Alaska Media Link

P.O. Box 102156, Anchorage, AK 99510
(907) 274-7896 -- fax (907) 274-5465

Rachel D’Oro

(c) ANCHORAGE DAILY NEWS

2/14/99

   Dr. Dick Mandsager, director of the Alaska Native Medical Center, was at home ironing pants and watching ''ER'' when the phone rang shortly before 9:30 p.m.

   ''Dick, we have a problem,'' said the worried voice of Jim Mayers, the on-duty nursing supervisor. ''You'd better come in. We just lost the other pump and have to consider evacuating.''

   Mandsager needed no further explanation. The hospital had lost its heating system amid the worst cold snap of the decade.

   Mandsager told Mayers he was on his way.

   So began a demonstration of effective crisis management. While temperatures outside hovered at 20 degrees below zero on Feb. 4, dozens of hospital staffers applied years of disaster planning and routine drills to actual life. Some prepared to evacuate almost 110 patients, including nine premature babies, while others worked frantically in the basement boiler room to revive the disabled system.

   ''People knew what they had to do,'' Mandsager said. ''Part of crisis management is, you've got to have staff you trust.''

   Alaska is no stranger to disasters, with its extreme temperatures, fires, plane crashes and mechanical failures. The state requires public agencies and emergency handlers like hospitals to develop crisis response plans, and regularly practice them. Many businesses develop disaster plans on their own. In Anchorage, the city's Office of Emergency Management holds yearly mass-casualty drills involving fire and police departments, the military and other emergency workers, including hospital staffers.

   This is how one organization switched from dress rehearsals to the real thing.

Taken by surprise

   No one expected a mechanical breakdown at the Native hospital, which opened just a year and a half ago. The new heating setup seemed especially dependable because it was built to back itself up. No one yet knows what caused the malfunction.

   Earlier in the day, at 11:40 a.m., things started to go wrong in one of the system's two pumps, which take turns pushing hot water and antifreeze throughout the building. One of the two expansion joints on a pump burst. Steam spewed. About 1,500 gallons of lime-green propylene glycol -- the antifreeze -- gushed onto the basement floor.

   In the adjoining control room, boiler operator John Rukovishnikoff heard a voice crackle on the radio. ''I need some help!'' Jeff Hillburn called. Rukovishnikoff rushed in with others and helped Hillburn shut a valve. A torrent of hot liquid drenched Rukovishnikoff.

   ''I never had time to change my clothes,'' he said. ''We were all too busy.''

   Over the next five hours, workers had to deal with the aftermath. Led by Robert Wilson, the hospital's engineering chief, they cleaned up the mess, shut off the 28 air exchangers that trade impure air for fresh air and located more glycol but not replacement parts. They finally found a Seattle wholesaler who would ship three expansion joints by the next morning.

   Hospital safety managers assured patients and staffers who noticed the funny smell that propylene glycol is relatively harmless. On the third floor, boiler operators piped thousands of gallons of glycol/water mix into coils, then got the system's second pump running. Most of the maintenance workers stayed past their shifts to see if the fix would hold.

   By 9 p.m., everyone figured they had the problem under control, even though the hospital still had no backup. Wilson thought about heading home to get some rest for his long-planned Caribbean vacation the next night. Mandsager had gone home three hours earlier. Now he was enjoying ''ER,'' a medical drama that, not surprisingly, is popular with health-care professionals.

   Then came the call from Mayers. An expansion joint on the second pump had split open, and 800 gallons of glycol gushed out. Again workers had to shut down the entire system, including air exchangers. The hospital has an independent hot-water system, but it works poorly without circulating air to spread the heat around.

   By 9:45 p.m., Mandsager was in the boiler room. Wilson told him they needed more glycol. And, somehow, they needed to patch together a fix before the building got cold. At 11 p.m., they would decide whether to evacuate.

   For now, it was time to activate the hospital disaster plan.

Disaster plan in action

   As Wilson called in the pipe fitters who originally installed the system, Mandsager closed down the emergency room to ambulances, diverting them to other hospitals. Then he got on the public announcement system and declared an internal disaster. The hospital had lost its main heating source and might have to evacuate patients, he said.

   Mandsager, Mayers and other on-duty staffers hunched over phones and called about 20 senior managers and nurses. People began streaming in within 15 minutes, ready to repeat the steps they had tried out during yearly drills.

