PREDICTING DISASTER

Jan. 1, 2010

 CONTINUING EDUCATION

To earn CEUs, see current test at

www.mlo-online.com
 under the CE Tests tab. The CE test covers all material in the Cover
Story section.

LEARNING OBJECTIVES

Upon completion of this article, the
reader will be able to:

  1. Identify characteristics of various types of disasters.
  2. Describe planning information to improve preparedness.
  3. Identify types of power supplies and how they are used.

Are we really
prepared for emergencies and/or disasters — natural or man-made?
Released on Dec.16, 2009, the 7th annual Ready or Not? Protecting the
Public's Health from Diseases, Disasters, and Bioterrorism
report
says, basically, that we are not. The report cites the nation's ability
to respond to public-health emergencies has serious underlying gaps —
gaps brought to light during the H1N1 flu outbreak. The report also
points to the ongoing economic crisis as straining “an already fragile”
public-health system.1

The Ready or Not? report says a “Band-Aid”
approach to public health is inadequate. Key infrastructure concerns
highlighted by the study were lack of real-time coordinated disease
surveillance and laboratory testing, outdated vaccine-production
capabilities, limited hospital surge capacity, and a shrinking
public-health workforce:

  • More than half of the states had experienced public-health
    funding cuts and a 27% cut in federal preparedness funds since
    FY2005, which “puts improvements that have been made since the Sept.
    11, 2001, tragedies at risk”;
  • Not one state received points on all 10 indicators;
  • Eight states tied for the highest score of nine out of 10:
    Arkansas, Delaware, New York, North Carolina, Oklahoma, Texas,
    Vermont, and North Dakota;
  • With three out of 10, Montana scored lowest;
  • 14 states do not have the capacity in place to assure the timely
    pick-up and delivery of laboratory samples on a 24/7 basis to the
    Laboratory Response Network, or LRN;
  • 11 states and Washington, DC, report not having enough
    laboratory staffing capacity to work five 12-hour days for six to
    eight weeks in response to an infectious-disease outbreak, such as
    H1N1; and
  • among a series of recommendations for improving preparedness is
    a suggestion for public-health systems to reach out quickly and
    effectively to high-risk populations, including strengthening
    culturally competent communications around the safety of vaccines.
    Health disparities among low-income and racial/ethnic minorities,
    who are often at higher risk during emergencies, must also be
    addressed.1
Another disaster preparedness expert speaks out

At the National Center for Disaster Preparedness
at Columbia University's Mailman School of Public Health — which offers
resources to the nation's system of hospitals, public-health agencies,
clinics, law enforcement, and emergency services — Irwin Redlener, MD,
its director, speaks and writes extensively on national
disaster-preparedness policies, pandemic influenza, the threat of
terrorism in the United States, and other related issues, some of which
echo the recent Ready or Not? report — main among his relevant
points is that we have paid no attention to vulnerable populations like
the disabled and children.2 In fact, Redlener goes so far as
to point out that we have not yet defined what a “prepared America” is.2
And he strongly suggests that we have a failure of imagination in
disaster planning: “No one is asking how far the consequences of
disasters go.”2

Dr. Redlener's lectures include material from his
book, “Americans at Risk: Why We Are Not Prepared for Megadisasters and
What We Can Do Now,” authored in 2006, which lists several major points
regarding disaster/emergency preparedness. He mentions “communications”
as a major necessity for disaster/emergency preparedness. His example
emanates from the terrorist attacks on Sept. 11, 2001, during which
police officers on the ground could not communicate with the
firefighters who were in the higher floors of the World Trade Center in
order to warn them to evacuate the buildings. Redlener laments the loss
of 343 firefighters on Sept. 11 due to the simple fact that police and
firefighters did not have interoperable communications devices. Yet,
five years later, Redlener says the situation had not been resolved. In
the interim, he discovered that Hurricane Katrina's first responders had
the identical communications problem.2 Now, a little more
than eight years after Sept. 11, have we achieved any better measure of
communication among first responders?

Redlener points to the slow, steady degradation
in our governmental agencies such as the Federal Emergency Management
Agency (FEMA) which was, in the 1990s, the “government's crown jewel.”2
During and after Hurricane Katrina, Redlener claims FEMA's leaders had
little or no experience. The handling of Katrina, he says, was the
“ultimate reality show, 'Bureaucracy Gone Wild'” and “the level of
incompetency and functionality demonstrated by the United States to the
entire world in New Orleans was without precedent.” (FEMA is now housed
under Homeland Security.)2 Redlener claims “Achilles' heel”
of American disaster planning is its transportation and communications
infrastructures — and weak infrastructures complicate disaster
preparations, “making us vulnerable.”

