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GUIDE: On-site power generation for hospitals
Power reliability has become one of the most pressing challenges for hospitals, where uninterrupted operations are essential to patient care and safety. In many regions, increasing grid constraints, extreme weather events, and aging infrastructure are putting added pressure on healthcare facilities to strengthen their power strategies. As a result, hospitals are evaluating layered approaches that combine utility service with on-site generation, energy storage, and renewable resources to improve resilience and maintain continuity of care.
Salas O’Brien’s comparison guide examines the power generation options hospitals are considering today, highlighting which technologies are practical in the near term and where each fits within a broader resilience strategy. It explores the tradeoffs that matter most during early planning and underscores the need for layered solutions that support both reliability and operational goals. This guide provides a clear framework to help healthcare leaders make informed decisions.
GUIDE: On-site power generation for hospitals
Contributors: Duc Bui, PE; Josh Cartwright, PE; Jeff Chiconski, PE; Eric Miller, PE; Henry Pramono, PE; Bill Scrantom, PE; Khaja Syed, P.Eng.; Alan Watson, PE; Alan Vanags, PE
The trend toward electrification places higher pressure on on-site generation to achieve resiliency.
Hospitals are expected to function 24/7 even during:
- Longer, more frequent grid outages
- Public Safety Power Shutoff (PSPS) events
- Extreme weather events, seismic events, and regional fuel disruptions
This pressure is shifting hospitals toward layered power strategies reinforced by increased clinical dependency on power-intensive technologies, trends to fully electrify operations, and heightened scrutiny of air quality and emissions.
This guide is written for healthcare executives, facilities leaders, and capital planning teams navigating these realities. It focuses on on-site power generation options that support clinical operations during grid disruptions and enables hospitals to evolve their energy continuity strategies responsibly over time.
Microgrid: the organizing concept
In healthcare, a microgrid is not a single technology.
A microgrid is a control framework that allows multiple on-site
power sources to operate together, isolate from the grid, and
prioritize critical loads.
Microgrids do not replace emergency power systems or eliminate
generators. They synchronize and combine energy from
generators, batteries, combined heat and power (CHP) systems,
fuel cells, and renewables such as solar PV and wind.
The objective is layered resilience — designing a system where
each asset performs the role it is best suited to perform. This
approach enables:
- Greater operational control
- Phased implementation
- Flexibility as technologies and regulations evolve
- Clinical continuity without compromising compliance
How the pieces work together
Each technology plays a specific role in maintaining reliable power
across different timelines.
- Microgrid controls. Orchestrate assets, manage transitions, and
prioritize clinical loads - Battery Energy Storage (BESS). Instant ride through, power
quality support, and seamless transitions for clinical systems - Fuel Cells. Steady backbone generation that reduces reliance on
stored fuel and can provide useful thermal energy - Generators (diesel or natural gas). Code required essential power
providing contingency coverage - Renewables (where feasible). Low carbon supplemental
generation from renewable energy sources
What happens during a grid outage in a microgrid-enabled hospital?
First seconds – stabilization
The microgrid controller detects the disturbance and isolates the hospital from the grid. Battery storage or UPS systems maintain voltage and frequency across the campus during this transition protecting sensitive equipment while other
generation assets come online.
First minute – emergency power
Emergency generators begin their automatic startup sequence. Under healthcare codes such as NFPA 110 and CSA Z32, the emergency power system must restore power to life-safety and critical branches within 10 seconds.
Extended outage – sustained operations
During longer grid disruptions, the microgrid operates independently. Fuel cells can provide steady base generation, batteries smooth out short-term fluctuations, and generators provide deep resilience. Facilities teams can also shed
non-critical loads or shift loads to extend fuel availability and maintain clinical operations.
Real-world experience
One of Salas O’Brien’s hospital clients in California learned about an extended outage days after the fact.
The microgrid and on-site power generation we designed had already carried the hospital through the event without the experience of even a flicker.
Curious if you could achieve the same? Reach out to: [email protected]
Why microgrid adoption is now possible for hospitals
The Centers for Medicare & Medicaid Services (CMS) has issued a waiver that enables qualified facilities to use a healthcare microgrid system under new code pathways, but alignment with Authorities Having Jurisdiction (AHJs) remains essential.
This signals a clear shift.
Hospitals are no longer limited to “diesel only” thinking when planning compliant emergency power strategies. Many of Salas O’Brien’s experts are working with governing bodies and AHJs on these advances.
Power generation strategies are system decisions.
There is no single right answer for a hospital’s power and resilience strategy. This comparison matrix explores the practical advantages and constraints of each option to support layered and evolving approaches.
What drives hospital power decisions?
Hospital power decisions are shaped by a combination of clinical, regulatory, and operational realities – including cost and protection from downtime.
