Operational risk "Blackout"!

Dost areas of work only function with electricity. In order to increase the agility and productivity of companies, to drive digital innovations and to control personnel and customer demands, electrical energy is and remains the most important pendulum of all. On the other hand, the Achilles' heel of civilization is sudden standstill.

If the power supply is cut off due to a defect, homes and clinics could be critically affected in addition to homes and public facilities. We would never want to have to experience certain scenarios (see the 2014 SVU safety exercise), such as a permanent power shortage that is thwarted by a pandemic.

Two examples of the extreme effects a power interruption could cause: In the operating room (abbreviation: OR) of a hospital there is a self-sufficient power supply. If the power supply is interrupted, a switch that connects the batteries to the operating theatre circuit flips. The activation of vital equipment may be delayed by a few milliseconds. The situation could be even more serious if the batteries or equipment were not serviced.

It also seems increasingly possible that internationally organised blackmailers are causing damage to Swiss businesses, as research and studies (see study "Vulnerability of Swiss hospitals to cyber attacks") underline. Recently, Swiss facilities were infected with DoS (Denial of Service) computer viruses, which block or shut down individual operating facilities in a similar way to a blackout.

The unimaginable conditions that exist in sensitive facilities when there is a prolonged blackout are illustrated by books such as "Blackout: Tomorrow is Too Late", written by Marc Elsberg. - Two short passages to approximate the situation: "Chaos reigns outside the hospital. (...) People wandering helplessly."

Claudio Leitgeb, Head of Division at Zurich University Hospital, is increasingly informing media people about potential dangers: "It all depends on what extent a power blackout represents. For example, how severe the regional power shortage really is." Leitgeb points out two main risks to intact hospital operations:

"We don't know how much fuel will be effectively delivered to our units after three to four days of emergency. - We also don't know how patients and their families will behave in such a tense situation."

"How patients and relatives will behave in such a tense situation, we don't know," Claudio Leitgeb, head of security at University Hospital Zurich.

Vulnerabilities
A prolonged power outage could not only block important public operations, it thwarts life at every level. Due to the wide sensory interconnection of many logistics, transport and communication areas, the economic "vulnerability" increases many times over.

Heating and air-conditioning systems and ventilation, certainly quite a few supermarkets, and finally also transport companies and ATMs would stop working - especially if the blackout knocks out interconnected electricity suppliers.

Shortly before two minor neighbourhood outages in Zurich, several independent voices simultaneously pointed out what it means to have to manage and exist without electricity. Both Swissgrid, the Swiss transmission system operator, and the Federal Office for Civil Protection and Disaster Assistance (FOCP) raised the issue of a possible power shortage in Switzerland.

The question of which distribution approaches will still function at all in the event of a power failure lasting several days

"Even our hydraulic hospital beds, which weigh up to 250 kg, need electricity," Claudio Leitgeb, co-organizer 21st Symposium on Emergency Medicine.

only a few specialists know about it. Toni Frisch, the head of training at the Federal Department of Defence, Civil Protection and Sport, DDPS, often emphasises this in public:

"The supply of food to the population alone is a huge challenge in the event of a disaster." The DDPS tested the state of emergency "power blackout lasting several days combined with a pandemic" in the SVU14 joint exercise. Since then, certainly since the recent regional blackouts, crisis and information managers have been rethinking the complex challenges during a blackout.

Reduntant systems
In the city of Zurich alone, there are 14 sub-networks operated by the Electricity Works of the City of Zurich (EWZ). Important facilities such as the university hospital are connected in a redundant power circuit. In other words, if the main network fails, it actually only takes two seconds to automatically connect the power of another network.

"So there would have to be a widespread power shortage to cut off our electricity," says Claudio Leitgeb, head of security at the university hospital. If there is a shortage that is expected to last longer than one day, the hospital would implement an extraordinary energy management system. This would involve using not only the emergency power grid, but also only the most necessary equipment, buildings and floors. At the University Hospital Zurich, the operating facilities have been running on three so-called redundant power circuits for a few years now - in contrast to simple households.

The head of security admits: "The priority is our core business, i.e. medicine and nursing. The operation of the three dozen or so operating theatres. In order to be as economical as possible with the energy reserves, we would first take individual buildings and departments, such as our admin, off the power." It is estimated that operations could be coordinated in this way for a good 35 hours without medical handicaps.

Without emergency power, however, there would be consequences for hospital operations. The emergency power generators of the university hospital allegedly need 15 seconds to start up. Nevertheless, they only work with diesel. For this reason, the university hospital has a permanent supply of 90,000 litres of diesel - enough for four days at full capacity.

Logistical limits
A power shortage could be kept in check for a while. However, if processes had to be reduced to the minimum - see restricted equipment - hospital staff would face major logistical challenges. In the event of a prolonged power cut and a reduction in diesel reserves, the crisis team would thus face some organisational challenges.

"Provided", says the head of security, " our personnel are available, they reach the workplaces. So that we can organise ourselves in the best possible way in the event of a crisis", Claudio Leitgeb informs us, "intervention units up to and including local reporting runners have been defined in the University Hospital's crisis plan". In addition, a so-called upstream pretriage and a triage operation would be set up

If batteries were also used in the operating room and intensive care units, other areas could only be controlled with paper and pencil. Claudio Leitgeb: "Without electricity, we can't register patients properly. You have to imagine it: The MRI, the X-ray and dialysis machines, even our hydraulic hospital beds and operating vehicles, which weigh up to 250 kg, need electricity."

In the event of a mass incident, people seeking help and their relatives would be cared for by USZ staff trained in care work (independently of search services, Samaritans and chaplains). With between 10,000 and 12,000 people arriving daily today (employees included), many more loose bundles of people seeking help, perhaps injured, would certainly arrive in the event of an emergency.

Of course, such a "village" needs protected operation chains as well as sufficient supplies of medicines, water, food and appropriate maintenance of hygiene rooms. Claudio Leitgeb: "Actually, there should never be a total power failure. Even experts could never really assess the true extent."

One thing the security chief wants to emphasize, however, is "the 'all-of-the-above' mentality should never settle in, even among security guards."

Quality standards
In a meeting room far from the actual hospital, the university hospital's safety officer says, "Of course - in the 40-km-wide, mountain-side corridors of the university hospital, it takes sophisticated operational management."

Whether it's a minor IT malfunction - which may devour a few patient files - or a total interruption in the supply of medicines - because the SAP warehousing software may go on strike: the operational safety culture is subject to risk management, which takes into account as many sources of danger as possible.

The Head of Safety and Environment, together with the operational management, is guided by quality standards such as the EFQM Excellence Model and norms based on the ISO 31000 standard, so that, in an institution as large as the University Hospital Zurich, there are, as far as possible, neither obstructive disruptions nor economic losses.

"Because," Claudio Leitgeb knows, "the longer a blackout lasts, the more the public's expectation of health care grows exponentially."