Pandemic influenza

What about our preparations for a healthcare
surge during a flu pandemic? Redlener's commentary on preparedness
during the H1N1 flu season and potential pandemic, include his
example of hospitals full to overflowing. In New York City alone, a
flu pandemic could see 2 million of its 8.2 million citizens suffer
from the H1N1 flu, with 200,000 of those needing hospitalization. He
asks whether or not anyone has thought through the consequences of
this type of need in surge capacity.3

Disaster-preparedness expert, John M. Barry, a
prize-winning and New York Times best-selling author of five books
including “The Great Influenza,” answered that query in a September 2006
MLO
article: “Our penchant for just-in-time operations would have a
crippling effect on all institutions, but particularly upon those charged
with taking care of large patient populations suffering from influenza.
Supply-chain interruptions would wreak havoc, and few, if any, industries
have any 'surge capacity.'”4

Debating the flu

Throughout the latter
part of 2009, citizens nationwide debated the wisdom of getting H1N1
vaccinations; at the same time, vaccine producers — for a variety of reasons
— failed to meet established deadlines. In fact, an almost laissez-faire
philosophy about H1N1 permeated many communities. The one item that seemed
to rouse popular interest was a government announcement for employers: The
Centers for Disease Control and Prevention suggested that they develop
“flexible leave policies” so that employees with flu-like symptoms or with
family members with symptoms could use those without fear of losing their
jobs. Statistics from that 1918 flu epidemic did not seem to make much of an
impact on today's potential victims:

  • The 1918 flu pandemic killed about 675,000 Americans.5
  • The 1918 flu's high death rate hit 15- to 34-year-olds.5
  • The influenza epidemic came in three waves. The first wave, in the
    spring 1918, took far fewer victims than the second.5
  • People's indifference to the 1918 flu epidemic, both at the time and
    like today, led directly to the rapid and deadly spread of the disease.
    Many believed lethal epidemics were a common factor in their lives; at
    first, the flu seemed no different.5
  • Most people had already lived through at least one smaller-scale
    epidemic (e.g., cholera, yellow fever, malaria), so another incurable
    disease had little effect on those who had already survived one. Flu
    news paled in comparison to the news from the European Front during
    World War I.5
Terrorism threats

In the past year alone, we have had a sampling of
different situations that either threatened to or actually put
first responders, public-health professionals, and healthcare workers on the
front lines and/or at risk, and created potential problems and disasters for
others down the disaster-/emergency-containment line. When it comes to
terrorists, Redlener admits that America has some “tasty targets for
terrorists.”2 He pointed out in 2006 that in a national disaster
or emergency concerning disease spread or terrorist activity, we had no
plans for closing our borders. We still do not. Redlener recognizes Israel
as a good example of a country that is prepared because its citizens
actively practice their preparations for such eventualities.

Fire and flooding threats

Outside Los Angeles in September 2009, several
wildfires tore through the Angeles National Forest. The largest, the Station
Fire, burned more than 140,000 acres, destroyed nearly 100 structures, and
claimed the lives of two firefighters whose vehicle fell from a road into a
steep canyon. Evacuation orders affected thousands in and around the city.
6

A year ago in January, river waters spread over highways, farms, towns, and
parks in Washington, shutting down traffic on a 20-mile stretch of heavily
traveled Interstate 5 between Seattle and Oregon and threatening the federal
roadway north of Seattle. The risk of landslides also was high, leading to
closure of all passes across the Cascades.7

Shooting threats

The Fort Hood shooting incident in late 2009 came as
a shock to most people. Maj. Nidal Malik Hasan faces 13 counts of
premeditated murder and 32 counts of attempted premeditated murder stemming
from the Nov. 5 shootings at a processing center at the Fort Hood Army Post.8
For lab personnel, however, Nov. 10, 2009, may have been an even more
shocking incident.

As reported by The Dark Daily, in a suburb
near Portland, OR, a gunman entered a laboratory facility owned by Legacy
MetroLab, shot his estranged wife, then killed himself. Two other
individuals in the laboratory were injured, including a man admitted to the
hospital with multiple gunshot wounds.9

One other example of a shooting attack within a
clinical laboratory or pathology group practice took place on June 28, 2000,
when Rogert Haggitt, MD, professor of Pathology and director of Hospital
Pathology at the University of Washington was shot and killed in his office
by a pathology resident, Jian Chen, MD, who then turned the gun on himself
and died. Chen's contract had not been renewed. Chen had spoken to
colleagues at least 60 days earlier about purchasing a gun, and had been
offered but refused counseling.9

Because attacks like these are such a rarity, it is
difficult for clinical lab managers and pathologists to develop specific
contingency plans for such an event. On the other hand, these events are a
reminder that the unexpected can always happen. Thus, establishing a clear
emergency-response chain of command and protocols for all types of events
can prove invaluable when the need arises.9

