BLACKOUT

After the lights went out, Marty Maduro, a Medigas customer service representative in Newmarket, Ontario, rigged his location's phone system to run off his car battery. “This enabled us to keep an open dialogue with our clients and continue to call everyone on our disaster list,” says George Ristevski, president of Medigas parent Praxair Healthcare Services, based in Danbury, Conn.

After the lights went out, Rochelle Arini-Monza, an Apria Healthcare branch manager in Troy, Mich., worked from her car and took orders by candlelight so drivers could be dispatched. Ryder Trucks faxed a list of fuel locations and set up a special account for the company's Michigan branches in case gas was needed.

After the lights went out, Zeb Pirzada, CEO of Medstar Surgical in College Point (Queens), N.Y., worked from a paper log of his critical patients. He and his staff contacted drivers by Nextel radios to get them on the road. As some lights in New York came back on the next morning, “we were already there delivering oxygen,” Pirzada says. He adds that the company not only took care of its own clients but assisted competitors' customers as well.

The Blackout of 2003, the biggest in U.S. history, began on Thursday, Aug. 14, eventually covering 9,600 square miles and leaving 50 million people without electricity in eight states and parts of southern Canada. National, regional and local providers alike sprang into action when the power went off. While independent dealers attempted to keep customers comfortable and secure, their efforts were hindered by the loss of phone service. Larger providers put emergency procedures into play and coordinated resources across the area.

“Literally, tens of thousands of Apria patients on oxygen, ventilators, apnea monitors, infusion/enteral pumps and nebulizers were without power,” says Lisa Getson, executive vice president, business development/clinical services for the Costa Mesa, Calif.-basedprovider. “Over 50 of our own branches and infusion pharmacies and their employees were personally affected, yet they pulled together in the crisis and no patient care issues resulted at all.”

Here at HomeCare, we received similar reports from our readers by phone, e-mail and letter telling us of providers' overwhelming response to the blackout. Their actions, all praiseworthy, prove that HME providers are not afraid of the dark — and they can operate in it, too. Here are just a few of their stories.

More Than a Battery Backup

Drew Devlin, director of clinical services at Landauer Metropolitan Home Care in Mt. Vernon, N.Y., found himself calling customers on the company's analog fax line when overloaded digital lines wouldn't go through. The company kept tabs on its ventilator patients, especially those on high-liter-flow oxygen. If the company couldn't reach a patient by phone, it dispatched a driver for a visit.

Jeff Josephs, one of the provider's respiratory therapists, had particular concern for a patient recently discharged from the hospital and in the midst of transitioning home. “Jeff didn't say, ‘Here's your battery backup,’ and leave,” Devlin says. “He stayed with the patient a good three or four hours” assessing the situation and, in the end, helped transition that patient back to the hospital.

Well-Rehearsed Plan

Associated Healthcare Systems, an HME provider with nine locations in the state of New York, had a customer-service hub without power, but the company did have a well-rehearsed emergency plan.

“First, we made sure we got in touch with our branch staff,” says Peter Storey, vice president, though contacting them was not easy. Many offices lost phone service, and the cell circuits were overloaded. “All of the patients' calls come [to our customer-service center], and luckily we have a backup power source for our phone system,” he continues. Once contact with the branch offices was made, “we made sure [the branch offices] called in to us every 15 minutes so we could let them know of any local patient issues they needed to take care of.”

Each branch office maintains a priority-customer list that includes ventilator patients. In the case of a power outage, “we're proactive and call all of those patients first, so they can switch over to their backup battery,” Storey explains, adding that the company also “made a lot of deliveries [Thursday] night to patients who expressed concern about getting low on oxygen tanks.”

As another precaution, the company's trucks are equipped with liquid oxygen reservoirs “so we can provide liquid oxygen without having to go to an oxygen supplier,” Storey says. Despite these preparations, the evening of Aug. 14 was a tiring one. “Our people stayed on the phones until about 8:00 p.m. until we were sure the call volume had died down.”

A Night at the Office

One of Oakwood Home Medical Equipment's bio-med technicians spent the night at the company office, sleeping on a hospital bed.

He wanted “to make sure we did not miss a single patient,” says Marlene Adams, reimbursement director for the Allen Park (Detroit), Mich., provider.

“We handled approximately 287 patient calls from 4:30 p.m. Thursday through midday Friday. We triaged our patients based upon immediate need, and our service technicians worked around the clock Thursday through Saturday … [They] delivered to apartment complexes with non-working elevators and walked up as many as 12 flights of stairs carrying heavy tanks to patients in need.”

As some other providers, Oakwood also helped service the home patients of other companies. “Apparently, many called the only company they found open,” Adams says. “The Blackout of 2003 proved many things. Our electrical transportation system and policies may be outdated, but our customer service policy certainly is not.”

Michigan Convoy

Fourteen Apria drivers left from parts of Indiana and Michigan to support the provider's Troy, Ann Arbor and Harrison Township locations.

