A 'bomb cyclone' hovers over the central United States in March, leaving flooding in its wake
Photo courtesy of NOAA/Center for Satellite Applications and Research
Mother Nature can pack a powerful wallop, often with little advance notice. Case in point: the “bomb cyclone” that wreaked havoc across the central United States in the form of rain, snow and high winds this past March. Record flooding in these areas caused some health facilities to evacuate or halt operations.
Organizations breathing a sigh of relief that they were spared shouldn’t relax for long; the National Oceanic and Atmospheric Administration cautioned in its spring forecast that “the stage is set for record flooding,” possibly eclipsing the catastrophic flooding seen in 1993 and 2011 and impacting an estimated 200 million Americans.
“The truth is that most communities face severe weather or threats today that could result in casualties that could overwhelm an unprepared hospital,” says Kevin Yeskey, M.D., principal deputy assistant secretary for preparedness and response at the Department of Health and Human Services. “Hence, being prepared is crucial. It means being able to save lives and prevent morbidity resulting from a disaster. Plus, the man-made deleterious economic impact on your [reputation], and the lost revenue from facility damage and possible closure can far outweigh the costs of preparedness.”
John Koch, P.E., associate partner with Jaros, Baum and Bolles, consulting engineers in New York City, agrees being ready for weather emergencies like floods is a necessity.
“The local community relies on hospital facilities being continuously operational, regardless of any weather event. Therefore, it is imperative that health care institutions remain online once the weather event has passed in order to continue to serve the community,” Koch says.
Research from the U.S. government’s Fourth National Climate Assessment (https://nca2018.globalchange.gov/) shows that many hospitals are at inundation risk from storm surges along the East Coast during hurricanes.
“We have also demonstrated that a large number of hospitals across the country are at risk from flooding inland when we compare the location of these facilities with the flood risk zones designated by FEMA,” says Shubhayu Saha, health scientist with the Centers for Disease Control and Prevention. “These findings raise concerns around the extent of preparedness of these facilities, taking into account the environmental risks that are likely to increase in the future with climate change.”
The country’s aging infrastructure doesn’t help matters, either. “Bridges and roads can easily get washed out. Power can be lost for long stretches. The water supply can become contaminated or inaccessible. Hospitals have to think about all these vulnerabilities and what they’re going to do when resources aren’t accessible due to a flooding event,” notes Chad Beebe, AIA, FASHE, ASHE’s deputy executive director for advocacy.
Better flood planning is particularly needed today in the wake of recent Centers for Medicare & Medicaid Services regulations, too.
“CMS put its emergency preparedness rule into effect in late 2016, triggered by a number of natural disasters like Hurricane Sandy,” Beebe says. “As more flood events continue to happen, we can likely expect a flurry of additional new regulations to come.”
Yeskey believes many health care facilities are more prepared now to weather a storm and endure a disaster than they were 15 years ago.
“Recent flooding disasters have shown that health care facilities are better prepared to shelter in place and have improved plans to evacuate before reaching an extreme situation,” Yeskey says. “However, there is still work to do. Hurricane Sandy in 2012 showed us that the need to prepare is never complete.”
Koch echoes that sentiment.
“Sandy was an eye-opener for all types of services and industries that rely on infrastructure systems for continuity of business and services. After the event, we saw a major focus toward upgrading and elevating infrastructure and providing resilient designs that are flexible to strategically plan for future climate change and uncertain weather patterns that may occur in the future,” Koch says. “In addition, we are seeing hurricane and major storm preparation drills and action plans being implemented into an organization’s regular operational workflow.”
Terry Elliott, director of construction programs for Harris Health System — which includes Ben Taub Hospital, a Houston facility that suffered flooding in 2017 — says health care facilities have historically focused on events that they have either previously experienced or are likely to occur, given their location.
“While these are considered best practice risk management activities, the problem is that major flooding events are occurring with greater frequency and magnitude,” Elliott cautions. “While health care systems may not be able to afford to have a complete flood-proofing system in place, they can preplan for the events, identifying the most critical infrastructure elements to protect, and engage subject matter experts to assist with the risk assessments that should be part of every hospital’s planning.”
Another potential weak spot? Health care providers, operations and maintenance staff, construction and facility planning team members, and emergency planners aren’t always on the same page when it comes to hazard preparations.
“If you can bring these groups together to develop a plan, then you will have the support of your entire institution,” says Matthew L. Berkheiser, DrPH, CIH, CSP, associate vice president and chief safety officer at the University of Texas MD Anderson Cancer Center in Houston, which endured Hurricane Harvey relatively unscathed two years ago.
What’s at stake
Kate Renner, AIA, EDAC, architect and design researcher with HKS Inc. in Washington, D.C., says the repercussions of being unprepared are wide ranging and can include life safety threats to building inhabitants, lack of access to critical care, building and infrastructure failure, downtime, costs incurred for repair, community impact and travel disruption, and costs incurred for a partial or complete rebuild.
Yeskey says some health care organizations are more susceptible than they think, even if they’re not located in a flood plain.
“Flooding can happen almost anywhere in the country. And, like any type of disaster, it can overwhelm health care facilities,” Yeskey says. “Also, while a flood may not directly impact a hospital, the loss of a region’s power supplies, transportation, potable water, wastewater handling or communications can adversely impact hospitals. Flooded or obstructed streets can prevent patients and supplies from reaching hospitals. Flooding inside a facility can mean fire hazards, exposure to toxic chemicals and infectious waste. Loss of electricity can result in loss of services and a patient care environment that is too hot or too cold for patients and staff.”
