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Hospitals and Hurricanes

As climate change fuels more extreme weather events like intense heat waves, flooding, and powerful hurricanes, hospitals face a critical need to plan for the impacts on their operations and ability to serve communities. Extreme weather poses a real threat of leaving areas without access to emergency care when it's needed most.

Between 2000 and 2017, hospitals in the United States had to evacuate patients 114 times due to natural disasters. The aftermath of Hurricane Sandy a decade ago demonstrated how quickly hospital resources can become strained. After Hurricane Maria hit Puerto Rico, a third of reported deaths were linked to delayed or interrupted healthcare access.

Despite the pressing need, developing robust climate resilience plans is challenged by several key factors:

  • Lack of Predictive Data Health systems struggle to obtain localized projections on the future impacts of climate change in their communities. While we know severe storms, precipitation, heat waves, and wildfires will increase overall, it's difficult to pinpoint specific risks like flooding or road closures that could cut off access to hospitals without more granular mapping data.

  • Size and Geographic Spread As healthcare providers span multiple regions with varying climate vulnerabilities, resilience plans must be flexible and account for diverse needs across different facilities and patient populations. It's an intricate challenge for large, multi-state health systems.

  • Financial Constraints The COVID-19 pandemic has taken a heavy financial toll, leaving hospital operators with fewer dollars even as they recover from the public health crisis. Costly infrastructure upgrades and new construction to fortify against climate threats may need to be addressed incrementally.

Here's an in-depth look at how hospitals can prepare for hurricane disasters and flooding through robust climate resilience planning, with engaging details and clear examples:

I. Assess Vulnerabilities

The first step is understanding a facility's risks - and this requires taking a forward-looking approach given the escalating impacts of climate change. The federal government recommends healthcare facilities conduct prospective risk assessments using predictive climate data, rather than just examining historic events. Why is this crucial? Dr. Paul Biddinger, chief preparedness and continuity officer at Mass General Brigham and director of the emergency preparedness research, evaluation and practice program at the Harvard T. H. Chan School of Public Health, explains, "We know we will have more severe storms, more precipitation, more heat waves, etc. But knowing that in broad strokes doesn't really help you if you don't know for sure whether your hospital is at dramatically increased risk of flooding, and therefore might need to evacuate." Mass General Brigham took this proactive approach in 2015; their analysis identified over $300 million in required capital improvements to bolster vulnerabilities across their system related to climate change impacts.

II. Fortify Facilities

With a clear view of the threats, hospitals must then take decisive action to harden their facilities and infrastructure against foreseeable risks like flooding, wind damage, power outages, and more. We've already seen major health systems put serious muscle behind this effort. When Hurricane Sandy struck in 2012, NYU Langone Health had to evacuate over 200 patients as their backup generators were drowned by storm surge flooding. The $1 billion incident was a wake-up call, prompting the installation of an extensive iron and steel flood barrier system capable of protecting vulnerable areas like loading docks from future flooding events. Anything that absolutely cannot get wet is being relocated higher up at facilities like NYU Langone and Ochsner Health in New Orleans. This includes generators, fuel stores, and expensive medical equipment/supplies being moved from basements and lower floors to upper levels. For new buildings and major renovations, health systems are properly "sizing" their construction for the increasing climate risks down the road. Upgrades to structural integrity, windproofing, drainage, and other resilient design elements can help ensure these multi-million dollar investments don't get crippled by future disasters.

III. Emergency Power & Resources 

Even the most fortified hospitals could still face outages and shortages when a hurricane's fury disrupts regional infrastructure and supply chains. Robust backup systems are essential for uninterrupted operations. In addition to elevating generator plants as noted earlier, hospitals are building multiple levels of redundancy into their emergency power sources through battery backups, additional generators, and microgrids to reduce any single point of failure. From water reserves for sanitation to stockpiling enough food and fuel to last over a week, many hospitals have implemented "hurricane orders" to build up essential supplies ahead of storm threats. Having resources on hand is vital, but hospitals must also plan how to replenish those supplies if disaster modes linger. Ochsner Health has arranged backup supply lines for diesel fuel that include National Guard support and even barge shipments up the Mississippi River if needed.

IV. Transportation & Evacuation Plans

When disasters escalate beyond a facility's capabilities, hospitals must be prepared to safely move patients - both transferring between partner sites for load balancing or executing full-scale evacuations. Detailed planning and practice make this immense logistical challenge feasible. Health systems invest in specialized vehicle assets to keep critical staff and patient movement possible even during flooding events. Ochsner Health maintains a fleet of flat-bottom boats and high-water trucks styled after National Guard rescue vehicles. Beyond obtaining appropriate transport resources, procedures for executing evacuations must be meticulously mapped out - detailing the order patients are moved, staffing responsibilities, egress routes, and more. Frequent drills are key, with Nebraska Medicine going so far as to strap executives into sleds to simulate patient evacuations down stairwells. With bad enough disasters, even full patient evacuations may be required - transferring hundreds of people between partner hospitals across a region. This is prompting improved coordination, like the patient load-balancing systems established in Washington and Oregon to enable real-time care relocations during crises.

V. Reduce Facility Burden

Preventing hospital overload and straining resources in the first place should be a top priority during emergencies. This means proactively messaging the public while leveraging community partnerships. Well ahead of projected severe weather impacts, hospitals should issue clear public guidance through media, social channels, and emergency alert systems - asking people to come to the ER only for true medical emergencies. UW Medicine in Seattle does this routinely during heatwaves and storms to reduce unnecessary patient surges. Hospitals can work with counties and municipalities to establish resources like cooling/warming centers that can accommodate people seeking relief from hazardous temperatures without adding to ER overcrowding.

VI. Insurance Considerations

Safeguarding a healthcare facility is one thing - ensuring it remains financially resilient through an insurable risk management strategy is another critical piece. This means obtaining appropriate coverages by conducting climate risk assessments, no trust for disaster preparedness but to ensure your property/casualty, business interruption and liability coverages are sufficient for the increasing threats in your region. Insurers will be looking closely at the robustness of the resilience and emergency response plans. Having comprehensive strategies reviewed positively by underwriters can prevent coverage limitations, denials, or sky-high premium costs. For hospitals in high-risk geographic areas for hurricanes, wildfires, flooding, and other climate-amplified disasters, elevated insurance pricing is likely unavoidable. It's a fiscal reality to plan for as the costs of climate impacts are passed on.

The bottom line is that robust, multi-layered climate resilience capabilities are no longer just a best practice for hospitals - they are a necessity for protecting a healthcare facility's ability to serve the community when disaster strikes in our rapidly warming world.

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