Hello there! There are questions I like to ask....What would happen to the coma patient(s) when there's a power outage on not only the hospital but also the nearby areas of the town/city? And since the coma patient is kept alive by machines, would he/she die when the power is out? Also, what can the hospital staff do during the power outage for the coma patients?
Hey there @oxymitch! Thanks for the ask! This is an interesting one :)
First: I’m going to assume that your situation is going to last more than a couple of days, that they’re going to be isolated, and also that it will happen with no warning. Why? Because that’s the model I have to build an answer on.
Easy ones: If the backup generators work, the power stays on, and the patients will be fine. If the loss of power is transient, less than a few hours, staff can be used to take over the machine functions in the short term. If the hospital has notice and they think they’ll lose power, they can actually transfer out their sickest patients to other facilities. Even if they lose power but the hospital is still accessible, they can request transfers for their sickest patients. Critical care transport units will transport those patients as far as needed to get them an ICU bed somewhere.
Now, let’s look at the truly catastrophic scenario, because of course we should.
So, first things first: hospitals have backup generators. As long as t he generators work and have fuel, your hospital will generally function in its usual manner, excepting that they will not permit surgeries in case of a total power failure.
However, these generators are typically kept at, or even below, the level of the hospital, and flooding can knock these out. It happened in New Orleans during Katrina and I believe it happened in New York during Sandy, with a couple of major hospitals closed due to flooding.
Let’s assume the power goes down completely – the worst possible case. Worse, help isn’t coming or can’t arrive any time soon – the true disaster scenario. Ambulances can’t get there by ground, all the air support is tied up on other missions or the storms are too bad to fly a helicopter.
So, what happens to the coma patient in the ICU? Honestly, their outcome isn’t going to be great, and they’ll likely die.
Ventilator-dependent patients require a machine to breathe for them, with very specific settings: volume, pressure, PEEP (positive end-expiratory pressure, essentially the “pushback” from the vent), etc. If the machines go down someone has to ventilate them manually, squeezing a bag 10-20 times a minute, indefinitely. It ties up staff that could be utilized in other places. Hell, that staff member can’t even leave the room for five minutes to pee.
The other big issue is that IV pumps go down, too. Most IV pumps have some battery life, and some will last for hours, but many – especially those that are used strictly in-hospital, and have batteries only to get the patient to the bathroom and back – won’t work after 30-180 minutes. So the medications that are keeping most ICU patients alive won’t flow, and getting correct doses by drip – by pure gravity and the graces of a drip set – is next to impossible, especially in the dark.
So these patients – many of whom are on 3, 8, 10, a dozen medication drips (plus their ventilator), are in deep, deep shit.
[There is an ABSOLUTELY PHENOMENAL podcast] about what happened in a hospital in New Orleans during Hurricane Katrina, based on a book [Five Days at Memorial by Sheri Fink]*. The hospital lost power, lost backup power, were isolated, lost radio contact, kept hearing stories about looting. They were surrounded by water and couldn’t leave. And, surprisingly quickly, the doctors began to euthanize.
Their logic was this: these patients need machines to breathe for them, to pump them full of medications. Hell, most medication dispensers – the mini-pharmacies on units – absolutely require power to dispense any meds at all.
These patients were going to gasp to death without ventilators, or were going to drown in their own fluids from heart failure, or meet whatever end the ICU was barely keeping them from. So doctors decided to give big doses of fentanyl and midazolam – a painkiller and a sedative – and ease their patients’ suffering once and for all.
Right or wrong, the intent was kind. Right or wrong, their actions probably meet the legal definition of homicide. (Right or wrong, we do this for our pets all the time.)
The concept of triage is about the greatest good for the greatest number. A fictional hospital might make the choice to allow all ventilated patients to breathe on their own – or not, but to not give them any support. That frees the staff up to save the patients they know they can help. Save who you can, and let go who you can’t. This is done in disasters every day by EMS.
I’m not saying what happened at Memorial was right, or that it was wrong; that’s not my place. (The NPR podcast goes into that at length.) I’m just saying that it happened, and that you might find it an interesting reference point for your story.
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