A Critical Connection:	&EPA
The Water and Healthcare/Public
Health Sectors
During emergencies, water utilities, healthcare facilities, nursing homes, public health agencies, primacy
agencies and local emergency managers should work together to minimize detrimental impacts to public
health caused by disruptions in drinking water and wastewater services. Early planning and communications
are vital. Facilities such as hospitals need safe drinking water to care for patients, perform surgeries and sterilize
instruments, especially when an emergency strikes a community. Water utilities need to know how they can
best assist and advise their critical healthcare customers. Learn more below.
1. Build Relationships
Relationship Building
Fairmont Public Utilities (FPU) in West Virginia
experienced a water shortage in 2007. Aware that
water was critical to the Fairmont Regional Medical
Center (FRMC), FPU staff:
•	Conducted weekly in-person meetings to help FRMC
plan surgeries
•	Used all available media outlets to keep FRMC and
its patients constantly informed
•	Developed a critical customer list, including FRMC,
that is still used today
Meet each other. Utilities should participate
in healthcare preparedness coalitions or other
public health preparedness groups. This is also
a good time to share your day-to-day and
emergency contact information. Water utilities
could invite healthcare and public health staff to
tour their facilities.
Attend events together. Accredited hospitals
conduct annual drills or exercises that could
be based on a water supply emergency. EPA's
Training & Exercise Plan and Tabletop Exercise
tool can help. Both sectors should contact their
local emergency management agency (EMA) to
see what EMA training and exercises could be
jointly attended. EMAs also play a critical role in
protecting human health.
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2. Coordinate Preparedness
Plan with each other. The Centers for Medicare arid
Medicaid Services mandates water management
programs in all healthcare facilities and emergency
preparedness plans that cover water service
disruptions. Water utilities and healthcare facilities
should work jointly on these programs and plans.
Assess together. It is important for hospitals to
update their hazard vulnerability assessments
annually. This is a good opportunity to invite
your water utility to help you better plan
an emergency water supply and to better
ascertain where your hospital's "water
weaknesses" are.
Tip
Healthcare facilities could:
•	Install redundant feeds from the municipal water
system
•	Ensure their water system is looped
•	Install exterior water hook-ups for hauled water
•	Install a booster pump in a multi-storied facility
Water utilities could:
•	Notify healthcare facilities of planned flushing
events - brown water can negatively impact
facilities such as hospitals
Boil Water Advisory (BWA) Impacts
BWAs can present challenges in patient care.
In Georgia, hospitals cancelled procedures and
shut down hot meal services. In Massachusetts,
hospitals bagged water fountains and used
baby wipes for baths. Utilities can help mitigate
healthcare impacts by being prepared to recover
from BWAs as quickly as possible. For example,
utilities can collect and analyze water samples
using pre-stocked emergency sampling kits
and rapid testing methods (e.g., Colilert-18 vs.
Colilert-24).
3. Coordinate Water Use Advisories
Keep messages straight. Utilities can coordinate
advisories with public health agencies ahead of
time to help avoid confusion and to save time.
Remember, a "Boil Water" advisory can be treated
as a "Do Not Use" advisory by healthcare facilities.
Facilities do not want to draw in contaminated
water, so they need to know if a boil water advisory
is precautionary (e.g., issued due to a loss of system
pressure) or due to an actual contaminant identified
in the water system.
NON POTABLE
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Tip
The Centers for Medicare arid Medicaid Services
requires facilities to reduce the risk of growth
and spread of Legionella and other opportunistic
pathogens in building water systems. CDC
developed a toolkit with this goal in mind, and
EPA published guidance regarding technologies to
control Legionella in premise plumbing.
4. Work Together on Water Quality
Stay informed. Water utilities need to let health care
facilities and dialysis centers know about planned (e.g.,
seasonal) and unplanned changes (e.g., main break)
in water chemistry and storage. These changes affect
medical equipment used to provide patient services.
Be aware. Water utilities need to know where
home dialysis units are distributed (dialysis centers
will know), and utilities need to be sure that these
customers are contacted a bout water quality changes.
