New HHS Initiative Empowers Local Responders

With emPOWER, local public health authorities and emergency responders can better prepare for and respond to massive power outages

EMS Compass LogoThe GIS map displays the number of Medicare beneficiaries in each state, as well as those with electric‐dependent medical devices to identify areas subject to risk during power outages. (Image courtesy of Office of the Assistant Secretary for Preparedness and Response)

Imagine if EMS providers knew in advance where and when an emergency might occur. They could try to prevent it, or at the very least make sure they were prepared to mitigate the problem.

In some ways, the emPOWER initiative does just that. Created by the U.S. Department of Health and Human Services (HHS), emPOWER uses Medicare records to help local officials find people who depend on electric-powered medical equipment, such as ventilators or in-home dialysis machines.

"During the blackout in the northeast in 2003, the number one admission and discharge [reason for Medicare patients] was power and device failure," said Kristen Finne, a senior policy analyst with the HHS assistant secretary for preparedness and response (ASPR). "For many of these individuals, power outages can be life threatening within hours so they naturally call 911 whenever there’s an emergency."

The emPOWER initiative has three major components:

  • The emPOWER Map displays the number of Medicare beneficiaries who rely on electrically dependent medical equipment by zip code or county. The data is completely de-identified and does not indicate the exact location of the individuals, but the aggregate information gives planners an idea of the scope of the potential problem during an emergency.

  • Emergency Planning Datasets, available to state public health authorities, provide more specific information on the number of people within a zip code or county who rely on certain electric devices or other healthcare services, such as dialysis or home health. State health officials can share the information with local planners or responders to provide more situational awareness.

  • Local public health officials can request Outreach Response Individual Datasets from CMS (via ASPR) that include limited individual information, such as the addresses of Medicare beneficiaries who use electrically dependent medical equipment.

While Medicare beneficiaries might make up only about 15% of the total population, a much larger proportion of people requiring these medical devices is likely a Medicare beneficiary, since Medicare covers older Americans as well as those with disabilities. At the same time, emPOWER’s creators recognize that the information is only a piece of the overall picture.

"When using emPOWER, think of it as the floor, not the ceiling — it’s the baseline to start from," Finne explained.

Not only does emPOWER provide a good starting point for estimating the potential impact of a power failure on patients with medical devices, but it also demonstrates the power of using healthcare data to plan for and mitigate emergencies. In the future, Finne said, other sources of health information could be used for similar or expanded efforts.

"EMS providers every day are seeing more and more people in their communities on this complicated durable medical equipment," said Gregg Margolis, a paramedic and director of the division of health system policy at ASPR. "Up until now there’s been no systematic way to get information on who may need help because they depend on these devices or to project the potential impact of a power outage on the health care system. This kind of information helps EMS understand their community better and prepare in advance."

While many communities request that patients and families notify EMS and other first responders when someone is on a device such as a ventilator, these registries are often difficult to maintain, incomplete and out-of-date. The emPOWER system looks at claims every month to keep the system as accurate as possible.

In several exercises in cities such as New Orleans and Binghamton, New York, HHS tested the ability to use the Medicare claims to find individuals during an emergency. Partnering with local responders, officials knocked on doors of beneficiaries reported to be using electrically dependent equipment. In more than 90% of the cases, the information was accurate.

But emPOWER’s developers hope that the information it provides leads not only to better emergency preparedness, but also more effective day-to-day operations. Seeing how many people and what types of equipment are used in a region should spur agencies to ensure providers are trained and comfortable when responding to these patients’ medical emergencies at any time.

"EMS providers respond to these exacerbations and complications every single day," Margolis said. "Right now it’s an entirely reactive response. The information in emPOWER really gives you the opportunity to understand the trends of these sorts of equipment in your community and be much more proactive for how to plan for, respond to and perhaps prevent these incidents from occurring."

Finne said that while the information provided by emPOWER is a big step forward, the key to preparedness and helping people who might be more vulnerable during emergencies is to work with partners across the community. Organizations providing EMS services need to be part of local healthcare coalitions to ensure a coordinated response.

"The first person they’re going to call is 911," she said. "This is a problem that is rapidly growing. It’s not getting smaller. And the technology is getting more advanced. It will take the whole community to really anticipate and plan for the needs of all of these different populations."