissioning new power systems; pro-viding surge protection and selective coor-dination; using bypass-isolation transferswitches; selective load pickup and loadshedding; keeping at least 72 hours of on-site fuel storage; providing means to con-nect portable generator sets; providingboth physical security and physical pro-tection; separating between normal powerand EP; limiting possible equipment loca-

tions; considering exposure to the 100-year floodplain; clear labeling; fire protec-tion; and many other requirements.The Joint Commission issued its “Sen-

tinel Event Alert, Issue 37: Preventingadverse events caused by emergencyelectrical power system failures” in 2006.Since then, many hospitals have per-formed an EP gap analysis that considerswhat is powered from EP and what is not.Moreover, many hospitals have per-formed vulnerability analyses and riskassessments of EP reliability. However,many other hospitals have not performedthese assessments.An industry ListServ has seen many

recent discussions about the pros and

cons of running a hospital’s generatorsweekly, including finding incipient fail-ures sooner vs. the impact of increasedcycling from more starts each month. Some states require it; many do not.

Some generator manufacturers recom-mend it. There are good arguments onboth sides of the issue, particularlyabout following manufacturers’ recom-mendations.

2 Maintenance and shutdownsHow many hospitals actually conductpower shutdowns to perform mainte-nance? What backup provisions areconsidered when equipment is de-ener-gized for maintenance? Safe electricalmaintenance requires turning off thepower, and with the changes in the2009 edition of NFPA 70E, Standard forElectrical Safety in the Workplace, therehas been an increasing focus on electri-cal arc-flash safety. How many hospitals keep their elec-

trical one-line diagrams updated toreflect current system configuration?Without updated documentation, howdo hospitals plan to manage internalelectrical failures effectively? There areparallels between activities required forsuccessful planned shutdowns andemergency management procedures forunplanned failures.Hospitals that are not fortunate

enough to have bypass-isolation transferswitches find it difficult to maintaintheir transfer switches, because doingso safely requires de-energizing thebranch fed by the switch. As a result,transfer-switch maintenance in those cases is often minimal at best.

3 Circuit breaker testingEmergency power circuit breaker exercis-ing requirements generally have beenenforced inconsistently in the past. How-ever, some Centers for Medicare & Medi-caid Services-contracted state organiza-tions have started enforcing these require-ments during surveys. This situation has caused consternation

for facilities that previously have not beenheld to them. The 1999 edition of NFPA99, Standard for Health Care Facilities,requires that the essential electrical sys-tem (EES) “main and feeder circuit break-ers shall be inspected annually and a pro-gram for periodically exercising the com-ponents shall be established according tomanufacturer’s recommendations.” Based on the EES definition, one might

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LEFT PHOTO COURTESY OF EMERSON NETW

ORK POWER; RIGHT PHOTO COURTESY OF CATERPILLAR INC.

READY FOR TOMORROWSIX CRITICAL AREAS OF EMERGENCY POWER MANAGEMENT

BY DAVID L. STYMIEST, P.E., CHFM, FASHE

Emerson Network

Power’s Liebert STS2

static transfer switch in

service at a health care

facility’s data center.

This switchgear from Caterpillar Inc. canbe configured for emergency generatorparalleling or emergency transfer and

load management.

Another impact of ongoing construc-tion and renovations is the impact on theloading that will be seen by the transferswitches and generators under worst-caseconditions, also known as peak demandloading. Because monthly load tests oftenare scheduled for low-activity times, loadtest readings usually do not represent realpeak demand load.Some state AHJs require that hospitals

know and report their existing EP peakdemand loading before modifications areapproved. However, most do not. Most hos-pitals do not have permanently installedmetering to facilitate that process. Thereare a number of approaches for accuratelydetermining EP peak demand loading. Some also have expressed concern not

only about not being able to predict EPload growth over years, but also after util-ity power has been off for days. Somehave reported that upon investigation,existing transfer switches and even gener-ators have been found to be overloadedfor worst-case situations. In fact, EP loadgrowth actually has surprised somehealth facilities after disasters occurred.

Substantial electrical system modifica-tions also could invoke the need to updateexisting electrical system selective coordi-nation studies and the corresponding arc-flash hazard energy analysis. Electricalsystems with poor selective coordinationcan have outages that are more extensivethan necessary. The selective coordination issue has

been and still is controversial, and someNFPA code-making panels have beenattempting to deal with it. HFM

David L. Stymiest, P.E., CHFM, FASHE, is a senior con-

sultant at Smith Seckman Reid Inc., Nashville, Tenn.,

and chairman of the NFPA Technical Committee on

Emergency Power Supplies. His e-mail is DStymiest@

SSR-inc.com. The views and opinions expressed in

this article are the author’s own and not the official

position of NFPA or any of its technical committees

and should not be considered to be, or relied upon

to be, a formal interpretation. Readers are encour-

aged to refer to the entire text of all

referenced documents and NFPA

members can obtain staff interpreta-

tions of the various standards by log-

ging on to www.nfpa.org.

