They have maps of the grid, where the disconnects are, and many disconnects have remote monitoring. This are probably the primary way, when a car hits a pole and it falls, the lines short. That will trip a circuit breaker and the circuit breaker will tell the utility it tripped. Their maps will identify that if that breaker trips then this section of wire and these accounts are offline.
Now we also have smart meters, and these can monitor the power from every house and also do this.
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