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Report: How to Make Hospitals Resilient Enough to Face Extreme Weather Disasters

By Umair Irfan, E&E reporter
5/9/2014 10:19:50 AM

Beyond injuries and infections, climate change's onslaught bears down on hospitals and clinics, further impairing health in the wake of disasters.

Medical infrastructure is especially vulnerable in a warming world and losing or weakening its capabilities, even for short periods, leaves lasting scars on afflicted regions, whether New Orleans or New York. As disasters become more frequent and costly, health officials are desperately searching for ways to shield themselves from future problems without learning the hard way (ClimateWire, Oct. 18, 2013.)

"The health sector has this unique role in the community when it's impacted by high-impact weather," said Shalini Mohleji, a policy fellow at the American Meteorological Society Policy Program. "It really affects how that community can respond and how that community can recover."

Ambulances at Columbia Hospital. (Credit: Flickr/uberzombie)

Mohleji directed a study from the American Meteorological Society issued late last month highlighting the risks hospitals face from threats like tornadoes and floodwaters. The report also outlined general strategies mitigating future harm.

As storms like Hurricane Ike and Superstorm Sandy showed, hospitals often have critical components like backup generators and elevator hardware in flood-prone spaces like basements. The unseen bowels of these buildings also house computers that track patient records and expensive MRI machines. These machines make hospitals energy hogs that are the first to notice power disruptions.

When the water pours in, the ill and immobile -- those already in a precarious situation -- stand to suffer the most, often at the most dangerous times. This happened during Superstorm Sandy, when volunteers in Manhattan hospitals carried patients down flights of stairs to ambulances as the lights flickered out (ClimateWire, Aug. 12, 2013).

The trouble is that such disasters are infrequent. When they strike, many hospitals are facing them for the first time or have a false sense of security after past near-misses.

The solution, Mohleji said, is risk management -- identifying threats, figuring out which ones you can tolerate and preparing for the ones you can't.

Much to be done

Preparations include physically hardening buildings and erecting floodwalls. Incremental adaptations, like moving pumps and machinery to higher floors, are another important strategy. Hospital administrators should also rethink how they operate, like incorporating diverse redundant systems. This could mean using solar panels to augment backup diesel generators.

"Resiliency is really something that can be improved through successful risk management," Mohleji said.

Though the brick-and-mortar aspects are the most visible parts of medical infrastructure, how people anticipate and respond to disasters is crucial to medical resilience, as well, whether they are doctors, public health workers, chronically ill patients or the public.

"It's really necessary that everyone that's involved in a city be considered a part of the [health] community," said Lewis Goldfrank, a professor and chairman of emergency medicine at the New York University School of Medicine.

A hospital that survives a storm but is evacuated leaves a void in the health system as doctors and patients are rerouted to other facilities, said Goldfrank, who contributed to the report. This creates a logistical nightmare of tracking people during the apex of a disaster and drastically slows how hospitals recover. NYU Langone Medical Center, for example, only reopened its emergency room in April, almost 18 months after Sandy struck.

Meanwhile, the people least equipped to deal with these problems, such as those who are impoverished and infirm, become the most vulnerable as their neighborhood clinics sit idle. The way through this, according to Goldfrank, is to assess health resiliency at the community level, establishing a base line of care among the people a hospital serves and a path to restore that standard of care following an extreme weather event.

"In these big public health emergencies, you need to be able to draw on research about how well every community works every day," he said. "You need to know what they feel about how the city works [in order to] create this long-term collaboration."

This entails broader societal changes, from how we prioritize care to how facilities share resources to where we build hospitals under a changing climate, but it's an ongoing process. "We're all going to have to work hard to deal with these terrible tragedies," Goldfrank said. "We certainly need to do more."

Reprinted from ClimateWire with permission from Environment & Energy Publishing, LLC. 202-628-6500.

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