9. In addition to the previous replies, the following is a DRAFT summary of the impact of the energy crisis as per the Blood Centers of California. This DRAFT was provided by a member of the California DHS Laboratory Field Services for the sake of discussion and planning, and a final document may be issued in the near future:

"California blood centers as a system of blood delivery are part of a state disaster preparedness program. The nature of that program assumes that disaster is probably not state-wide. The program is reliant on the resource sharing and a chain of communication and delivery that includes all California blood centers. This type of response is designed to cover only at best a 12-hour critical period for only one blood center in the devastated area. During and after the immediate disaster the blood center would open for collections, storage, and delivery, in alternate locations. Note also that during a disaster the public response is enormous and recruitment activities can be minimized. This is not an appropriate plan for normal blood services for 1.1 million transfusions annually. It is designed for short- term response only and it would be dangerous to assume that disaster plans can be used to during our current energy crisis.

Blood centers in California are adversely affected by the energy crisis. The public focus on adverse effects generally turns to storage and manufacturing, but the unrecognized threat to the blood supply is the inability to collect units on our blood drives during blackouts at our blood drive locations. More than half the blood in California is collected in businesses and community locations where the blackouts will not be exempt. Employers and locations managers will not allow blood collection activities to occur if they are aware of pending blackouts. Blood drives will be canceled with as little as a few hours notice. Also blood drives will be stopped if unexpected blackouts occur. The impact of these events will cause a blood supply crisis particularly during the summer months when the blood supply is already dangerously low. The concern for the blood supply cannot be underestimated, realizing under normal circumstances that the California blood supply is more that 200,000 units of blood short in meeting the 1.1 million transfusions given annually. Consequently blackouts should be considered extremely dangerous to the state's blood centers ability to make blood available.

Blood centers will try and maintain blood drives and center collections based on the needs of their client hospitals. Most of these collection activities have been planned for months, sometimes for a year. These collections are part of an overall inventory system of resource procurement that suffers from the slightest change in numbers. This delicate balance between collection and need creates at best a week's supply of red cells. But during the summer blood centers can be operating with only a day's supply of blood. Blackouts will cause emergency situations.

Compounding the supply issue are all of the manufacturing and storage issues. Our state's platelet supply is approximately 95% automated, making the needs for constant electricity critical. Some centers will have equipment on generators, but some may not. Numbers of equipment that can go on emergency loads is usually low, determined by the size of generator and the constant change in circuit load of any business. Also there is equipment in multiple locations as outreach to our donors. Many of these locations do not have backup power. This automation has varying response to generator kickover and/or total shut down. Most often product will be lost. In a center with 20 apheresis machines that is a significant event. Down time is critical also because donors can not wait. The scheduling of platelet donors is very precise based on the 2 hours needed on each machine to produce one product. Most donors will leave, creating additional lost product.

Automated equipment in our laboratories may be on generator, but once again the number of machines dedicated to generators is limited. Even a 1-hour interruption can affect product output and as production declines the staff must be replaced or go into overtime. Services to hospitals that are dependent on laboratory equipment will be impacted and over time orders of a stat nature will be undeliverable. The testing of blood products is automated. The schedules for testing correspond to collections, inventory need, staff shifts, and product output to meet daily demand. Even though equipment is on generator, unexpected or prolonged effects of blackouts will have an effect on blood availability. The delay of one or two hours can mean that blood needed for the next day may not be available. The laboratories of our blood centers are not designed to maintain the blood supply and services with re-occurring blackouts as part of the routine.

The storage of our products ranges from refrigeration to freezing. This equipment may have generator protection in the main location, but satellite collection and depot locations are temperature-monitored but not power-protected. The blood industry as a whole is not financially able to provide generator coverage for every location. Blackouts cause problems to storage equipment which varies by type of equipment, product type and volume, and type of failure event. Some refrigerators can hold temps only 30 minutes while others might have 1-2 hours. Blood centers have refrigerators of all types, sizes, in their centers, some on generator, some not. During a disaster boxing and movement from one refrigerator to another can occur, but this is designed for one event of a short duration. This is not something blood centers can sustain over time. Keep in mind disaster plans ALWAYS rely on resource sharing. There will be some refrigeration that is monitored, but not staffed so that supply could not be saved. Frozen inventory generally can be maintained in closed freezers, but our frozen inventory volume is not the bulk of our transfusions, it is our red cell inventory storage that is compromised. Our platelet products are stored in environmental chambers on moving rotators. These products have less than a 5-day life and their loss would be critical to inventory and distribution patterns.

Blood centers may know about their main center power grid designation, but not about that for all of their satellites and depots. Once again, our critical locations are not owned or managed by blood centers, they are mobile locations in wide geographic areas. Some blood centers cover more than a dozen counties for collection and hospital distribution. The location implications are vast. The timing of blackouts will not help blood centers. Donor collection events and locations are not flexible. Timing only helps the main center where less than 50% of our blood is collected. Even in the center there will be donors that leave because of discomfort or schedule changes. Blood centers are not financially able to purchase more generator coverage. The manufacturing and collecting services are too widespread to make it feasible. Even if it were possible it is the collection of the units that is in jeopardy. There is no good news when it comes to blackouts. Scheduled afternoon blackouts hit blood centers at their peak collection hours. There is no warning system that will work. To restate what has been said in another way, blood centers are at the mercy of people, people who own and run businesses, people who are the blood donors. Blood donation is a human event supported by human generosity and optimal conditions. There is no doubt the blood supply will be adversely effected by the energy crisis."

ADDENDA May 23, 2001

10. The CBBS leadership has just been informed that the California Public Utilities Commission (PUC) has announced that "non-residential customers of California's electric utilities have until June 1st to apply for exemption from rolling blackouts". Business customers must demonstrate in their applications that being subject to rotating outages presents a significant danger to public health and safety. Claims of economic harm or inconvenience will not be considered, nor will applications from residential customers. The California PUC will decide on or before the 2nd of August who will be exempt. If you work at a California blood bank that might be impacted by rolling blackouts, please access the electronic form at http://www.rotating-outages.com or call 1-888-741-1106 to obtain the form. (AS OF 5-13-02, THIS WEB PAGE IS NOT ACTIVE.) It seems that each free-standing blood collection center may need to submit a request for exemption. If you are aware of any blood centers that could benefit from this information, please forward this message (or at least the information) to them.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator