This article is sponsored by Cummins. In this Voices interview, Consulting Specifying Engineer spoke with Mike Sanford, senior sales application engineer with Cummins, about resiliency in emergency power generation systems serving healthcare facilities, and overcoming the challenges of providing safe and reliable power during an outage.
Consulting Specifying Engineer: Will you start off by introducing yourself and your role at Cummins?
Mike Sanford: I’ve been in the power generation industry since 2012, so about 14 years. I’ve been with Cummins for 12 of those years. My background is engineering, though I’ve served in a wide variety of roles at Cummins, from leading our sales application engineering teams, to technical marketing, to product strategy and sales enablement. I served for a time as a corporate lobbyist in D.C., working with our legislators on on-site power microgrid policy. More recently, I served in our new energy solutions team, supporting the development of microgrids within North America.
What are some of the biggest, but often overlooked, challenges impacting emergency power systems serving healthcare facilities?
There are definitely challenges when it comes to emergency power systems in healthcare. A big one is the service and support after sale. Hospitals depend on these systems for safety and saving lives. Long-term maintenance, testing and access to trained technicians are critical to ensure the system performs when it’s needed most: when everything else has gone wrong.
Another challenge is fuel quality and readiness. Standards like NFPA 110, which is the standard for emergency and standby power systems, require ongoing fuel testing and management to make sure that the fuel is stored properly and usable when needed.
The third revolves around emissions compliance and air permitting, certainly an often-overlooked challenge. New engine-driven generators installed today may need to meet a higher emissions standard, sometimes including a Tier 4 engine and/or exhaust aftertreatment such as a catalyst or diesel particulate filter.
Healthcare facilities that depend on these large reciprocating engine-driven generators for life safety power fall under regulations such as the EPA’s RICE NESHAP and New Source Performance Standards (NSPS) for stationary engines. As emissions limits have tightened over time, especially at the state and local levels, new installations often require exhaust aftertreatment systems and detailed air permitting, which may add to the cost, space and operational complexity of projects that are primarily about reliability.
Especially challenging is when hospitals want to do more with those otherwise stranded assets, such as participating in a demand response or utility curtailment program. Many air permits and federal rules treat emergency engine generators differently depending on how they’re used. If the engine operates for anything beyond testing, maintenance or a true failure of normal power, those engines can quickly lose their emergency status from an air compliance perspective. That can trigger stricter emission standards, additional permitting and operational limits, which can make participation in those grid support programs difficult or impossible.
How does service and support come in to play for hospital operators?
This is a big one, because it doesn’t matter where the equipment’s going, long-term service and support after installation is going to be key.
Any healthcare facility, whether a small outpatient center, a surgery center or a large healthcare campus, expects these on-site power systems to perform instantly, without hesitation, during an outage or other power failure. But that reliability depends on consistent maintenance and testing by highly qualified technicians throughout the life of the equipment.
Emergency power systems must be routinely exercised and tested under load with detailed documentation to comply with standards like NFPA 110 as well as NFPA 99, the Healthcare Facilities Code. These standards require verification that the entire system, from the engine or emergency power source (EPS) to the transfer switch, can perform as intended.
Modern power systems include advanced controls, sophisticated subsystem components and complex paralleling systems. Technicians with manufacturer training and access to factory software, parts and engineering support are best equipped to properly test, diagnose and maintain these systems.
You mentioned “fuel quality” as an ongoing challenge related to maintenance of the generator. Can you expand on that?
When there is a failure to start, or an alarm on a generator, fuel quality is typically one of the top five, if not top three reasons. That’s because diesel fuel in hospitals is often stored for long periods of time.
A healthcare facility may store up to 96 hours of fuel per generator set. In an emergency application, those generator sets are typically only running for about 30 minutes, maybe once a month.
Unlike fuel in vehicles like cars or trucks, where the fuel is regularly turning over, emergency generator fuel can sit in storage tanks for years, effectively untouched. That creates risks such as fuel degradation, water contamination and microbial growth.
Standards like NFPA 110 provide guidance aligned with engine manufacturers that says end users must conduct regular fuel inspection, sampling and maintenance, annually at minimum.
After testing, facilities may need to follow up with polishing or filtration to ensure that fuel will perform reliably when the generator is called to start during an outage.
There are additional challenges with biodiesel. Biodiesel blends are very common in the United States, and it is difficult to get diesel fuel without some level of biodiesel. Biodiesel blends can be more susceptible to oxidation and biological growth during long-term storage, and may have different cold weather performance characteristics depending on the blend level and the climate.
In healthcare applications where emergency start reliability is critical, facilities and end users must carefully evaluate their fuel specification, the amount of fuel they’re storing and the maintenance practices around their fuel storage if they’re using biodiesel, especially at higher blends like B10 or above.
There is also a growing interest in alternative fuels. For example, hydrotreated vegetable oil, or HVO, is a very interesting product which can offer lower life cycle emissions over traditional diesel fuel, and improved fuel storage stability compared to conventional diesel.
The challenge here is acquiring HVO and identifying a reliable source.
What exciting new technologies are helping healthcare campuses to best serve their customers?
One of the most exciting developments is the integration of microgrids and distributed energy resources (DERs) to improve the reliability and operational resilience of a facility or campus. Advances in controls, power electronics and system orchestration make it possible to combine various types of on-site generation alongside energy storage and intelligent grid interfaces, so that critical hospital loads can ride through disturbances such as grid events or localized outages while maintaining stable, high-quality power.
Within the DER strategy, there are exciting developments around battery energy storage systems (BESS) which are creating valuable opportunities for large load centers, particularly for short duration outages and power quality events. BESS can respond almost instantly to voltage sags, switching transients or brief grid disturbances, allowing those critical medical loads to ride through events that might otherwise force a generator start.
In some cases, these systems can be used to ride through a multi-hour event before the on-site generation is called to operate, reducing wear on the engine generators, limiting the amount of potential emissions generated on site and improving resiliency and system responsiveness.
Most healthcare campuses or facilities around the U.S. and around the world are not moving away from traditional engine-based generation. Instead, the trend is to keep those resources — diesel or natural gas engine-driven generator sets — as a core part of the resiliency strategy while adding other technologies like battery energy storage, renewable integration and advanced controls.
The diesel generator provides proven long-term duration backup capability, while DER integration helps optimize response time and maintain resiliency across a wide range of outage scenarios. The most successful installations are taking a hybrid resilience approach, using multiple different technologies together so that life safety power is maintained while supporting modern operational and sustainability goals.
Looking beyond the challenges impacting healthcare facilities today, what’s on the horizon?
On-site power generation for healthcare is moving beyond the simple traditional backup reliability or resiliency plan, towards dynamic integration with multiple assets, grid connectivity and a broader look at a campus energy strategy.
Utility interconnection will continue to be a major focus as campuses add more distributed generation technologies. Storage, interconnection studies, protection coordination and cybersecurity considerations will become more prevalent and more complex.
Load curtailment and flexible demand strategies are also gaining significant attention, especially around large load centers. In some cases, they are mandated by state or local authorities, such as in Texas and a few other states. Rather than relying solely on backup generation, some facilities are exploring controlled load reduction or automated response strategies during peak grid stress events. This allows hospitals to participate in those grid reliability programs while preserving critical life safety functions.
I want to be clear, though. It’s very rare for a large load center such as a hospital to intentionally curtail load by lowering their demand. It is typically easier or more effective for them to increase their on-site generation, which effectively serves as a curtailment.
Finally, the idea of “bring your own power” is emerging as a model for large campuses and load centers. This concept involves designing facilities so they can operate semi-independently of the grid, either as an initial installation operating entirely with on-site power, or operating in parallel or semi-independently for an extended period of time during disruptive events or periods of grid instability.
This is done by combining a mix of technologies — engine generators, battery energy storage, renewable technologies and intelligent controls — into one coordinated resilience platform. This will be a challenge in the U.S. as utilities struggle to keep up with large load centers being built across the country.
Overall, the future of on-site power in healthcare is likely to be a hybrid, flexible ecosystem that supports patient safety first, while adapting to the evolving energy landscape without compromising resiliency.
Thank you for reading. Click the link to learn more about Cummins Healthcare solutions.