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RESOURCES ON THE WEB

The resources below were used by theauthor to prepare this article.

National Fire Protection Association(www.nfpa.org) documents:• NFPA 70-2009, National ElectricalCode®, Article 708 — Critical OperationsPower Systems (COPS)

• NFPA 99-1999, Standard for HealthCare Facilities, paragraph 3-4.4.1.2

• NFPA 110-1999, Standard for Emer-gency and Standby Power Systems, para-graph 6-4.6

American Society for Healthcare Engi-neering (www.ashe.org) resources:• “Managing Hospital Emergency PowerSystems — Testing, Operation and Main-tenance,” David Stymiest, ASHE Manage-ment Monograph, July 2009

• ASHE ListServ

Health Facilities Management magazine(www.hfmmagazine.com) articles:• “Power Players: Finding emergencypower system vulnerabilities,” March2008

• “Shock Resistant: Preventing arc-flashhazards in the hospital setting,” October2009

• “Powering Down: An orderly process forswitching off hospital electrical equip-ment,” June 2004

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infer that the requirement for periodicexercising extends not only to the break-ers between the generator and relatedtransfer switches (which is the limitedscope of a somewhat similar 1999 NFPA110, Standard for Emergency and Stand-by Power Systems requirement), but alsothe life-safety branch and critical-branchcircuit breakers on the load side of thetransfer switch. Feeder breakers can befound in electrical distribution systemsdown to and including main breakers onthe lowest-level panelboards. But what about facilities in which the

generators are paralleled with the incom-ing utility service? In those situations,depending on the design, the power to theemergency loads might go through thehospital’s main switchboard. So, it is possi-ble that the requirement for periodic exer-cising might extend to most or all of thecircuit breakers in the higher distributionsystem levels. Facilities, therefore, shouldbe careful in system designs and boundarydefinitions or they may be in for a surprisefrom an authority having jurisdiction (AHJ).There has been some pushback about

this requirement from health facilitiesprofessionals who believe exercising(opening and closing) an EES circuitbreaker can cause substantial disruptionwithin the hospital.

4 Fuel oil storageAlthough many hospitals have more thanthe minimum required on-site storage offuel oil as a result of years of focusedemergency-management planning, those

intending to make changes in existing EPsystems or to install new EP systemscould be affected by the change in fuel oilstorage requirements in the 2010 Guide-lines for Design and Construction ofHealth Care Facilities. Whereas the 2006 edition required

only 4 hours of fuel storage, the 2010 edi-tion now requires storage capacity thatpermits continuous operation for at least24 hours. The required on-site EP fuel oilstorage capacity is different for differentstates, and is sometimes even differentdepending on the locality. Regardless of the on-site storage capac-

ity, hospitals continue to face the questionof how much fuel to have on hand andhow to manage that stored fuel oilaccording to NFPA 110 requirements.

5 Failure planningAs more clinical, support and infrastruc-ture-management functions become elec-tronic, the EP system importance contin-ues to grow. For instance, has the increas-ing importance of the electronic healthrecord been matched by equally robustcontingency planning for internal electri-cal failures?Hospitals should ensure that their inter-

nal EP component and system failure con-tingency plans are effective and that userresponses also will be equally effective.Most hospitals have failure procedures forgenerator failures. Many also have prac-ticed those procedures. If a generator failsduring a utility outage, there likely willbe clinical and support service impact.

Those protocols should be determinedand practiced as well. Other than generator failures, there

also can be such internal failures as atransfer switch or the critical branch riserin a patient tower. Transfer switches arecomplex electromechanical devices thatfail from time to time. Riser failures havebeen caused by events such as sprinklerhead damage or contractor core drilling.It is wise to have predetermined respons-es for these internal failures that couldhave severe impact on patient care.

6 Construction and modificationsWithout clear EP system branch markingand strong construction managementpolicies, it is easy for ongoing changes inhospitals to lead to improper connectionsof new equipment and modifications. Many hospitals find equipment con-

nected to the wrong branch (e.g., life-sup-port equipment connected to the life-safe-ty branch). Hospitals also report that theyare surprised to find red outlets that godead when normal power drops out. Sometimes such situations occur with

new construction or renovation projectsand could have been corrected with aconcerted commissioning effort. Some-times this situation is long-standing andthe culprit cannot be determined. Without an effort to field-validate the

existing EP system, these situations are hidden from view until an internal failureexposes them. At that point one can onlyhope that there is no negative patient-careimpact.

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Management

LEFT Five Cummins Power Generation generator sets — four gas and one diesel — installed at a hospital. RIGHT This paralleling switchfrom Generac Power Systems allows the main power leads of each generator to be connected together at a common point.

LEFT PHOTO COURTESY OF CUMMINS POWER GENERATION;

RIGHT PHOTO COURTESY OF GENERAC POWER SYSTEMS

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