Earthquake threats

A minor earthquake
rattled southeast Nebraska on December 17th but caused little damage and no
injuries. The U.S. Geological Survey (USGS) reported the 3.5 magnitude quake
struck two miles north-northwest of Auburn. Though not known for its
earthquakes, Nebraska has experienced several notable ones since its
founding in 186, the most serious a magnitude 5.1 quake in 1877 in the
east-central part of the state.10 The National Earthquake
Information Center reports from 12,000 to 14,000 earthquakes yearly or an
average of about 35 earthquakes every day.11

Conclusion

Not only have we heard the results of a notable
annual report and read the arguments of disaster/emergency experts,
throughout this section, Drs. Poutanen and Williams and Mr. Sharar share the
outcomes of their varied real-life disaster/emergency situations, each of
which resulted in lessons learned and incorporated into their institution's
preparedness plans. This is a new year, and new years typically begin with
some mighty resolutions. Perhaps 2010 is the year for a thorough evaluation
and upgrade of your laboratory's disaster/emergency plan(s), taking into
consideration the types of disasters discussed here. We predict that by
year's end we will all be better prepared, beginning now.

References


  1. http://healthyamericans.org/reports/bioterror09/
    .Accessed 12/23/09.

  2. http://fora.tv/2006/09/15/Irwin_Redlener#comments_section
    . Accessed
    12/23/09.

  3. www.youtube.com/watch?v=saM7iG_aKDg
    . Accessed 12/23/09.

  4. www.mlo-online.com/articles/0906/0906clinical_issues.pdf
      Accessed
    12/23/09.

  5. www.haverford.edu/biology/edwards/disease/viral_essays/redicanvirus.htm

    . Accessed 12/23/09.

  6. www.cnn.com/2009/US/weather/01/08/washington.floods/index.html
    .
    Accessed 12/23/09.

  7. www.cnn.com/2009/US/weather/01/08/washington.floods/index.htm
    .
    Accessed 12/23/09.

  8. http://www.foxnews.com/story/0,2933,578945,00.html
    . Accessed
    12/23/09.

  9. www.darkdaily.com/gunman-enters-clinical-laboratory-in-oregon-yesterday-two-dead-two-injured-111

    . Accessed 12/23/09.

  10. www.1011now.com/home/headlines/79467002.html
    . Accessed 12/23/09.

  11. www.crew.org/home/eqfacts.html
    . Accessed 12/23/09.
Why lab professionals should care about mass-fatalities planning

If your
disaster-preparedness plan fits on one page, it is not a
complete plan. Most preparedness-oriented medical or emergency
professionals would opine that, in general, disaster/emergency
planning is an underdeveloped asset — for hospitals,
laboratories, and communities — for many reasons: time (e.g.,
competing priorities; contemporary business; funding; politics
(regional, community, internal); lack of a functional
preparedness-organizational structure; and/or lack of a communal
belief that “it” could happen here and, therefore, a presumption
that preparedness planning is optional.

And mass-fatalities plans are (by anecdotal
experience) often overlooked; and if a plan exists, it often merely
states a location where decedents will be located, or states, “Get
refrigerated trucks.” The single most common, and egregious, error in
mass-fatalities planning is to think the plan only requires a place to
“keep the bodies.”

Second, labs (in hospitals) as well as
pathologists are the likely recipient of fatalities in plans-gone-bad —
they have personal incentives to appraise and promote improving the
condition of their facilities' plans. And the only way to appraise a
plan is to read it. A comprehensive forensic plan, which can provide
guidance for a much simpler hospital plan, can be found at
www.dmort.org/FilesforDownload/NAMEMFIplan.pdf
 (National Association
of Medical Examiners).

Third, in certain situations (i.e., pandemic
influenza), there will be no help from outside (DMORT) because everyone
will be affected — communities, states, and facilities will need to
respond locoregionally.

And fourth, good plans are highly
interdisciplinary, providing compassionate, secure, and respectful care
for both the living (relatives) and the deceased.

The two factors that can drastically reduce the expected
battery life are heat and allowing the batteries to become overly
discharged.

