Is your IVF lab prepared for a natural disaster?

March 13, 2011Carole No Comments »

The 8.9 M earthquake in Japan last Friday (March 11, 2011) and subsequent tsunami created extensive havoc in the northeastern port city of Sendai and caused hundreds, perhaps even thousands of deaths. The exact toll in lives and property is not yet known. The earthquake was strongly felt just south in Tokyo and resulted in shutting down railways, roads and airports.  Although this earthquake was extraordinary in both its size and scope, smaller disturbances in our everyday life happen fairly frequently. Local power outages are not uncommon due to a variety of events including routine summer or winter storms, flooding, vehicular (car into pole) accidents and earthquakes.  Even poorly planned digging during construction can disturb a power line and cause a temporary loss of power. An IVF lab is highly dependent on continuous electrical power to run incubators, freezing devices, monitor storage tanks, perform routine microscopic procedures, maintain ambient lab temperatures and air quality in the lab . Phone services is essential for most programs because most programs have a call-out alarm system that notifies staff by paging them when a storage tank is warming or the incubator gas concentrations are outside allowable ranges.

One measure of the quality of your IVF program is in how well the lab anticipates and responds to disruptions in utilities, particularly electricity. The American Society for Reproductive Medicine  and Society for Assisted Reproductive Medicine published joint committee recommendations, “Guidelines for development of an emergency plan for in vitro fertilization programs“, which outlines what should be included in an emergency plan. Three areas of focus are most important, namely, protecting patients and program personnel, protecting gametes and embryos, and protecting paperwork and equipment, in that order of importance.

Some disasters may require evacuation of patients and personnel and a plan should be in place to move people out of harms way. Once patients and non-lab personnel are out of harms way, the possibility of embryo rescue can be considered if it is safe for lab personnel to remain on site. It is difficult to move embryos when they are in culture. Theoretically, they could be placed in test tubes, moved to another site, and returned to culture but the chance for mishap is great. In some cases, the solution may be to cryopreserve gametes or embryos and then move them to a safe place, until they can be thawed and returned to culture. Vitrification is a very useful cryopreservation method for an emergency because it does not rely on mechanical freezing equipment to freeze the embryos and it is much faster. In addition, it can be very effective for eggs and embryos at any stage. Some traditional freezing protocols must be modified to accommodate different embryo stages, making freezing multiple patient samples at various culture stages in an emergency a daunting, probably impossible task.

Embryos and gametes already in storage tanks are easier to deal with. Smaller tanks are usually on coasters and can be wheeled and, depending on their size, even carried up a flight of stairs to a safe site if the elevators aren’t working. All these well-laid plans may fall apart if the lab becomes too dangerous too quickly for lab personnel to risk a rescue of embryos. That is why every IVF consent form has a paragraph which indemnifies the lab against liability for destruction and loss of embryos and stored specimens due to natural disasters, terrorism or acts of war. If the lab has advance warming of incoming disaster, for instance, a hurricane, then obviously more can be done. If there is a warning period of days, not hours, cycles can be canceled, embryos can be frozen and transfers may be scheduled earlier on day 3 or 4, instead of five.  Storage tanks can be topped off with liquid nitrogen to increase the time before liquid nitrogen deliveries will be needed, assuming a disruption of services will likely occur.

Programs sometimes have official or unofficial agreements with other IVF programs in town that they will share resources or otherwise come to each others aid in the case of emergency. Patients may be directed to these alternative clinic sites for continuation of care.  In some cases, patients may be evacuated out of the area completely.  If patients are told to evacuate, patients should take all their cycle medications and a copy of all their medical records so they are ready if their care is transferred to another clinic at a remote site.

All medical records and specimen inventory records should be kept in duplicate in two separate locations. Back-up copies come with their own potential for problems because any medical records storage location (real or virtual such a cloud storage) must be protected from possible loss of patient confidentiality and even identity theft.  Although protecting back-ups as well as the originals can be a headache, back-ups are essential. For instance,  if the embryo storage room is destroyed, there should be a way to identify all the patients whose specimens were lost so that they can be contacted and informed of the loss and next steps.  If specimen storage tanks are moved, inventory records should be moved to a safe place also. Tanks should be identified as containing human tissues so that emergency personnel can identify them. After the dust settles, there must be a method to identify where specimens are, who they belong to and whether they are intact.

Every lab should have a back-up emergency power source that automatically kicks in when the local utility has a power failure. Surgery centers and hospitals are required to have a stand-alone power source whether it is a diesel or gas-powered generator or even extensive battery packs. Often these back up systems don’t power every outlet, but only the red emergency outlets. Lab staff need to make sure that their essential equipment is plugged into these emergency outlets so that their equipment gets some of the minimal back-up supply. Regular outlets will be dead. Back-up power is designed to last hours, at most a day or so, then fuel sources need resupplied. In the case of widespread natural disasters, utility power may take days or weeks to return and other fuel sources like gas or diesel may be hard to obtain. Stand alone clinics should also have a system in place to provide back-up power to run the labs essential equipment for some reasonable period of time.

When interviewing a program, you should probably ask about their disaster preparedness. A good IVF program is good with the details and never ‘wings it’. They will have thought about their professional response during a disaster’s worst days.

 

 

 

 

 

© 2011, Carole. All rights reserved.

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