Health Care Facilities and Lightning Protection Systems Special Risk Factors: Lightning is a hazard to all types of structures. But let’s face it, we have higher standards for hospitals and health care facilities than we do for many other buildings. As places of healing, such facilities must be designed, constructed, and maintained to be as safe as practical. For many health care facilities, this goal requires a lightning protection system (LPS). Parkland Hospital in Dallas, TX has a lightning protection system as part of its preparation for severe weather events. Credit: Hicks Lightning Protection Consider: – Modern medicine depends on sensitive electronic equipment that is vulnerable to destruction by lightning surges. A zap from lightning can damage essential equipment such as MRI and other imaging systems, computers, communication systems, security systems, back-up generators, pumps, climate control, and air conditioning, therapeutic devices, and patient monitoring and record keeping. – Hospitals contain dangerous materials such as oxygen and potentially explosive gases, hazardous biological and radioactive waste, and toxic chemicals that can be released as a consequence of lightning damage. – Evacuating a hospital in the event of a fire or failure of critical systems is difficult, expensive, and impacts patient care. – Lightning passing through an unprotected building can electrocute patients, staff, and visitors causing, on rare occasion, debilitating injuries or death. Powerful surges due to lightning damages mission critical electronics and equipment more frequently than is reported; damage is easy to attribute to other causes and difficult to diagnose. For example, the damage to component U9 is obvious, yet C2 has damage that is nearly invisible. Credit: Joseph Randolph An executive at a regional trauma center offers a simple explanation for installing lightning protection systems. He explains, “Without lightning protection, I can’t risk having someone on the operating table during a thunderstorm.” Small clinics and individual practices are also at risk, as recent headlines make clear: – “Lightning strike forces dentist to finish procedure in car.” – “[Lightning] Fire hits Ohio Veterinary Medical Association building.” – “Doctor’s office demolished after [lightning] fire.” Severe damage was done to an orthodontic clinic in Bowling Green, OH after an overnight lightning storm ignited a fire. It was the second lightning fire in the town in a week. The practice had about 1,000 active patients that had to be directed to other providers. Credit: Joe Imel/Daily News Indeed, Disaster Preparedness for Physician Offices by American Society for Health Care Risk Management recommends consideration of, “a lightning strike causing a fire in your office when every treatment room is filled.” Safety Risk Assessment (SRA): According to FGI Guidelines for Design and Construction of Hospitals, 2018, Section 1.2-4: “All hospital projects shall be designed and constructed to facilitate the safe delivery of care. To support this goal, an interdisciplinary team shall develop a safety risk assessment.” Lightning factors into several areas in an SRA. For example: – Infection Control Risk Assessment (ICRA) – Lightning damage to the ventilation system can interfere with air pressurization and exhaust necessary to control the spread of airborne pathogens. – Patient Handling and Movement Assessment (PHAMA) – See case study below about evacuating a hospital in the dark and without elevators following a lightning strike. – Medication Safety Assessment – Lightning damage can interfere with the operation of electronic devices necessary to control and dispense medications. – Security Risk Assessment – This addresses, “the protection of vulnerable patient populations, the security of sensitive areas, the application of security and safety systems, and the infrastructure required to support these needs.” Cameras, electronic locks, smoke detectors, alarms, and communication systems are just a few of the safety and security systems that can be taken off line by lightning. While lightning is not mentioned specifically in the Guidelines, it is part of the infrastructure envisioned by FGI. This is made clear when it states, “An all-hazards approach to design should be applied to help the facility prepare for… natural disasters.” The protocols for investigating lightning hazards are in National Fire Protection Association (NFPA) 780 – Standard for the Installation of Lightning Protection Systems, Annex L, “Lightning Risk Assessment.” The assessment can be easily conducted online. In hospitals, factors such as the need to maintain continuity of critical services and difficulty in evacuating a building increase its vulnerability to lightning damage. The NFPA criteria will satisfy risk assessments required under: – Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers (42 CFR §482.15) which requires an “all-hazards” risk assessment, – Florida Building Code, – FEMA and State Continuity Of Operation (COOP) planning under Phase I – Readiness and Preparedness, – Veterans Administration (VA), A/E Submission Requirements for VA Medical Center Major new Facilities, Additions & Renovations, – National Institutes of Health, NIH Design Guidelines, and – Other governmental and institutional standards and policies. Many hospitals are incorporating rooftop gardens as a