New York City Health Care Systems did its best to prepare for Hurricane Sandy in 2012.
Some had built flood barriers that could handle a storm surge of up to twelve foot – more than two feet higher than ever in the area. Then the storm hit and the tide was turned on fourteen feet. Water gushed into hospital buildings and blocked backup generators. The strength went out. The staff had to evacuate an estimated 6,500 patients. Five hospitals closed in the city.
Sandy became a regional wake -up call about the need to support the physical infrastructure of health facilities against climate -related extreme weather events. Hospitals cannot deliver the required supply if storms or heat waves switch off electricity, tear off the winds from the roof, freeze the temperatures, freeze pipes or forest fires suffocate clinics with smoky air.
“If you make sure that the walls are intact, you can help your patient's health, just like an inhalator for your asthma,” says Tess Wiskel, HMS trainer for emergency medicine at the Beth Israel Deaconess Medical Center. “Thinking about the infrastructure and resilience of health systems will improve patient care and prevent unnecessary morbidity and mortality.”
Climate change already increased the risk of damage to the physical infrastructures of hospitals by 41 percent worldwide and 38 percent in the United States between 1990 and 2020. This goes from an analysis of XDI (the cross -dependency initiative), which was used part of a group of companies to quantify and communicate the costs of climate change. The report estimates that a high risk of partially or complete closures from extreme weather events is exposed to twelve hospitals by the end of the century, including 477 in the USA. Researchers also document hospital damage to extreme weather events and calculate the interrupted care in the following months.
“I think that health systems wake up for this,” says Gregory Ciottone, Associate Professor of Emergency Medicine in Beth Israel, founding director of the BIDMC scholarship for catastrophe medicine and global expert on medical readiness for disasters. “The conversation increases because we see dramatic weather events in the USA and globally.”
However, the campaign does not yet reflect the operations.
“I think that it is essential for hospital leaders to investigate which damage limits are necessary to ensure that their institutions do not fail during the climate and are not able to serve their communities,” says Paul Bidditioner, Chief Preparation and Continuity Officer at Mass General Brigham and an HMS Associate Professor of Emergency Medicine. “Unfortunately, I don't think that this problem still gets appropriate attention.”
Facilities that receive Medicare and Medicaid funds must carry out vulnerability analyzes at risk every year. However, studies indicate that only about 20 percent of the US health systems have evaluated climate threats for their infrastructure, said Bidditioner. In addition, danger calculations are taken into account based on historical weather data Rhode Island Medical Journal in 2021.
In view of the importance of the problem, the members of the HMS community have taken over the leadership roles in raising awareness, creating guidelines for medical centers and building and retrofitting with climate change.
Learn from the front of the front
Tool kits, reports and other materials can support health systems by centering the problem and exchanging information and best practice.
Faculty and students of the HMS and in the center for climate, health and the global environment (C-change) at the Harvard Th Chan School of Public Health, including Wiskel, have come together with the non-profit Americares to carry out a national survey and to create climate resilience for frontline clinics that were updated in August 2024. Cambridge Health Alliance. The healthcare climate of the healthcare system, which has the mass of General Brigham among its members, includes the infrastructure in the publication “Climate Action: A Playbook for Hospitals”. Groups such as the WHO, the US Ministry of Health and Human Services as well as the National Oceanic and Atmospheric Administration have also provided alarmed increases and advice.
HMS miters offer further data and case studies. Last year alone, Ciottone and colleagues Best Practices released from the forest fires of Los Angeles, Hurricane Helene and extreme heat, droughts and fires.
Recommendations are carried out by the bandwidth, including the acquisition of backup current and communication systems. Increasing the critical infrastructure over the likely flood heights; Install particle filtration; Setting an expert in disaster medicine or naming a lead of weather resilience that can advise on risk and infrastructure improvements; Procurement of emergencies in advance in the case of medical supply chain failure, as followed by the hurricanes Maria and Helene; And procedures for repairing and re -entry of facilities according to weather -related damage.
