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Chapter 15 Disaster PACS Planning and Management
(similar to mirroring hard drives in RAID, Redundant Arrays of Independent
Disks). Another was advertising itself with an axe concept: if we let a blindfolded
person wielding an axe into the PACS room and let him smash his axe
once into any PACS component, the PACS should still work.
The image of Jack the Ripper axing PACS servers in a network closet does
indeed appear quite thrilling except for one little caveat: somehow it is assumed
that the room itself stays intact. But the wrath of Mother Nature knows no
bounds and can go much further than the zeal of our blindfolded antihero.
Our pre-Katrina PACS system, provided by a major PACS manufacturer, was
located on the seventh floor of a solid concrete building. It had backup servers,
power generators, tapes, and many other safety features located in the same
area. It was naturally assumed that if anything takes down a solid concrete
building, we would have much bigger problems than worrying about the PACS.
This assumption was wrong.
Here is a brief list of wounds, each being mortal, that our imaging network
received during the hurricane:
1. Severe power loss in the hurricane-affected area. The power was out for
weeks, and when it returned, it was not stable. Meanwhile, the power was
still reliably available in neighboring cities as close as 50–70 miles away.
2. Severe connectivity loss. While our PACS servers survived the hit, they lost
network connectivity. One obvious reason for this was the same loss of
power, but it was not the only reason. For example: one local telecommunication
provider had located all its backup power generators on the first
floor. They were quickly submerged during the flood, taking down the entire
wide-area network.
3. Loss of technical support and onsite personnel. Almost everybody evacuated
to safer areas as the storm was approaching. Many systems, left to their
own engines, quit only because there was no one there to push the “restart”
button.
4. Complete collapse of the public utility infrastructure. In the immediate aftermath
there was no water, gas, power, or telecommunications, and all but a
very few roads were flooded to a depth of several feet. The city was under
strict martial law. This went on for several weeks. As a consequence, patients
fled the city without their medical records. While the PACS hardware
was undamaged, there was no practical way to get to the data.
5. Multiple technical problems. For example, routers sporadically changing
their IPs, servers running in overheated rooms (servers restarted, but the
cooling did not), physical damage, and so much more.
6. Multiple logistical, administrative, and personal problems, and an unstable,
chaotic work environment. When the centralized chain of command failed
and fell to pieces, and when personal issues overwhelmed everyone, even
the smallest problems turned into major obstacles.
Now, if we return to the beginning of this chapter, axing PACS servers look
more like child’s play compared to New Orleans in September 2005 (Fig. 91).