Notify and advise. Hospital administrators should
let utilities and the state drinking water regulatory
agency know if they have additional watertreatment
(e.g., point-of-entry) or filtration systems in their
hospitals. Utilities can help advise hospitals on the
maintenance of these systems.
Enhance protection. Hospitals and other facilities
have devices (e.g., autoclave) that can cross-
contaminate their plumbing if they have no backflow
prevention program in place - a utility can help
advise a hospital or other healthcare facility on an
effective backflow prevention program, which will also
help to protect the municipal supply.
Office of Water (AWBERC, MS 140)
5. Ally with Poison Control Centers
Keep each other in the loop. Water utilities could
share information with poison control centers
(PCCs) during a water quality incident because the
centers will get calls from the public. Likewise, PCCs
should communicate with utilities about calls that
they receive potentially related to water quality.
Assist with outreach. PCCs can be an asset for a
utility to help advise the public about water use
because they can be viewed as an impartial third
party (neither "government" nor "utility"). Call
1-800-222-1222 to be connected with your state's
PCC.	
?¦
Elk River, West Virginia MCHM Spill
The West Virginia Poison Center (WVPC) helped
West Virginia American Water (WVAW) and local
healthcare facilities by:
•	Answering questions from the public and health
care providers about triage and treatment of
suspected MCHM adverse effects
•	Sending MCHM information sheets to hospitals,
clinics and physician offices
•	Providing information related to determining the
health screening value for MCHM and using the
value to make health related decisions
•	Monitoring social media to determine exposure
concerns shared by the public and developing
media releases to address these concerns
•	Posting flushing instructions on the WVAC website
•	Participating with WVAW in a Town Hall Q&A
•	Explaining water quality results such as "non-
detect" and "parts per million" in plain language
•	Serving as a subject matter expert for the WV
Bureau for Public Health and the Governor's office
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6. Respond Together
Other Resources
Know the Incident Command System (ICS). This
system will allow water utilities, healthcare facilities
and public health agencies to respond together
during an emergency, especially if each organization
begins their response to the incident at different
times. More information about ICS can be found on
both EPA's and FEMA's websites.
Coordinate with emergency management. Your
EMA may know how to get alternate drinking water
and wastewater services and may be able to help
issue water use advisories through automated
phone dialing systems and/or the Emergency Alert
System.
•	Flushing Guidance for Premise Plumbing and
Service Lines to Avoid or Address a Drinking Water
Advisory - 4572: This Water Research Foundation
publication identifies situations when flushing
is advisable and explores the best practices for
flushing premise plumbing and service lines.
•	Exercise Development Toolbox: Helps utilities
and response partners design, develop, conduct
and evaluate both public health discussion and
operations-based exercises.
•	National Disaster Medical System (NDMS):
Incidents may overwhelm state, local, tribal and
territorial health resources. When that happens,
the NDMS can supplement health and medical
systems and response capabilities.
Ik
Boston's Big Break
^	• On Saturday, May 1, 2010, a
coupling on a 10-foot diameter
; '	if \	pipeline broke on a Massachusetts
¦¦¦	w	Water Resources Authority
® *	(MWRA) water supply tunnel,
I	which started to leak millions
of gallons of water. A boil water
order was issued for the Boston
metropolitan area. Medical
I	„	facilities were contacted directly
by water suppliers to discuss safe
water practices. Additionally,
I %	based on their water source within
the MWRA system, some were
informed they did not have to boil water. Some facilities, like the Boston Medical Center, were directly
impacted by the boil water order and quickly implemented plans for water conservation, alternate food
and nutrition, clinical operations and facilities management (e.g., ice machines). Media coverage was
intense, requiring careful crafting and coordination of public health messages from both the water and
healthcare/public health sectors.

Office of Water (MC 140) EPA XXX-XXX-XXX November 2018 https://www.epa.aov/waterresiilerice
Office of Water (AWBERC, MS 140)	EPA 817S20001	December 2018
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