Those of us from the lab (anatomic pathology
manager, the cytologist who serves on the hospital DECON team, and I)
have been working with a hospital interdisciplinary team to update and
enhance our mass-fatalities plan — which is the proper term and means
how we will manage an unusual number of deceased persons. The Omaha
Metropolitan Medical Response System (OMMRS) created a Mass-Fatalities
Subcommittee several years ago — chaired by a forensic dentist who is a
DMORT member — to enhance planning for a mass-fatalities incident in the
Metro Omaha area. I became the informal facilitator and principal author
of the plan when our hospital Emergency Planning Committee was tasked
with upgrading ours. We did not have a decent plan (which is not
uncommon), but are now nearing finalization of a much more comprehensive
effort. We have received lively and extensive content input from ED,
DECON team, nursing, infection-control, safety, security,
maintenance/engineering, and lab personnel — so, to be sure, it is not
“my” plan. It was sent recently to the chair of the OMMRS
Mass-Fatalities Subcommittee for his input. The goal of the OMMRS and
our plans is to seamlessly integrate them as fully as possible.

While our Methodist Hospital plan is not perfect,
here are its contents thus far:

1. Overview

2. Policy statement

3. Authority for plan activation

4. Oversight of operations

5. When to activate the plan

6. Facility sites used for the plan.

7. Pre-intake (to morgue site) procedures during plan activation:

   7.1 Inpatient deaths

   7.2 ED deaths
   7.3 Pre-admission
deaths.

   7.3.1 Fragmented remains, decontamination of
remains, evidence.

8. Accessory morgue site operations:

   8.1 Laboratory/Pathology morgue (Site 1): Intake and
release, security, supplies and staffing,
       
movement of remains, site operations outline, site temperature
management, ordinary operations,
       
accessory site comments, occurrence management.

   8.2 Site 2: Site preparation and security, intake and
release procedures, supplies and equipment,
        
staffing, site operations plan, site temperature management, occurrence
management.

   8.3 Site 3: reference to Site 2 plans. Site 3
operations plan.

 9. Family Assistance Center

10. Conclusion of mass fatalities operations:

     10.1 Authority for deactivation

     10.2 Procedures for deactivation

11. Post-incident procedures and involved personnel behavioral
health assessment.

As for accreditation, there are many valid
preoccupations for labs, inspectors, and accrediting agencies today, and
I do not believe one can rely solely on the lab inspection process to
ensure emergency preparedness. Laboratory accrediting agencies should be
encouraged to adopt instruments exploring those more specific attributes
of preparedness, which a lab may have or lack. Some such preparedness
attributes have been explored in the CLSI (formerly NCCLS) Document
X4-R, Planning for Challenges to Clinical Laboratory Operations During a
Disaster; A Report, which, parenthetically is, being revised at this
time into a consensus document, GP-36 (exact title pending).

Participate in facility and community
emergency planning committees and training.

For example, your hospital emergency planning committee; Local Emergency
Planning Committee (http://yosemite.epa.gov/oswer/lepcdb.nsf/HomePage);
Metropolitan Medical Response System (www.hhs.gov/mmrs);
Citizen Emergency Response Team (www.citizencorps.gov/cert);
emergency communications (www.arrl.org
or

www.reactintl.org/public
); other. Disaster response plans are
local concoctions, and most preparedness learning and progress is
experiential — by preparing and planning with others. Participation is
number one! For example, a cytotechnologist in our lab is a DECON team
member and helped develop our institution's mass-fatalities plan; she
now knows an enormous amount about mass-fatalities planning in a
hospital, which was learned by the interdisciplinary process of
developing an actual plan. That knowledge is portable.

Peruse existing Web and print resources, which
can help guide and supplement the above.

The CLSI X4-R document was written specifically by and for
laboratorians, with expert reviewers, as an overview of non-analytic
challenges of disaster which can affect operations.

Promote preparedness, in a collegial/team
fashion, in appropriate professional and voluntary activities where you
have gained preparedness knowledge.

Practice personal preparedness
(self and family) is important and easy to neglect (www.ready.gov).

Bottom line: Everyone and every lab exists
somewhere on the preparedness spectrum. Whatever you have done — whether
nothing, a little, or a lot — that is your plan. When the unexpected
happens, no one is permitted to “opt out.”

—Thomas Williams, MD

Medical Director

Methodist Pathology Center

Methodist Hospital

Omaha, NE

Infectious-disease pandemic planning

The first case of severe acute respiratory
syndrome (SARS) appeared in November 2002, killing 800 people around the
world, including 44 in Toronto. Dr. Poutanen was a frontline healthcare
worker involved in the clinical, laboratory, infection-control, and
public-health response directed against the Toronto SARS outbreak.

We were involved in the response to SARS in
2002-2003. We learned many lessons from the experience, and we used
these as starting points for our influenza pandemic-preparedness plans
developed ahead of the H1N1 pandemic. This year, we were able to put
these plans into action when H1N1 arrived. The key lessons that were
useful in influenza pandemic-planning were:

Have a preparedness plan! We did not
have one for SARS and were forced to respond in real time. But we had a
plan before H1N1 was recognized, so we just had to “fine-tune” it for
H1N1 specifics.