way to incorporate nature into the healing environment. At Mercy Medical Center in Baltimore, the metal handrails and shade structure are used as strike protection devices to eliminate the need for traditional air terminals (lightning rods) near patient areas. Credit: Dillon Lightning Protection Systems, Inc. Example: The potential consequences of a lightning strike are demonstrated by a 2017 incident in Pasco County, FL. An EMT on the scene vividly recalls that a hurricane was approaching and, “As the initial rain bands began to make landfall, lightning struck…Regional Medical Center Bayonet Point (RMC)—the county’s only trauma center… This triggered a fire and then a sudden and total loss of all power. Due to the unique circumstances of the lightning strike and fire, backup systems failed, and all staff, along with 225 patients, were abruptly left in the dark. Doctors in the middle of procedures suddenly had no light; patients on ventilators were left reliant on backup battery power; elevators ceased to operate. The clock was ticking. “Pasco County Fire Rescue… quickly extinguished the fire. However, it rapidly became apparent that the fire was only one of several problems: Nonambulatory patients on the hospital’s second and third floors were now trapped due to a lack of functioning elevators, and all patients on powered medical equipment were now relying on backup battery power, with various time frames until the batteries were drained. With no power to the hospital, there was no way to recharge the batteries on equipment such as IV pumps, ventilators, cardiac monitors, etc. Suddenly the small fire and power loss became an MCI [multi-casualty incident].” EMS World, July 2017 A lightning strike became a multi-casualty incident and complicated preparations for an approaching hurricane. 70 ambulances and several ambulance buses responded. Credit, WTVT, Tampa, FL. Despite the need to make hurricane preparations in their own communities, assets from around the state were diverted in response to the call for assistance. Through teamwork, training, and good-luck (the hurricane downgraded to a tropical storm), no patients suffered significant consequences due to the evacuation. The county was left with a bill, however, and — it could have been worse. Design and Installation Considerations: A lightning protection system requires a whole building approach. The system must comply with nationally-recognized standards, including LPI 175, UL 96A, and the previously mentioned NFPA 780. These standards have been vetted by peer-reviewed studies based on extensive field and laboratory research. The standards call for a network of air terminals (lightning rods), lightning conductors, and ground electrodes to create a safe, low-resistance path between the top of a structure (including rooftop equipment) and the earth. All wiring and services passing through the building envelope must be protected with surge protective devices. The structural system, major pieces of equipment, HVAC, plumbing, and other metallic systems within the building have to be bonded to achieve electrical equipotential, and all the facility’s grounding systems have to be interconnected. Note that it may be necessary to exceed the requirements in the standards to provide sensitive health care facilities and equipment with the highest levels of protection. Lightning protection requires more than just a few air terminals on the roof. From rooftop equipment to building services tucked in the basement, the lightning protection system must protect the entire building and provide a low resistance path from the sky to the ground. Credit: Above Left, Bonded Lightning Protection, Jupiter, FL. Above Right, DoD Medical Facility A lightning protection specialty contractor, certified by the Lightning Protection Institute, should be part of the design and construction team. The LPS professionals must collaborate with the architects, electrical and systems engineers, and construction team to assure proper design and installation of the LPS. Inspection and certification under the Lightning Protection Institute – Inspection Program (LPI-IP) should be part of building commissioning. Make provisions to have the facility reinspected every two to five years and whenever the building is remodeled. Operating and maintenance staff and vendors must be trained to work around an LPS. For example, installation of new equipment may require connections to the LPS, and caution must be used to maintain the LPS integrity when performing rooftop work. Facilities are encouraged to review protocols for discharging patients when lightning is in the vicinity. As the National Weather Service and other public safety organizations urge, “When thunder roars, go indoors.” (Download a lightning safety poster here.) Final Thought: Lightning can occur concurrently with tornadoes, hurricanes, floods, wildfires, and other disasters. Installing lightning protection systems contributes to community resilience by helping to assure hospitals remain functional during times of crisis when they are needed the most. Further Information: Lightning Protection Basics Lightning Protection Risk Assessment “Preventative Care for Medical Buildings” Medical Construction and Design, July-August 2015. “Standing Ready: Lightning Protection for Hospital Rooftop Gardens, Terraces,” Medical Construction and Design, September-October 2018.