The need for an action extends to Boston. Alexandra Tarabochia-Gast, MD '17, has a 2022 study in Coauthoring in Geohealth These quantified flood risks for hospitals along the east coast. After only the U -Bahn area in Miami and New York, Greater Boston took third place for the predicted effects of a hurricane in category 2. Ciottone quotes youngest summer villages, small local forest fires and smoke that reached the city from Canada as local examples of climate medical challenges. The Boston Globe reported that four emergency rooms in the city had to reject the patients during a historically cold weekend in February 2023 after pipes were frozen and planned, which flooded the facilities.
Building for the future
Partners Healthcare (now Mass General Brigham) took into account the destruction of the hurricane Katrina, which was arranged on the golf coast on the golf coast in 2005, and built the new Spaulding rehabilitation hospital, which was completed in 2013, and built the essential mechanical and electrical devices of the hospital, including backup generators. The first floor was installed thirty inches above the five hundred -year flood line to prepare for the forecast increase in sea level during the eighty -year lifespan of the building. Triple -glazed windows and parasols areolating from extreme heat and cold and can be activated for ventilation in an emergency. Berms, drainage systems and a green roof can reduce heavy rain and floods. There is a storage for at least four days with essential supplies. These and other innovations prompted the healthcare climate to describe Spaulding as “one of the most sustainable and resilient hospitals in the country”. The partners made the full application for a proposal for the design that others can adjust.
The effects of Hurricane Sandy in the New York subway area motivated the partners to investigate his weaknesses for the future climate in Boston, and General Brigham will continue to be included in his decision-making. Several hospitals began to redesign their HLK systems in order to cope with higher cooling loads and increase redundancy in the event of a power grid error. Other rensics facades and roofs to withstand wind speeds that had previously been relegated to places such as Miami, but were now expected in Neugland.
“Some of the forecasts were amazing and led to construction principles that we would never have been busy,” wrote Baugh, bidditioner, and her co -authors in their newspaper 2021.
A clinical building that is built at Mass General is to withstand an increase in sea level, rainfall and over 90 degrees over 90 degrees in the next fifty years. It can also work independently for up to four days and double its occupancy to absorb patients from older, less resilient parts of the hospital during emergency, says Biddinger.
Boston Hospitals also learn from the success of other health systems. Messe General Brigham is considering obtaining the same flood lock that the Tampa General Hospital protected while the Hurricane Helene and Milton.
Take the long view
Protecting the infrastructure requires money and must compete with other financial priorities from the hospitals. However, experts quote several reasons for the investment.
First, repeat that climate change is inevitable and, as in patient care, prevention is cheaper than the repair after discharge.
“Crossing your fingers and hoping that something doesn't happen is not a good strategy for disaster prevention,” jokes Ciotton.
WiSkel learned to change people by changing their verbs: “Not” flooding could do this in our hospital, but “to become floods”. ”
Second, the costs may not be as high as they feared when they are included in plans at an early stage. Spaulding estimates that the characteristics of climate sensitivity only make up 0.3 percent of the building sample because they were embedded in the initial design.
Third, individual health systems do not have to prepare for all eventualities at a time. You can identify the climate risks that apply to your region and prioritize them according to probability, expected effects and the institutions currently provided. Decisions can be planned for short or long -term and retrofitted or new construction work.
Preparing for the climate and other emergencies – including, but not limited to infrastructure considerations – Ciottone increases the financial, operational and energy efficiency of hospitals.
Such a willingness is to take into account the infrastructure that enables employees and patients to get into hospitals to plan and practice emergency procedures and to coordinate with other health facilities and the local government. It is all part of the strengthening of a health system that is both decisive and fragile.
“The US hospital system is already beyond capacity in many places.” We are all extremely dependent. “
Stephanie Dutchen is an editorial director in the HMS office for communication and external relationships.