Have a communications plan. Throughout the
H1N1 waves, efficient communication between public health and our lab
occurred primarily via e-mail lists, created as part of our preparedness
plans. Keeping in touch with public health was allowed us to how the
outbreak was unfolding in our community so we could respond accordingly.

Prepare for biosafety. Since SARS, our
hospital has had mandatory annual biosafety training, covering personal
protective gear and infection-control practices, with a focus on
pandemic preparedness. In addition, public health has had an educational
campaign focusing on practicing healthy hygiene. All of this helped
prepare our laboratory personnel so that it was easier for them to
follow tailored advice for H1N1.

Prepare for increased demands for testing.
We anticipated increase workload with respiratory testing and the need
for molecular testing as part of pandemic preparedness and trained many
staff. While we could have done more ahead of time, the measures in
place enabled us to efficiently respond to increased demand that
occurred with H1N1, including for novel investigational molecular tests.

Follow metrics in real time. We learned
quickly from SARS that following a paper trail of results did not result
in efficient data tracking. We had plans in place ahead of time to
develop real-time laboratory and hospital information system codes for
new tests, such that [this time] all results were available online as
soon as they were available.

Have psychosocial support. After SARS, as
part of pandemic preparedness, our hospital had a resiliency team speak
to every department, including our laboratory personnel, advising them
of resources available in the event that a pandemic or other emergency
evolved. Having these resources available ahead of time made coping with
a new emergency less daunting.

Have a preparedness plan! Going through
the motions for a possible emergency is key to being able to respond to
one. The plan will have to be fine-tuned to the specific emergency.

Be prepared to introduce new tests with little
notice
. Ensure you have the right resources (money, staff, and
space) to efficiently validate new tests as required, depending on the
emergency. Have dedicated persons who can efficiently validate tests,
write procedures, and train personnel accordingly.

Use bar codes, interfaces, and electronic
reporting
to free up skilled technologists from data entry and to
avoid data-entry errors.

The most important item that I would want to have
in case I was stuck in the lab during a disaster or an emergency?
Assuming I had access to food, water, and functioning toilets (which may
not always be the case), I would want to make sure there was adequate
and comfortable space to sleep. Responding to an emergency is
exhausting; being able to get sleep is critical.

—Susan M. Poutanen,
MD, MPH, FRCPC

Microbiologist/Infectious Disease Consultant

University Health Network

and Mount Sinai Hospital;

Asst. Prof. Dept. of Laboratory Medicine and Pathobiology
(Medicine, Microbiology) and Dept. of Medicine (Infectious Diseases)

University of Toronto

Toronto, Ontario, Canada

Quake shakes up California lab

The Northridge
earthquake occurred in Southern California in 1994, with Northridge
Hospital Medical Center located within a half mile of the epicenter. The
worst aspects of this disaster were disruption of water service and
having two countertop instruments fall to the floor, which remained
completely out of service for 10 days. A mess was created by all objects
from countertops and shelves that fell to the floor. The pathology
grossing area was a mess with spilled specimens and formalin. Various
pieces of equipment also moved from their original locations including
blood-bank refrigerators and other analyzers. Refrigerators had the
potential to topple over but did not, while filing cabinets posed a
significant risk of falling and potentially injuring personnel.

Lessons that we learned were to secure as much
equipment to the floor or counters as possible. Labs need to ensure they
have adequate utilities or backup (water supplies, emergency electrical,
medical gases). A disaster plan should include both short- and long-term
goals in case some or all testing cannot be performed. Provisions should
be made to send specimens to other labs or hospitals in case of an
emergency. Blood supplies may need to be relocated if operations are
compromised.

Our chemistry analyzers require water for
operation, so we stockpile an emergency supply of water — enough for a
week to 10 days — in case of another disaster. The hospital's
Engineering staff has portable air-conditioners in case of a failure
with the main air-conditioning or chilled water system. We also arrange
for outside electrical generators to be brought in case of a emergency
generator failure.

—Donald P. Sharar,
CLA, MT(ASCP)

Director of Laboratory Services

Northridge Hospital Medical Center

Northridge, CA

Uninterruptible power supplies keep the lights on in the lab

Plug in your
lab equipment, turn it on, and never lose power. This exclusive
MLO
interview with Mike Stout, VP of Engineering at Falcon
Electric provides valuable insight into how to keep the lab
operating even with “dirty power,” brown-outs, and power
outages.

MLO: Can you tell us when you began to
provide backup power to medical laboratories and why?

