Stephen PirainoDirector, Corporate Purchasing & Supply

Chain Einstein Healthcare Network

Disaster Preparedness for Supply Chain Management

Types of Emergency Situations

• Internal Scenarios• Damage to Facilities (Fire, Water Pipe Breaks)• Power/Utility Outages, IT Outages• Labor Action/Strike

• External Scenarios• Weather (Tornado, Hurricane, Flood, Snow/Blizzard)• Earthquakes, Fires, Mudslides• Mass Influx of patients (Plane crash, Vehicle accidents, Flu Pandemic)• Vendor/Supplier Issues (Long-term outages, out of business)

My Emergency Situation Experiences

• Earthquake: Long Beach, California: October 1, 1987

• Typhoon: Guam, Marianas Islands: January 10-12, 1988

• Plane Crash: Washington, DC, September 11, 2001

• Significant Patient Influx: Bethesda, MD: Spring-Summer 2003

• Susquehanna River Flood: Harrisburg, PA

Whittier Narrows (California) Earthquake

• Earthquake hit at 7:42am, October 1, 1987• 6.0 magnitude earthquake lasted about 20 seconds• Occurred on the Whittier fault which runs from Chino Hills to Whittier and

part of the larger Puente Hills fault which runs from just west of downtown Los Angeles to the Puente Hills area.

• Naval Hospital Long Beach located 17 miles southwest of Whittier (19 miles due south of Los Angeles)

• 9,000+ people displaced and over 10,000 buildings were damaged. Damage estimates in greater Los Angeles area was over $350 million.

• Over 500 measurable aftershocks occurred over the next few days.

Greater Los Angeles Area

Various faults literally surround the greater Los Angeles area. Each year the southern California area has about 10,000 earthquakes. Most of them are so small that they are not felt. Only several hundred are greater than magnitude 3.0, and only about 15-20 are greater than magnitude 4.0. If there is a large earthquake, however, the aftershock sequence will produce many more earthquakes of all magnitudes for many months.

Naval Hospital Long Beach, CA

• Located on a 65-acre tract, Naval Hospital, Long Beach was officially commissioned in February 1967. Initially, the hospital was a five-floor structure with a capacity of 350 beds.

• In September 1973 construction was completed on an additional inpatient tower with a capacity of 220 beds, a comprehensive outpatient care area and an administrative wing.

• Additional administrative and logistics support spaces in the first floor basement, orthopedic and general surgery units on the second floor, the OB-GYN services on the third floor -including a newborn nursery and alcohol rehabilitation service with 65 beds on the fourth floor.

Naval Hospital Long Beach, CA

Naval Hospital Earthquake Damage

• Outpatient Pavilion exterior was designed with virtually all glass panels, floor to ceiling.

• 80% of the glass was shattered• Administrative areas: 30% of windows shattered• 4th Floor inpatient alcohol rehab unit: air conditioning pipes in ceiling

ruptured leaving a foot of water on the floor • Inpatient tower in general ¼ of windows shattered• Facilities/Engineering concerned of possible major structural damage to

main carrying beams

Initial Emergency Response Actions

• Decision made to evacuate all patients• Set-up large tents on front lawn area of the hospital for protection from the

elements• Non-critical Bed-bound patients set on litters & litter stands• Critical patients evacuated by helicopter transport, others by ambulance

Initial Support Services Response

• Engineering/Plant Ops Director conducted building assessment for structural soundness

• Materials Management staff deployed disaster supply carts and planned for re-supply

• Purchasing Officer makes emergency buys for plywood, and construction materials to board up windows

Significant Advance Planning is NeededIt Could be Much Worse

Lessons Learned Long Beach Earthquake Future Planning

• Analyzing and evaluating the immediate and short-term actions of the evacuation and comparing the results in terms of evacuation times, training needs, transportation requirements and operational problems.

• Materials Management Disaster Supplies: review of breadth and depth of items, disaster carts, cart “mobility”.

• Disaster Supplies: Expiration Dates, Plan for Rotation with day-to day stock

Typhoon Roy Guam, Marianas Islands

• The only difference between a Typhoon and a Hurricane is the location where it occurs. In the Atlantic and Northern Pacific the storms are called Hurricanes; In the Northwest Pacific, South Pacific and Indian Ocean they are called Typhoons (or Cyclones)

• Typhoon Roy reached its peak intensity as a Category 4 equivalent obtaining peak winds of 135 mph on January 10, 1988. At this point the storm was located about 587 miles ESE of Guam

• The storm weakened somewhat over the next few days and made its closest approach on January 12th with the eye passing about 45 miles north of Guam (8 miles south of the island of Rota)

Typhoon Roy near peak intensityCategory 4 (Saffir-Simpson scale)

Path of Typhoon Roy

Damage Estimates

• Guam and Rota received moderate structural damage and extensive crop losses. On Guam alone, agricultural losses reached $23.5 million (1988 USD). Most structural damage was limited to broken windows.

• Rota (50 miles north) had the worst damage: At least 200 of the 450 of homes were destroyed and the remainder were damaged; 95% of the power poles fell on the island, resulting in severe disruption to daily life.