What drives the decision
Clinical continuity dominates, while code frameworks establish the baseline. Beyond compliance, hospitals prioritize systems that are defensible during inspections, provide reliable fuel during extended outages, and can be deployed within occupied care environments where construction and commissioning must work around ongoing patient care.
Where strategies break down
Generators meet compliance requirements but do little to address extended outages beyond 96 hours. Grid improvements are underway, but slow. Transmission upgrades and utility hardening often lag hospital needs. Decarbonization is frequently treated as a future-only problem, which raises costs and limits options later. When power decisions are pushed to the end of master planning, flexibility shrinks and operational risk increases.
What works in practice
Successful programs treat power as clinical infrastructure, planning for layered resilience, phased transition, and early coordination with AHJs and utilities. In some cases, creative funding strategies can help owners realize these benefits sooner. We can help.
Salas O’Brien helps hospitals with power strategy
We can help you build predictable, defensible, clinically-aligned power systems that can operate through uncertainty.
To begin a conversation about resilient on-site power strategy, reach out to [email protected].
Duc Bui, PE
Duc Bui is an expert in the electrification of healthcare facilities. A leading provider of electrical engineering solutions and an innovator in using low voltage DC power for LED lighting , he holds a US Patent on Direct Current Power Delivery System. Duc specializes in healthcare facilities and pharmaceutical facilities with a strong presence in California serving large corporations such as Kaiser Permanente, Abbott Vascular, Tenet, University of California Irvine, and the University of Southern California. Duc serves as a Principal for Salas O’Brien. Contact him at [email protected].
Josh Cartwright, PE
Josh Cartwright is an experienced electrical engineer specializing in the design of commercial, government, education, and healthcare facilities. His expertise includes electrical power and emergency distribution systems, lighting and power design, as well as communication and alarm systems. As a principal in charge, he has a proven track record of leading multidisciplinary teams to deliver highly coordinated, project-specific solutions. [email protected]
Jeff Cichonski, PE
Jeff Cichonski is a principal and mechanical engineer with over 25 years of design and management experience. His focus on building long-term relationships by being responsive to our clients’ needs is demonstrated in his execution of both design and project management. Jeff brings a vital understanding of building systems to his work as Salas O’Brien, in particular for healthcare facilities, universities, and manufacturing facilities. His experience ranges from hospital expansions and renovations to infrastructure upgrade projects. Contact him at [email protected]
Eric Miller, PE
Eric Miller is a project manager and senior mechanical engineer with 25 years of experience in the design and energy analysis of commercial and institutional HVAC systems. His work includes chilled water plants, heat recovery systems, and steam and hot water generation, along with system-level energy analysis to support effective, high-performing designs. Eric has led projects across multiple sectors, with a strong emphasis on healthcare and values the opportunity to improve facilities that directly support patient care. [email protected].
Henry Pramono, PE, LEED AP
Henry Pramono is a leader in advanced electrical systems for healthcare facilities, combining innovative solutions with a focus on clean energy and resilience. Henry continues to push boundaries and achieve breakthroughs in creating high-performance, sustainable environments. Henry serves as a Principal at Salas O’Brien. [email protected]
Bill Scrantom, PE
Bill Scrantom is a seasoned mechanical engineer and strategic executive with more than 35 years of experience leading project delivery, business growth, and client success in the built environment. At Salas O’Brien, he combines deep technical and operational expertise with forward-thinking leadership, advancing our organizational goals as well as those of our clients across critical market sectors. A nationally recognized expert in sustainable healthcare design, Bill is known for his ability to connect with clients, guide teams through complex challenges, and deliver results across every stage of the project lifecycle—from early planning through delivery and beyond. Bill serves as the Chief Strategy Officer for Salas O’Brien.
Khaja Syed, P.Eng, MSc
Khaja Syed is known for his leadership and project management skills across multi-national projects. His experience includes significant roles in designing and managing complex electrical systems for hospitals and pharmaceutical, educational, governmental, and industrial facilities. Khaja serves as a Principal at Salas O’Brien. Contact him at [email protected] .
Alan Watson, PE
Alan Watson is a senior electrical engineer and subject matter expert with 20 years of experience in electrical power and SCADA systems. He brings deep expertise across power generation, renewable energy, and microgrids, utility interconnection, and medium-voltage system design. Alan’s background includes commissioning and field start-up for system integration, switchgear installation, and communications networks, and he is known for providing trusted technical leadership on complex, large-scale electrical systems. Alan serves as a Principal at Salas O’Brien. Contact him at [email protected].
Alan Vanags, PE, LEED AP
Alan Vanags has 30+ years of design and management experience. Alan focuses his efforts on providing technical guidance and leadership to his staff, as well as directing highly technical projects. An electrical engineer by training, he oversees a broad spectrum of projects, including laboratory buildings and complex hospital projects to campus infrastructure planning and design. Alan is a Principal with Salas O’Brien. Contact him at [email protected].