   The team called other major hospitals and asked them to stand by in case they had to move about 70 patients to available beds. The rest would go to the medical center's hostel, which has a separate heating system. The plan was to send hostel residents to hotels, if necessary. They called Elmendorf Air Force Base to borrow 100 arctic sleeping bags in case enough beds were not immediately available.

   Among the people called in early were Steve Breithaup and Mike Halko, who worked on the committee that modified the internal disaster plan when the hospital moved to Diplomacy Drive near Tudor Road. They regularly review the disaster plan, lead hospital staffers through yearly internal drills and participate in the city's annual mass-casualty exercise.

   Breithaup and Halko said they were impressed by the professionalism displayed by their colleagues.

   ''Folks didn't panic,'' Breithaup said. ''Practice may not make you perfect, but at least it makes you very comfortable.''

   At 9:55 p.m., Breithaup called the Fire Department to announce the internal disaster and ask for help moving patients in case of an evacuation. The fire dispatcher reached Dennis Hoke, the department's deputy chief of technical services, at home. Hoke decided the situation warranted launching a crisis action team through the city's Office of Emergency Management. He called OEM chief Bob Stewart, then headed over to the hospital.

   By 10 p.m., Stewart was driving to his office at the main fire station in South Anchorage to organize a group of helpers, including fire, transit and other city officials. Their mission: to find rides and hospital beds for patients. The flurry of phone calls began. After checking with the hospital, they also started looking for at least 1,000 gallons of glycol and dozens of cots in case people had to move to other heated buildings on the hospital grounds.

   The OEM team made some of the same phone calls hospital staffers had already made. In hindsight, Mandsager said, the hospital should have involved the city sooner and avoided such double calls. Also, he said, the hospital should have called the Alaska Air National Guard to help transport glycol.

   The crisis could result in some changes to the hospital's disaster plan, Mandsager said. ''We learned some important lessons,'' he said.

Making it work

   Back in the boiler room, Wilson wondered if he and his wife would have to cancel their vacation. His exhausted crew was still cleaning the spill from the floor and equipment.

   About 10:15 p.m., the pipe fitters arrived to help. Around the same time, maintenance workers reached the service manager of a local chemical supplier, who shipped over 28 55-gallon drums of the glycol in the back of a delivery van.

   At 10:30 p.m., three People Mover buses and two smaller AnchorRides vans rolled up to the curb outside the Native hospital's emergency room. Inside, hospital staffers scrambled to place patients, including the premature babies, as well as four people on ventilators and two on IV lines. They sifted through rosters, separating the seriously ill from the healthier patients to determine who would go where.

   From the hospital, Hoke checked in with the city team five minutes later. The glycol had been found, he said.

   For the next 20 minutes, the OEM team mapped out a detailed transportation plan. City and medic buses, ambulance companies and paramedic vans would be used, if necessary. ''It was intense until about five minutes before 11,'' Stewart said. ''Then it got pretty quiet while we waited to hear what would happen.''

   Shortly after 11 p.m., Mandsager and two dozen others met with Wilson. The thought on everyone's mind: Would they have to send vulnerable patients out into the aching cold?

   'We'll have a pump working shortly, and we found more glycol,'' Wilson said, to the crowd's relief. His workers had replaced one of the bad expansion joints with one of the good ones, creating a functional unit that would get the hospital through the night.

   The disaster team went home after sharing the good news with their municipal counterparts and the other hospitals. But the boiler room crew hung around until they filled the system with glycol and got the pump humming again by 2:30 the next morning. They would return in a few hours to start installing the new joints.

   Wilson sent all but two workers home, then found an empty bed. He shut off his pager and two-way radio, then fell into a deep sleep. At 5:30 a.m., one of the workers woke him up. One of the valves in the shut-down pump was dripping glycol.

   Morning crews rigged a tarp shroud around the leak until the new parts arrived. Before the air exchangers gradually came back on line, some parts of the hospital were uncomfortably warm and stuffy, while others were chilly.

   By 4 p.m., the repair job was nearly done. Wilson told his wife their vacation was still on, and that he would be home soon to shower and pack for their red-eye flight. En route to the airport, Wilson swung by the hospital to make a final check.

   Everything was fine.

   ''I was pretty wired the first couple of days of vacation,'' Wilson said from his hotel room in the Dominican Republic. ''I had no trouble sleeping on the plane that night, though.''

E-mail me