• 4 days earlier and 1500 miles to the east, severe damage was recorded on Ebeye Island where low-lying areas were inundated by waves between 20 and 22 ft. Approximately one third of the homes on Ebeye were destroyed by the storm. An estimated 3,500 people were left homeless as a result of Roy in the Marshall Islands.

• Guam has time to prepare!

U.S. Naval Hospital Guam(Situated on a cliff 140 feet above the Phillipine Sea)

U.S. Naval Hospital GuamHistory, Facts & Figures

• Hospital Opened in 1954 at this location (prior location was destroyed during retaking of the island in 1944)

• Average Daily census from opening to 1965 was 100 patients• Census Jumped to 300 starting in September 1965 with receipt of aero-

medical evacuated patients from Vietnam. Census routinely ran in excess of 700 in 1968 and 1969 due to continued influx of patients

• Additional buildings were added around that time to bring capacity to 1200 patients.

U.S. Naval Hospital GuamHistory, Facts & Figures

• After the draw down from Vietnam the hospital became quiet again, serving the 10,000 military assigned to Guam and their dependents, as well acting as a Veterans Hospital and the local trauma center.

• It was re-awakened in 1975 to care for the 100,000 refugees from South Vietnam in Operation New Life, in 1991 for the evacuation of the Philippines after Mount Pinatubo erupted in Operation Fiery Vigil, and again in 1996-97 during the evacuation of Kurdish, Muslim, Iraqi, Iranian, and Turkish people from Iraq in Operation Pacific Haven.

• In 1988 the building infrastructure still existed, but average daily census averaged around 100 patients

U.S. Naval Hospital GuamPlanning for Typhoon Roy

• Ahead of Roy's arrival in Guam, the military and the public was given sufficient warning by the local disaster preparedness team. An estimated 1,200 people evacuated to shelters across Guam and all flights to and from the island were canceled for January 12.

• Because of Guam’s transportation infrastructure, narrow roads, constructed of crushed coral and oil, driving on wet roads was normally hazardous and slippery with many accidents.

• Military housing was spread across the entire 30 mile island from Andersen Air Force Base on the northern tip, to the Naval Air Station mid-island, to the Navy Shipyard at the southwest at Apra Harbor

Map of Guam

U.S. Naval Hospital GuamPreparing for Typhoon Roy

• Because of the drop in barometric pressure associated with a typhoon, concern over pregnant women going into labor was significant.

• All pregnant women over 28 weeks were recalled to report to the hospital approximately 36 hours prior to expected arrival of the storm.

• Since most of these were active duty military or dependents and spouses may have had military responsibilities related to the storm, in many cases, minor children also accompanied the pregnant mom’s

U.S. Naval Hospital GuamMaterials Management Preparation Activity

• Logistics/Materials Handling actions to set up approximately 200 additional beds, and bedside furniture

• On Campus Warehouses approximately 4 blocks away housed “disaster crates” built on pallets

• Crates stored either bed frames, mattresses, furniture, or linens• Many forklift trips from warehouse to hospital loading dock• Resources were a challenge since local national civil service Materials Mgt

staff were home taking care of their own preparations

U.S. Naval Hospital GuamMaterials Management During the Storm

• Normal supply stocking/re-stocking of patient units

• Assistance with stocking of supplies and linens on “hotel units”• All staff assisted with provision of meal services in cafeteria

• “Last Minute” set-up of Executive Sleeping Quarters. (Military Housing Quarters were not “Typhoon-Proof”

• 48+ hours on site at hospital…off-time…sleeping conditions

Materials ManagementEmergency Planning & Considerations

• Lessons Learned past experiences & Scenario Impact on MM Ops• Internal Scenarios

• Damage to Facilities (Fire, Water Pipe Breaks)• Power/Utility Outages, IT Outages• Labor Action/Strike

• External Scenarios• Weather (Tornado, Hurricane, Flood, Snow/Blizzard)• Earthquakes, Fires, Mudslides• Mass Influx of patients (Plane crash, Vehicle accidents, Flu Pandemic)• Vendor/Supplier Issues (Long-term outages, out of business)

Materials Management Emergency Planning

• Do your management team and your staff, take part in regularly planned disaster drills?

• Do all your employees know your departmental and hospital/health system disaster preparedness plan and where the manual is available for reference?

• Does the hospital have back-up communication devices (2-way radios) in case of telephone and mobile phone outages?

• Do you have key suppliers disaster plans and multiple means of contact? • Med-Surg Distributor, Lab Distributor, Rx Distributor, Linen/Laundry

• Do you have emergency/disaster supply carts and are they regularly checked for expiration of supplies?

Materials Management Emergency Planning

• Are all Materials Mgt & Purchasing staff knowledgeable in manual operations (Internal Scenarios)

• Do you have manual/paper based (and Excel-based) files• Vendor Master (vendor names and contact info)• Item Vendor File (what vendors supply each item)• Item Master File (details of all products)• PAR Stock Master (Items, PAR location, Bin, and PAR quantity)• Inventory/Storeroom Master (Items and stock locations and stock

levels)• Consider “Bulk Order” of supplies for Weather Scenarios if JIT