title: Blackout 2003: preparedness and lessons learned from the perspectives of four hospitals.
abstract: BACKGROUND
  The blackout in North America of August 2003 was one of the worst on record. It affected eight US states and parts of Canada for >24 hours. Additionally, two large US cities, Detroit, Michigan and Cleveland, Ohio, suffered from a loss of water pressure and a subsequent ban on the use of public supplies of potable water that lasted four days. A literature review revealed a paucity of literature that describes blackouts and how they may affect the medical community.
  
  
  METHODS
  This paper includes a review of after-action reports from four inner-city, urban hospitals supplemented accounts from the authors' hospital's emergency operations center (EOC).
  
  
  RESULTS
  Some of the problems encountered, included: (1)lighting; (2) elevator operations; (3) supplies of water; (4) communication operations; (5) computer failure; (6) lack of adequate supplies of food; (7) mobility to obtain X-ray studies; (8) heating, air condition, and ventilation; (9) staffing; (10) pharmacy; (11) registration of patients; (12) hospital EOC; (13) loss of isolation facilities; (14) inadequate supplies of paper; (15) impaired ability to provide care for non-emergency patients; (16) sanitation; and (17) inadequate emergency power.
  
  
  CONCLUSIONS
  The blackout of 2003 uncovered problems within the US hospital system, ranging from staffing to generator coverage. This report is a review of the effects that the blackout and water ban of 2003 had on hospitals in a large inner-city area. Also discussed are solutions utilized at the time and recommendations for the future.
  
  
  CONCLUSIONS
  The blackout of 2003 was an excellent test of disaster/emergency planning, and produced many valuable lessons to be used in future events.
authors.affiliation: Department of Emergency Medicine, Wayne State University, Detroit, Michigan 48235, USA.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Klein
authors.forename: Marc S
authors.initials: MS
authors.lastname: Rosenthal
authors.forename: Howard A
authors.initials: HA
authors.lastname: Klausner
mesh_terms: D004189:Disaster Planning / Q000379:methods*; D011211:Electric Power Supplies; D004630:Emergencies; D004632:Emergency Medical Services / Q000458:organization & administration; D006739:Hospital Administration / Q000379:methods; D006801:Humans; D008284:Maintenance and Engineering, Hospital / Q000458:organization & administration*; D009511:New England; D011210:Power Plants; D011787:Quality of Health Care / Q000458:organization & administration; D014881:Water Supply