Facilities lacking measures to withstand flooding, such as elevated mechanical, electrical and plumbing infrastructure, may also be forced to close due to the inability to maintain life-saving systems.
“In catastrophic failures of systems such as these, facilities are forced to decant patients to other facilities, which may face similar challenges. Access to key entries and services, such as the emergency department, operating rooms and intensive care units, also may present challenges that result in the facility going on diversion or closing entirely,” Renner says.
Kelly Kalkowski, administrator/CEO of Niobrara Valley Hospital in Lynch, Neb., says even though damage was minimal in his facility after the major Midwest flooding event that occurred in March, it was a costly and inconvenient incident.
“Two of our patients had to be evacuated, we closed our doors briefly and power was temporarily lost on the first day of the flooding,” Kalkowski says. “Out here in Nebraska, we’ve come to expect these kinds of floods. Only this time around, we had very short notice to prepare — probably six hours.”
Health care organizations need to make plans to better prepare for, respond to and recover from a weather disaster. Each part of this plan has its own challenges. Some key points include:
Before. Planning should start well before an event by conducting a hazard vulnerability assessment. “Best practice would be to do this building by building, because organizations may have regional hazards to consider or the age of the building may be a factor,” Berkheiser says.
Next, leadership should assess how flood-prone their facility is. “Knowledge on the underlying risk of flooding can be beneficial in the design of contingency plans to ensure the integrity of the facility as well as ensuring continued access to care for patients,” Saha says.
Additionally, “examine your location related to the elevation above sea level and understand if you are in a flood prone area,” Berkheiser suggests. “Start at your front doors, look in your basements and understand how water can get into your buildings.”
Koch says organizations need to be proactive in protecting their buildings from water infiltration. “Incorporate dry flood-proofing construction techniques into the overall building construction in conjunction with incorporating permanent flood barriers to protect building entrances and exits,” Koch says.
Generators, HVAC systems and other mechanicals located on or below main levels are at risk during a flood. Hence, aim to elevate all existing critical infrastructure above the design flood elevation.
“Partner with local and regional emergency organizations,” Yeskey recommends. “Participate in community planning and exercises, and get every single employee involved in drills.”
It’s also smart for facilities to have a staffing support, discharge and relief plan. A flood can have traumatic psychological effects on staff, some of whom may have lose their homes and belongings, says Yeskey.
When planning, organizations must not forget about vulnerable populations like chronic care patients or the elderly and their special needs, or the general community beyond the front door. “Educate your community,” Renner says. “Residents should also be prepared for a flooding event, which enables them to be resilient.”
Lastly, and arguably most importantly, facilities should build flooding scenarios and preparation, response and recovery steps into their emergency operations plan.
During. When a severe weather event hits, an organization’s careful preplanning can pay off. The first step recommended is to execute the emergency operations plan. If necessary, “prepare to evacuate patients with their records intact and with ways for their families to find them,” Yeskey says.
Leadership shouldn’t be afraid to think outside the box, however.
“Consider setting up triage tents in your parking lot to screen out patients who do not present with life-threatening emergencies, which can keep a partially closed hospital functioning without becoming overwhelmed,” Yeskey suggests. “Also, consider consolidating functions like labs, radiology and surgery on one floor so your facility can continue to provide patient care.”
Additionally, Yeskey stresses the importance of partnering with local or regional resources.
“Try to respond together as a health care coalition versus trying to respond alone. After flooding from Hurricane Harvey in 2017, Texas health care coalition members worked together in the state’s command center to route patients appropriately to open beds,” Yeskey notes. “That routing kept facilities from becoming overwhelmed and saved lives. They even used airboats to move patients.”
Also, facilities should work closely with suppliers on plans for resupply when roads are damaged.
“You may need to find alternate suppliers or work with law enforcement in advance so your suppliers will be allowed into the affected area,” Yeskey says. “Health care facilities and services — not just hospitals — that are not part of a health care coalition can contact their state health department about joining one.”
After. Recovering from a flood or other weather emergency takes coordinated effort. Renner advises first assembling a multidisciplinary team of experts. “Have them assess the immediate damage and determine what is needed to bring the facility back into operational status,” Renner says.
The facility will also need to work quickly to repair flood damage and replace equipment and supplies as well as provide support to affected staff. “Facilities can recover more quickly when plans are in place to support staff with counseling, time off and resources,” Yeskey says.
Organizations should give careful thought to the improvements they want to make, too.
“Some communities have rebuilt to add green space around health care facilities instead of swaths of concrete, because green space increases water absorption, which results in decreased flooding,” Yeskey notes. “Other communities have woven canals into the cityscape to beautify the area and decrease flooding.”
Considering how devastating a flooding event can be to a hospital, nursing home or other health care facility, and the increasing frequency of these and other severe weather events, it’s important for health care organizations to reassess their abilities to withstand Mother Nature in her full fury.
Devising or updating a facility’s plan to properly prepare for, respond to and recover from a flooding incident should be a top priority, the experts concur. Because hoping for the best and assuming planning is up to par can easily put an organization under water — in more ways than one.
Erik J. Martin is a freelance writer based in Oak Lawn, Ill.