Stout: Falcon products have been sold to
medical laboratories for more than 20 years. Some of our early customers
were hospitals and clinical laboratories. The bulk of our
medical-oriented sales were through OEM customers, such as Baxter Health
Care, Beckman Coulter, and Wyeth, who bundled Falcon uninterruptible
power supply (UPS) equipment with their own electronic medical products.
With the advent of DNA sequencing, Falcon has also provided products to
many research labs. In fact, Falcon UPS products were used to protect
and back up the DNA sequencing equipment used for the Human Genome
Project.

Among Mike Stout's revelations, Falcon UPS products were used to protect and back up the DNA sequencing equipment used for the Human Genome Project, as well as the FBI Crime Lab and law-enforcement agencies around the world.

Further, we have supplied UPS units to the FBI
Crime Lab and law enforcement agencies around the world. In addition,
our voltage and frequency converters and UPS units are used by MIT
Lincoln Labs, Sandia and Los Alamos National Labs, Lawrence Livermore
National Lab, and CERN (the European organization for nuclear research).
Our voltage and frequency converters are utilized when the project calls
for the lab to deliver 230V/50Hz required for lab systems used overseas
or when the instrument, designed to operate at 120V/60Hz, is being sent
out of the United States and a converter is required.

The Falcon true double-conversion on-line UPS
provides a high level of power protection against the widest range of
power problems. The low-cost line-interactive, or “Smart UPS,” primarily
provides battery backup and has limited power-protection capabilities
for suppressing high-voltage transients. In addition, voltage regulation
can be poor. Basically, the utility power coming into these types of UPS
units goes through some surge-protection circuitry and then out to the
device. It is only when utility power is lost that a line-interactive's
inverter turns on and switches in. Due to the low cost of the typical
line-interactive UPS, the typical battery inverter output is a distorted
sinewave having a high level of harmonic distortion.

By contrast, the output inverter in our
double-conversion on-line UPS is operating continuously, both in AC utility
and battery modes of operation. The Falcon UPS converts the incoming utility
or generator power, filters it, and then rectifies it to DC. This removes
all of the unwanted AC frequency and voltage problems, including generator
frequency shift, voltage transients, voltage, and current harmonics. Once
the UPS has converted the incoming AC to DC, it regulates the DC voltage and
uses it to power our continuous duty insulated-gate bipolar transistor
(IGBT) pulse width modulated (PWM) inverter.

This provides an output with superior voltage
regulation (120Vac +/-2% domestic or 230Vac +/-2% European), even if the
utility power supplied to the UPS drifts by +/-15%. As a result, any voltage
sags and surges in the utility power are eliminated, along with most other
power problems. Should the utility power be lost, the UPS will simply start
to draw its power from the internal batteries without any switchover or
transfer required.

There are three basic UPS types, each offering more power
protection than the preceding: Off-line (SBS), the lowest grade; line
interactive (SBS), the middle grade; and on-line (UPS), the highest
grade.

The on-line UPS is like installing a “power firewall”
between incoming power and sensitive laboratory equipment — essential for
medical electronics, which often must be connected to outlets and circuits
shared by heavy-duty equipment that can corrupt the quality of utility
power. And, of course, medical gear is often most needed in times and places
that utility-power quality suffers, is interrupted, or goes away for
significant periods when the use of these instruments is paramount.

As the connected lab equipment is always receiving
optimum power conditions and voltage, the equipment accuracy, performance,
and reliability are assured, irrespective of the utility or lab outlet-power
quality. Seamless backup-power capability is a secondary benefit. Additional
battery banks may be added, providing up to several hours of backup.

MLO: Please describe your double-conversion
on-line UPS units in more detail. How do they differ from standby power
supply (SBS) units?

Stout: There are three basic UPS types, each
offering more power protection than the preceding: Off-line (SBS), the
lowest grade; line interactive (SBS), the middle grade; and on-line (UPS),
the highest grade.

When the battery runtime reaches 80% of the time recorded for
the first (installed) runtime test, the batteries should be replaced.

The off-line SBS offers bare-bones power protection
for basic surge protection and battery backup. Through this type of SBS,
equipment is connected directly to incoming utility power with the same
voltage transient clamping devices used in a common surge-protected plug
strip connected across the power line. When the incoming utility voltage
falls below a predetermined level, the SBS turns on its internal DC-AC
inverter circuitry, which is powered from an internal storage battery. The
SBS then mechanically switches the connected equipment on to its DC-AC
inverter output. The switch-over time is stated by most manufacturers as
being less than 4 milliseconds, but typically can be as long as 25
milliseconds, depending on the amount of time it takes the SBS to detect the
lost utility voltage.

