disaster preparedness overview for IVF laboratories

1. Emergency Disaster
Preparedness
Charles L. Bormann, PhD, HCLD
Massachusetts General Hospital
Harvard Medical School

2. Developing an Emergency Plan
• Every IVF program should have a plan to
protect fresh and cryopreserved human
tissue and to provide for continuation of
patient care in the event of an emergency
or natural disaster.
• Each IVF program should develop and
implement its own individual emergency
preparedness plan
– Appropriate for its geographic location,
– Actions to be taken to protect patients,
personnel, and specimens

3. Identify your Risk Factors
www.redcross.org

4. www.redcross.org

5. www.redcross.org

6. Emergency Preparedness
• Personal examples of Laboratory Emergencies
– Electrical Failure
– Hurricane Sandy
– Boston Blizzard
– Brigham Shooting
– Marathon Bombing
– Laboratory Flood
• Ways we were prepared
• Ways we were not prepared
• Improvements made
• Assessing your Laboratory’s Disaster Preparedness
• Developing an Emergency Disaster Plan

7. Transformer Crash
• Knocked out clinic’s power for ~ 8 hours
• All equipment connected to Emergency Backup Power

8. 35.5
36
36.5
37
37.5
38
38.5
39
39.5
40
40.5
0 30 60 90 120 150 180 210 240 270 300
Temperature°C
Time (minutes)
Temperature Increase

9. Power Outage
• Ways we were “prepared”
• Ways we were not prepared
– We never closely examined how each piece of lab
equipment responds during a power interruption
• Lab Improvements Post-Power Outage
– Purchased an Uninterrupted Power Supply (UPS)
units for each incubator
www.cap.org

10. Hurricane Sandy
• Formed Oct 22nd
• Dissipated November 2nd
• Winds spanned 1,100
miles
• Affected 24 States
• $68 billion in damage
• 233 deaths

11. Ways we were Prepared
• Sufficient time to order additional
liquid N2 tanks
• Identified which patients could be
rescheduled
– Cancelled FETs
– Adjusted day of ET(Day 3 vs Day 5)
– Identified patients that could be triggered ± 1 day
• Identified minimum # of staff required to work
• Secured housing for staff near hospital

12. 2015 Boston Blizzard
• Record Snowfall in
Boston: 110.6 inches
• $35 Million for snow
removal
• Statewide travel bans

13. Ways we were Prepared
• Sufficient time to order additional
liquid N2 tanks
• Identified which patients could be
rescheduled
– Cancelled FETs
– Adjusted ET day (Day 3 vs Day 5)
• Performed “freeze-alls” if necessary
– Identified patients that could be triggered ± 1
day
• Cancelled all gamete, embryo and PGT biopsy
shipments
• Identified minimum # of staff required to work
• Secured housing for staff near hospital

14. What Didn’t Work
• Poor understanding of hospital emergency
preparation policy
– No budget for staff housing
• Staff allowed to stay overnight in hospital rooms
– Staff required to use vacation days if unable to work
• Gas and Liquid N2 supplier employees went on
strike
– Strikebreakers unfamiliar with facilities and tank
exchange procedures
– Delays in receiving gas supply

15. Improvements Post-Blizzard
• Updated policies to include instructions for
securing on-site sleeping quarters during an
emergency event
• Assign administrative work to be completed for
those unable to commute to work
– Help eliminate the pressure for staff to attend work
when there are hazardous conditions
• Established a contract with a back-up gas supply
company in case there are issues with future
deliveries

16. Brigham Shooting
• Code Purple Alarm

17. Ways we were Prepared
• The lab has no windows and can only be
accessed with and ID badge
• All staff accounted for
– Communication with office and cell phones
• Hospital Email Announcements

18. Ways we were not Prepared
• Unable to hear the alarm in lab
– Alarm volume lowered in the lab to prevent startling
the embryologist
• Staff unfamiliar with all hospital codes
– Codes not posted in the lab
• Staff were never trained to handle internal threats
– All emergency drills focused on fires
• Staff unaware of panic button locations
– Unclear when they should be utilized

19. Improvements Post-Shooting
• Laboratory alarms (light and reduced sound)
• Hospital Code Education

20. • Practice Drills for each Code
– Perform on annual basis (similar to Fire Drills)
• Indicate location of panic buttons on
Emergency Maps
– Educated staff on when to use them
• Practice evacuating the Waiting Room, PACU,
and OR
• Identified resources for staff to deal with the
emotional aspect of these types of events
Improvements Post-Shooting

21. Boston Marathon Bombing
• Boston School Vacation (April 15-19)
• Marathon Monday

22. Sequence of Boston Events (April 15th)
• Marathon Bombing
– Limited to no cell
phone service
• BWH: Code Orange
Lockdown
• MBTA suspended
service Shuttle routes
closed

23. Sequence of Boston Events (April 16-18th)
• Hospital Lockdown
• Limited Shuttle Service
to Hospital
• Heightened Security
• Streets closed due to
suspicious vehicles
• Visit from President
Obama

24. Boston Shutdown (April 19th)
• One suspect killed
• Public Transit Network
Suspended: 5:40AM
• Businesses Closed
• Essential Staff Allowed to
Enter Hospital: 6:22AM
• Staff not allowed to leave
hospital: 8:27AM
• Code Amber Terminated:
6:29PM
• Second Suspect Captured:
8:42PM
• MBTA Restored: 10:48PM

