Life In The Hospital

How To Manage A Hospital Flood

Last week, we had a water line break resulting in hundreds of gallons of water running through the hospital. Fortunately, the broken pipe was on the second floor so the water didn’t have very far to travel. I learned a lot about plumbing that night and what to do when the hospital floods. Here are some of them:

Galvanic Corrosion Is Real

When two types of metal are attached to each other in the presence of water, a phenomenon called “galvanic corrosion” occurs. Over time, one of the metals will erode resulting in weakness of the pipes. The threads on pipes are particularly susceptible to degradation so, over time, threaded pipe connections can fail resulting in a water line break. Several decades ago, building regulations were put in place to require connections to be made with like-metals (e.g., copper to copper) but renovations done in buildings prior to the late 1970’s sometimes had steel to copper connections and these are susceptible to galvanic corrosions.

Water Keeps Flowing After You Turn Off The Main Water Supply

Our hospital is 16 floors high. Our water break was on the second floor. In this situation, even if you shut off the main water line, all of the water that is in the pipes on the 3rd through 16th floor will drain by gravity and so there will still be an enormous volume of water in all of those pipes that will continue to flow through a leak. The solution is to get the water to drain somewhere else – we talked about developing a “CODE F” to instruct everyone in the building to flush all of the toilets.

How Much Water Does It Take To Flush A Toilet?

When you turn off the main water supply to a hospital, no one can flush toilets. The solution is to pour water into the toilet manually. The magic volume of water is 5 gallons. I learned that we keep 5-gallon pails in our facilities department just for this purpose.

If The Water Damages The Fire Alarm System, Call The Fire Marshall

When the fire alarms don’t work, the fire marshall will require you to place “fire spotters” throughout the building. The number of these people will depend on the size of the building but will probably be one person for every 1 or 2 floors. They can have no other responsibilities and have to be constantly patrolling for fire and smoke. They need to have radio contact with the building’s command center. You have to keep them in position until the fire marshall inspects and approves the repaired fire alarm – the inspectors in our community work 8-5 so you have to get a lot of volunteers to do 2-hour shifts if you have a 16-floor hospital.

When Elevators Get Wet, You Can’t Use Them

When elevators get wet, the electronics that run them become unreliable so the elevators have to be shut down. If all of the elevators are down, you have to have some way of getting patients from one floor to another – whether it is because they need an emergent procedure, need to be transferred to the ICU, or need to be evacuated. The solution is an emergency stair sled. These come in a variety of shapes and models but allow patients to be safely moved down stairwells. Our regional trauma organization keeps a stash of them and a trailer full of them can be brought to the hospital to have on hand, just in case one or more patients need to be moved. Elevator companies are just like hospitals – they have workers on-call 24-hours a day for emergency maintenance. We had crews from two different companies working on our elevators and they were running in less than 8 hours.

The Medical Director’s Job Is To Ensure Patients’ Safe And Timely Care

One of the first things I did when we had our flood was to stop by the emergency department and instruct the ED physician to put our ED on divert status – that directed emergency squads to other hospitals. Without knowing how much the flood would affect patient care, it was important to stop the inflow of patients. Once our elevators were working, we went off divert status. Although the hospital medical director will be required to spend a lot of time in the hospital disaster command center, it is a good idea to get out and walk around to the nursing stations so that you know about any patients who are having clinical deterioration and you can plan for their evacuation or get additional resources to their room to hopefully head off transfer to the ICU.

There Will Be An Information Vacuum 

In a disaster situation, it is critical that you control the flow of information to the various hospital areas. If you don’t, rumors will fill in the information vacuum and staff will get anxious. At least once an hour, all night long, I made rounds to all of the nursing stations and the ED to speak with the nurses and the doctors and update them on what was going on and what we were doing about it. I estimated that I walked up and down a total of about 100 flights of stairs over the course of the night. We had many dozens of cookies from a local cookie company that we had planned on delivering 2 days later for nurse’s week – around midnight, the Chief of Internal Medicine and I delivered one box to each nursing station. Food relieves all fears. We also had specialists from the medical center’s communication department on hand all night to control external information to the press so that the messages carried on TV, the newspaper, radio, and even social media was accurate.

A Flood Is An Epidemiology Problem

A hospital flood creates all sorts of epidemiological issues. Mold can grow in wet walls and floor tiles. Affected food has to be thrown out and food preparation areas need to be cleared by infection control. Fortunately, our leak was from fresh water and not waste water so we didn’t have to worry about bacterial contamination. We had a member of the infection control team and our infectious disease physician on-site for most of the night.

Practice Makes Perfect

We have a disaster exercise (drill) twice a year at our hospital and we take these very, very seriously with involvement of all parts of the hospital. This really helped us manage our flood because everyone knew their roles (we even have labeled vests identifying each person by role) and knew how the team works together. The medical system’s Chief Medical Officer and Chief Executive Officer even came in and to give them credit, they stepped aside and let our disaster management run the show – they just quietly made suggestions to either me or our hospital’s Executive Director, who was leading the disaster management team.

You Can’t Just Turn The Water Back On

Once a plumbing leak is repaired, all of the pipes above it have to be filled with water and that takes a long time. Air locks can also develop in large portions of pipes, preventing the rest of the pipes from filling. It can take hours to fully restore water flow to the top floors after the entire building’s water supply has been drained.

May 20, 2017

By James Allen, MD

I am a Professor Emeritus of Internal Medicine at the Ohio State University and former Medical Director of Ohio State University East Hospital