The line-interactive SBS offers the same bare-bones
surge protection and battery backup as the off-line, except it has the added
feature of minimal voltage regulation, while the SBS is operating from the
utility source. This SBS design came about due to the off-line SBS's
inability to provide an acceptable output voltage to the connected equipment
during brown-out conditions. A brown-out happens when the utility voltage
remains excessively low for a sustained period. Under these conditions, the
off-line SBS would go to battery operation; and, if the brown-out was
sustained long enough, the SBS battery would become fully discharged, turn
off the power to the connected lab equipment, and not be able to be turned
back on until the utility voltage returned to normal. To prevent this from
happening, a voltage-regulating transformer was added; hence, the term
line-interactive was born. This feature really does help, as low-voltage
utility conditions are common. The downside for this design is that most of
the units available have to switch to battery momentarily when making
transformer voltage adjustments, and the associated switch-over voltage
transients may not be tolerated by many pieces of lab equipment, especially
those that are microprocessor-based or have a connected computer system. The
true advantage to the on-line UPS is its ability to provide an electrical
firewall between the incoming utility power and sensitive laboratory
equipment.

While the off-line and line-interactive designs leave
the equipment connected directly to the utility power with minimal surge
protection, the on-line UPS provides multiple electronic layers of
insulation from power-quality problems. This is accomplished inside the UPS
in several tiers of circuits. First, the incoming AC utility voltage is
passed through a surge-protected rectifier stage where it is converted to a
direct current and is heavily filtered by large capacitors. This tier
removes line noise, high-voltage (Hz) transients, harmonic distortion, and
all 50/60 Hertz (Hz) frequency-related problems. The capacitors also act as
an energy storage reservoir giving the UPS the ability to “ride-through”
momentary power interruptions. The battery is also connected to this tier
and takes over as the energy source in the event of a utility loss. This
makes the transition between utility and battery power seamless, without any
interruption.

The filtered DC is sent into the next tier, a
voltage-regulator stage. In the regulator stage, the DC voltage is tightly
regulated and fed to a second set of storage capacitors. The regulator stage
gives the UPS its ability to sustain a constant output even during sustained
brown-out or low-line conditions. The additional stored energy in the second
set of capacitors yields even more ride-through time without any battery
drain. The regulated DC voltage is next fed to the inverter stage where a
totally new 50/60 Hz, true AC sinewave output power is generated. This tier
gives the UPS a new, clean output with superior voltage and frequency
regulation, providing the ideal power source for laboratory equipment.

The on-line UPS can also provide other benefits like
frequency conversion for operating equipment designed for a 60-Hz utility
source on European 50-Hz utility power, or the reverse. The continuous duty
inverter also allows for the connection of large extended battery packs that
can provide up to several hours of backup time. In the case of a critical
process like DNA sequencing in a crime lab where only one DNA sample may be
available, this assures process completion in the event of long-term
utility-power loss. Only the on-line UPS can provide the level of voltage
regulation and power protection required by power-sensitive lab equipment.

MLO: Are the power quality and availability
needs of medical laboratories in other countries greater than those in the
United States, depending on where they are located?

Stout: Utility power in the United States and
Europe is typically much better than the power quality in developing
nations. Using this as a rule, however, is a poor measure of the power
quality inside any specific lab located anywhere in the world — including
the United States and Europe. One reason is localized power pollution often
being created by other equipment operating on the same lab power circuits,
which can happen anywhere. Large motors or other power-hungry devices in a
lab can create voltage sags, surges, and even high-voltage transients that
can disrupt the operation of sensitive lab equipment.

Also, many areas within the United States are subject
to power utility problems — sags, rolling brown-outs, even power outages —
due to seasonal conditions like a high rate of air-conditioning use during
heat waves. During the rest of the year, power-line problems often are
caused by snow and ice storms, hurricanes, tornadoes, and flooding. Other
causes of power interruption include accidents due to construction, vehicles
downing utility poles, or the ripple effect on the power grid from an event
that may be a thousand miles away.

That being said, developing countries' power can
present the harshest of power problems. Local power grids may be without
power for several hours a day. This is often the case in locations like Iraq
or Mexico City in the summer months. Voltage sags and surges may be
excessive, even destructive, beyond the operational limits of most lab
equipment. Differing countries have unique power problems.

To address these potential problems, Falcon's 230Vac
European models are designed with the widest input voltage range, typically
170Vac to 275Vac, while providing a regulated user-settable 208Vac, 220Vac,
230Vac, or 240Vac output. We can also provide battery-backup options of up
to several hours. In addition, we offer models with galvanic isolation
(completely separating the input and output) for use in locations where
grounding and common mode noise is a problem. In addition to our wide-input
range European models supplied to developing-world customers, we also supply
specialized rugged military systems in developing countries.

When the battery runtime reaches 80% of the time recorded for
the first (installed) runtime test, the batteries should be replaced.