25. Ways We Were Prepared??

26. Ways we were not Prepared
• April 15th (Day of Bombing)
– Unable to reach staff by cell phone (towers jammed)
– Did not have an alternative method for communicating
with outside staff
• Personal email addresses, landline phones, social media
– Did not have an established internal emergency
meeting location (only an outside location in case of
fire)
• April 19th (Mandatory city lockdown)
– Did not have an alternative policy/plan for handling lab
procedures
– Limited staff due to holiday

27. Improvements Post-Bombing
• Keep updated phone list of all employees and
key hospital personnel (smart phone)
– Provide copies to each member of team
• Set up a voicemail system in office
– Designate one remote number to record messages
for employees
– Provide number to all staff members
• Setup Email Distribution List for all staff
members:
– Include work and personal email addresses

28. Develop a Phone Tree
1. Decides what constitutes an Emergency
2. Determine who will need to know the
information your phone tree will communicate
3. Make a list of names and contact information:
Get 2 phone numbers from each person; at
least one should have voicemail
4. Decide who will sit on top of the phone tree
5. Test your phone tree on a regular basis
6. Staff should keep a copy of the phone tree with them
(smart phone)

29. Laboratory Director
Senior Embryologist Senior Embryologist Senior Andrologist
Embryologist
Embryologist
Embryologist
Embryologist
Embryologist
Andrologist
Andrologist
AndrologistEmbryologist
• Text Messaging
• Email
• Social Media

30. Egg Retrieval
IVF/ICSI
Embryo Culture
PGT
Embryo Transfer
Fertilization Check
• Direct to another facility
• Cancel cycle
• Freeze Oocytes
• No assessment, leave in culture medium
• No assessment, leave in culture medium
• Push Day 3 biopsies to Day 5/6
• Freeze all embryos
• Push Day 3 transfers to Day 5/6
• Cancel transfer and freeze all embryos
Lab Procedures: Limited or No Staff
Stricter policy on # of staff required to cover holidays. Each working
day should be equally staffed.

31. Brigham IVF Laboratory Flood
• Waterline burst above IVF
Laboratory
– Lab on 5th floor of 14 story
hospital
– 28,000 gallons of water
covered entire lab, OR, PACU
and offices
– Water contained anti-
corrosive agents

33. Ways we were Prepared
• Hospital Engineering notified Lab Directors
immediately
• Established emergency back-up agreement with
BIVF
• Patients immediately notified of clinical changes
– No break in patient care
• Electronic Medical Record System
– Backed-up on outside servers
• Duplicate copies of Freezer Contents
• Established SOPs and Maps for evacuating frozen
tissues

34. Ways we were Prepared
• Established vitrification SOPs
– Allowed for quickly cryopreserving oocytes and
embryos in the absence of power

35. Established Relationships with
Outside Vendors
Eduardo Kelly: www.steptoemd.comLeo McNamara: leovmcn@gmail.com

36. Ways we were not Prepared
• No internal lab flood alarm warming system
• Embryo/Gamete Storage Alarm System was destroyed
– No remote server
• MVE Solenoid Damaged in Flood
– Auto-fill did not work properly (Dangerous Situation!!)
• Incomplete Equipment Log: Electrical Lines, Gas Lines,
Computers
• Many paper documents destroyed (QC logs, product
inventory, protocol updates…etc)
• Did not Establish Gamete/Embryo Shipping agreements
in advance for patients being treated offsite
• Unfamiliar with how to handle insurance adjusters

37. Improvements Post-Flood
• Water/Flood Sensor
• Switched to a single alarm system (incubators and
storage tanks)
– All alarms connected to an outside server
• Updated SOP: Disconnect auto-fill lines until tank has
been thoroughly inspected by vendor
• Created a video and picture inventory of all laboratory
equipment (smart phone)
– Update annually

38. Improvements Post-Flood
• Updated SOPs to require shipping agreements in
advance of treatment
– Negotiated future rates for courier services
• Developed electronic QC sheets, inventory logs,
policy updates…etc.
• Identified resources for recovering damage
documents
www.firewaterwind.com

39. Insurance Adjuster
• Tag all lab items: Name/ Location
• Keep record of each item relocated or damaged
– Photograph each item (especially damaged or discarded items)
• Secure a climate controlled storage facility to maintain equipment
and records
– Identify appropriate storage locations for protected health information
(PHI)
• Identify an independent contractor that is familiar with clinical IVF to
assess damage
• Escort insurance adjuster and point out all damage
– Clearly describe the risks for contamination or equipment malfunctions
in an IVF program
• Provide insurance adjuster with references for experts on IVF
laboratory air quality, quality control testing…etc.
• Get a quote from vendors to replace all lost items
– Have vendor provide you with lead times for all equipment

40. Utilization of Frozen Embryos
• Frozen Embryo Transfers n=9925
60.8
14.2 13.1
6.5
2.1 1.6 1.3 0.3 0.1
0
10
20
30
40
50
60
70
1 2 3 4 5 6 8 10 >10
%ofFETs
# Years in Storage

41. Off-Site Storage Facilities
• Florida Location
– Category 5 Hurricane Safe
Room that can withstand
330 mph winds
• Minnesota Location
– F5 Tornado Shelter that
can endure 250 mph
winds
• Nevada Location
– Located on eastern side of
Sierra Mountains to
protect against
earthquakes
– Safe room to withstand
wildfires. Able to endure
1200 degree temps for 3
hours
www.reprotech.com

42. www.readyrating.org

43. www.readyrating.org

49. http://www.redcross.org/prepare/mobile-apps

50. www.asrm.org/SRBT