“There were about 1,500 oxygen patients who needed our help, and they were grateful when we got there,” says Dwayne Hargis, regional vice president of operations for the company's Twin States region, which covers Michigan and Indiana. “We all left Indiana not knowing whether we would have a hotel or not, but we were prepared to sack out on the floor of the Ann Arbor branch,” using sleeping bags and mattresses from the warehouse if need be.

“After working a 14-hour day, the Michigan delivery professionals were relieved and grateful to see their compatriots from Indiana show up to take over their routes for the rest of the day and night,” adds Andy Wagner, Apria's Twin States regional logistics manager. “Every single manager in our region volunteered to go to Michigan.”

Keeping Going to Keep Oxygen Flowing

During a power outage, home respiratory patients rely on backup cylinders. If the failure lasts too long, though, it can mean trouble, so doctors often recommend patients go to a hospital.

However, because the blackout affected such a massive area, “the volume of patients exceeded the hospital supply, requiring us to implement a plan for emergency deliveries,” says Bill Bryce, general manager of hospital services for Praxair. “Because the blackout occurred at the start of the weekend, most of our supplies were already committed. Our operations department did an excellent job moving inventory around the Northeast, making sure we kept not only our home care patients supplied, but also our hospital customers, to help them deliver oxygen to patients without power.”

In Canada, the company's St. Hubert (Montreal), Quebec, plant, unaffected by the blackout, “went into high gear, filling oxygen cylinders through the night,” says Bill Beckett, operations manager. “Trucks shuttled empty cylinders to the plant for refills, and dropped off full cylinders at our Medigas locations throughout Eastern Ontario.”

Answering Calls Around the Clock

At Detroit Oxygen and Medical Equipment, staff members stayed the night to make sure patients' needs were met. For five days around the clock, employees in the office — not an outside answering service — handled the phones, which still worked, along with lights and other necessary equipment, thanks to the company's generator.

Because most of the company's oxygen patients have backup systems in their homes, this reduced the number of oxygen visits required immediately. When patients called to let the company know they were using their backup system, each call was documented, and all of those patients received a follow-up call within 36 hours.

“From delivery technicians carrying a 150-pound oxygen tank up several flights of stairs, in the dark, to our accounts receivable specialists who answered patient phone calls and delivered equipment to hospital systems, our staff succeeded in every way possible,” says Julie Johnson, COO of the Warren, Mich., provider.

“It was clear to us once again that our company is comprised of the most caring and selfless individuals anywhere. It was an amazing team effort. [Our company] philosophy is to provide high quality service to our patients and referral sources. The 2003 blackout did not change our philosophy; it only proved our commitment to our patients.”

The same can be said for so many HME providers who went above and beyond when the power went out. During one follow-up call at Detroit Oxygen, a staff member asked, “How are you today?” The patient replied, “Still breathing, thanks to you.”

Emergency Plan Should Improve Every Time

“Not many industries have clients on [oxygen] concentrators,” says Zeb Pirzada, CEO of Medstar Surgical, College Point, N.Y.

As well, HME providers often must manage life-supporting equipment over a wide region. Such circumstances make proper emergency response vital. Check the following specific tips from some of the providers in this article to help improve effective emergency response for your company.

• Learn from every emergency. Companies should periodically review emergency procedures. At no time is this more important, though, than after an emergency occurs. After the blackout, Drew Devlin, director of clinical services at Landauer Metropolitan Home Care, Mt. Vernon, N.Y., held a meeting to analyze what happened and how the company responded. Although the emergency plan performed extremely well, Devlin made suggestions for improvement — a wish list, so to speak. For example, he considered an upgraded emergency generator system that “could power us without making us blink,” he says. He analyzed the phone system, much of it digital. Should the company have more analog lines? Essentially, the company considered everything “from priority equipment on down,” he says. This means that after each emergency, the provider stands better prepared for the next.

• Back up backups. To complement existing paper and digital files, you should always have a computer backup, Pirzada says. During the August blackout, four of his company's computers did not “wake up” when power resumed the next morning. “God forbid a fire should happen,” he says. “Take that [backup] tape home. You never know.”

• Manage staff fatigue by setting up emergency shifts, such as 12 hours on and 12 hours off, advises George Ristevski, president of Praxair Healthcare Services, Danbury, Conn.

• Be prepared for utilities to go down. “When possible, keep delivery trucks fueled and liquid oxygen tanks full at the end of the day,” Ristevski says. Also, keep flashlights and batteries well stocked. According to Devlin, “It's hard to find street addresses at night [during a blackout] without them.”

• Make sure local utilities know your company is a priority. Julie Johnson, COO of Detroit Oxygen and Medical Equipment Co., Warren, Mich., has her company listed with various vendors — including the oxygen supplier, gasoline supplier and, of course, all utilities — as a priority account.

• Proactively contact hospitals to inform them how you are handling the situation, says Ristevski, and what to tell clients if they contact the hospital. Most importantly, “find out the contact person in your local hospitals before any potential crises occur,” he says.

• Garner community cooperation. Developing mutual aid plans with various community resources, including the fire department, can only improve a provider's emergency response plan, Ristevski says.