MLO: What about oversight in foreign labs
regarding protecting refrigeration and other laboratory equipment?

Stout: Most medical labs throughout the world
attempt to meet either U.S. or European standards. Of course, some laws
change from country to country. In the case of vaccines, maintaining them in
a proper refrigerated environment is critical to their viability and, as
such, “universal” in nature.

Most UPS units are shipped with valve-regulated
sealed lead-acid, or VRLA, batteries designed for a typical five-year life.
The two factors that can drastically reduce the expected battery life are
heat and allowing the batteries to become overly discharged. If the UPS is
installed in an environment where the average temperature is 72^0, and the
charge is maintained, it should last the five years. Should the same unit be
installed in a 122^0 environment, the battery may only last about nine
months. Should the UPS not be plugged in for a period of six to 12 months,
the batteries may self-discharge down to the level where they cannot be
recharged and must be replaced.

In our SSG Series laboratory and industrial grade
on-line UPS, Falcon is the first to equip those with eight- to 10-year life
batteries. Again, at 72^0, these will yield an eight- to 10-year life; at
122^0, these batteries may last only four years. Both are a vast improvement
over the three- to five-year batteries. Allowing the batteries to become
overly discharged, however, will result in the same battery damage. Our SSG
Series UPS is UL Listed for operation in environments up to 55^0C (131^0F).

MLO: How can lab managers properly maintain
their UPS units to make sure their equipment will operate in a
disaster-recovery mode?

Stout: A UPS-testing plan is dependent on the
level or critical nature of the connected lab equipment and associated
process. In some cases, UPS testing may not be required. If the process is
critical, we recommend the following plan. When the UPS is first received
and connected to the lab equipment, allow the UPS to charge for 24 hours.
Next, with the equipment operating normally, disconnect the utility power to
the UPS, and use a stopwatch to record the amount of battery runtime until
the low-battery alarm sounds. Immediately reconnect the utility power to the
UPS. Record the amount of runtime in minutes and seconds on a label, along
with the date, and attach the label to the top of the UPS. Every four
months, conduct the 24-hour recharge and runtime test, and record the
results on the label. When the battery runtime reaches 80% of the time
recorded for the first (installed) runtime test, the batteries should be
replaced. Our website has a UPS tutorial and other information for those who
seek more in-depth details.

MLO: What are some common problems you see
in clinical labs' UPS units?

Stout: First, improper selection of UPS type.
Typically the lab purchases laboratory equipment based on its performance,
with cost being secondary. They will, however, purchase a $120 UPS to
protect a $50,000 piece of lab equipment with little research and without
regard for the UPS performance. Second, they have no battery-testing plan or
program. Third, improper installation of the UPS that does not allow for
proper cooling. This shortens both the UPS life and battery life.

MLO: Did your company have backup systems
in operation in New Orleans during Hurricane Katrina? If so, what was the
outcome for labs with UPS units there?

Stout: Falcon, along with most other UPS
companies, did have many UPS units operating in New Orleans during Hurricane
Katrina. The big problem experienced by hospitals and labs occurred after
the storm moved inland, and the city was flooded. Backup generators for the
hospitals and large labs were located in lower levels of the buildings,
below ground level. They were completely flooded and rendered unusable. This
left the facilities with no long-term source of emergency power, since the
UPS units installed were only intended to supply backup power for the
limited amount of time during the emergency-generator startup. Therefore,
the batteries were discharged during the first few minutes of the power
outage.

This incident led many government agencies to issue
new regulations specifying the installation of backup generators. These
generators must now be installed on roof locations in hospitals, in addition
to provisions implemented for mobile generator power connections outside the
facility to allow a mobile generator to be driven or flown in as a third
source of power to the hospital.

MLO: What challenges did/does Falcon
Electric as an organization face in developing its global business?

Stout: The Internet is the vehicle that opens
the world market up. In other words “the Internet is the great equalizer.”
Our website is not only our primary sales vehicle, it is also a
power-information site: truly a toolbox that will solve many problems not
addressed elsewhere.

Regarding logistics, our UPS units are small enough
to be shipped all over the world and require minimal service that can be
performed by the average lab technician. The only service required, aside
from cleaning the unit to ensure airflow to internal components, is battery
replacement. The simple instructions on this procedure are posted on our
website. Should a unit need to be returned to the factory to repair damage
from a power event, the batteries can be removed and the unit returned.
Users remove the batteries to reduce the weight significantly, which saves
on freight costs. In the case of our large-volume customers, we offer
service classes to their technical staff and provide spare parts.

Reach Falcon Electric at
www.falconups.com

, or call 800-842-6940 (toll-free in the United States), or 626-962-7770.
Send comments to MLO Editor Carren Bersch at
[email protected] .

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