EXECUTIVE SUMMARY

A hospital system’s experience with a severe water outage shows the value of emergency preparedness. The event was manageable because the system had carefully planned for such a crisis.

• Plan for the most common emergencies in any region.

• Work with local hospitals to share resources and coordinate a response.

• Practice how employees will respond to water shortages.


A Utah health system confirmed the value of emergency preparedness when it was faced with a severe water shortage after a wildfire. The affected hospital got through the crisis with relatively little effect on patient care because it had planned for the most likely emergencies in the region and pooled resources with facilities in a five-county area.

The events began on a Saturday morning when flash flood waters ran over the site of the recent Brian Head fire in Utah. The large volume of water running over the scorched earth overwhelmed and contaminated the spring water collection boxes that feed into the Panguitch, UT, culinary water system.

The city of 1,800 declared a “No Water Use” order for culinary water, which meant the water could not be used at all. Even boiling the water would not render it safe.

The 14-bed Intermountain Garfield Memorial Hospital, part of the Intermountain Healthcare system, relied on the city’s water supply. Once word of the water use order was received at the health system, its emergency preparedness team implemented its water disruption emergency response plan for the affected hospital.

Hospital Coalition Reacts

Because the duration of the water loss could not be predicted, the health system needed water filtration systems for the hospital in addition to shipping bottled water. Intermountain contacted the Southwest Utah Healthcare Preparedness Coalition, which includes healthcare representatives from five southwest Utah counties. Of the six participating hospitals, three are part of the Intermountain system.

The coalition plans for a wide range of crises and coordinates response efforts among the hospitals, says Steve Ikuta, BS, MEP, emergency management southern area manager for Intermountain Healthcare, based in Salt Lake City.

“Over the last eight years, we’ve been meeting on a regular basis to create those external partnerships, getting to know each other’s resources and what we have to loan or borrow during an incident such as this,” Ikuta says. “When I heard it was a ‘No Water Use’ order, I knew the coalition’s water filtration systems would be needed.”

Anticipating this kind of emergency, the coalition had used federal grant funds to purchase low- and high-density water filtration systems — models that can filter 60 gallons per hour and larger models that can process 720 gallons per hour. Because Garfield is a critical access hospital with a long-term care unit and an attached clinic, the coalition asked for both sizes from the hospitals that host them.

The coalition delivered the units to Intermountain Garfield Memorial, and they were operational by 3 p.m. of the day the water crisis began.

Water Supplied by Filters

By 3 p.m. Saturday afternoon, the filtration systems were fully hooked up, filtering water through a four-stage process. The hospital used the filtered water for drinking, handwashing, bathing, and food service operations.

“The health department was there, and we had water samples tested for chloroform and E. coli before we cleared it for use in the hospital, even though the manufacturer says the four-stage filtration system makes it safe to consume,” Ikuta says. “We took that extra step because we knew we had enough bottled water on hand to get by for 24 hours while we were waiting for the test to come back clean from the health department.”

To supplement the bottled water cached at Garfield Memorial, the Intermountain health system sent 150 one-gallon containers of water purchased from a local grocery store. Dixie Regional Medical Center in St. George, UT, the Intermountain hospital where Ikuta works, sent two pallets of 16.9 oz. bottles of drinking water — 2,880 bottles — which it stockpiled in its own emergency preparedness cache.

“We didn’t know if this would be a protracted incident or something that would end quickly,” Ikuta says. “It ended up going six days.”

Bottled water was used for drinking. Intermountain also delivered food service items including disposable plates, cups, bowls, and cutlery; dishwashers were not usable without the plumbed water supply.

A sister facility about 100 miles away, Intermountain Sevier Valley Hospital, supplied the hospital with clean linens.

Hand Hygiene Maintained

The affected hospital placed “Do Not Use” signs on faucets, showers, and other water sources throughout the hospital and even removed all the bedside drinking water containers, replacing them with bottles of water. The hospital’s public information department emailed all employees to explain the water restrictions and how to use the bottled water for handwashing.

Garfield Memorial borrowed portable handwashing stations from another hospital to set up throughout clinical areas of the hospital. They consist of a foot pump connected to a hose with a gooseneck end that is zip-tied to an existing faucet, Ikuta explains. The intake hose is put inside a one-gallon drinking water container or a five-gallon container of the filtered water.

“Our caregivers, patients, and visitors were still able to maintain hand hygiene using these systems and soap. They did that for the following six days,” he says. “On Monday we were able to provide our long-term care residents with hot water by hooking up the filtrated water supply to a portable propane water heater. The residents were able to take hot water sponge baths, which they loved because by day three they were already using the disposable hand wipes.”

Panguitch City lowered the “No Water Use” order to a “Boil Water” order on the second day, but the hospital still could not use the water supply and continued using only bottled and filtered water.

The order was lifted three days later, but before the hospital could restore regular water service, it first had to clean the hospital’s water system.

That required calling in an outside company to fully drain water out of pipes, fill them with chlorinated water, allow that to sanitize for several hours, flush out the system, and then test the water at locations in the hospital. That was accomplished within 48 hours.

Planning Pays Off

Ikuta says the entire emergency was handled as well he could hope for, and he attributes that to all the planning and coordination with other hospitals in the area. He strongly encourages hospitals to seek such partnerships.

“Back in 2013, we realized that since we’re in an earthquake-prone state, we could lose water, and so we needed these water filtration systems. We all pooled our money and purchased these water filtration systems, and five years later it was here and we got to use it,” Ikuta says. “It’s like paying your insurance premiums. You invest in it, and if you need it, it’s there to get you through this emergency.”

Practicing your response also is important, says Alberto Vazquez, MHA, FACHE, administrator at Garfield Memorial Hospital in Panguitch, UT. He coordinated the emergency response at the hospital.

“Now that we know it can happen, we practice our response more so that people are even more comfortable with it,” Vazquez says. “Practice with the equipment you have, the water filtration systems, the supplies you will use instead of using water. Get familiar with where everything is, and pull it out once in a while to use it and make everyone more confident when you do have a situation that requires it.”

SOURCES

• Steve Ikuta, BS, MEP, Emergency Management Southern Area Manager, Intermountain Healthcare, Salt Lake City. Phone: (435) 688-4145. Email: steve.ikuta@imail.org.

• Alberto Vazquez, MHA, FACHE, Administrator, Garfield Memorial Hospital, Panguitch, UT. Phone: (435) 676-1261. Email: alberto.vasquez@imail.org.