Editor’s note: This article is part of a series on the impacts of climate change and climate events on hospitals and health care facilities and related planning, preparedness and response efforts.

Severe and destructive hurricanes have become a regular occurrence. In terms of named storms, 2021 was the third most active year on record, according to the National Oceanic and Atmospheric Administration. Last year’s Atlantic hurricane season, which runs from June through November, included seven hurricanes. Four of those were major hurricanes, Category 3 or above, with winds of 111 miles per hour or greater

Hurricanes impacts can be substantial in terms of cost, lives lost and long-term recovery. The costliest Atlantic hurricanes after Hurricane Katrina in 2005 have occurred in the last decade: Hurricane Sandy in 2012; Hurricanes Harvey, Maria and Irma in 2017; and Hurricane Ida in 2021. The United Nations Intergovernmental Panel on Climate Change anticipates the frequency of extreme weather events, including Category 4 and 5 hurricanes, will increase in the future as the result of climate change.

For health care facilities, hurricanes can cause extensive damage to building structures, systems and infrastructure. Facilities may experience utility interruptions, including power outages and water supply disruptions. Sheltering in place requires that building functions be maintained, and evacuation of facilities may be necessary. Recovery and cleanup teams must be prepared to contend with mold, electrical hazards and hazardous materials.

Hurricanes often bring strong winds that can damage the roof and exterior of a facility, which can in turn exacerbate the impacts of heavy rains, says Larry Rubin, CEM, CHC, CHFM, CHSP, CPE, senior director of facilities and support services at Moffitt Cancer Center, Tampa, Fla. In the case of Rubin’s facilities, hurricane winds have caused external damage that then resulted in water damage inside the building.

“At a previous facility, we had mushroom exhaust fans on the roof,” Rubin says. “During one hurricane, the wind was 60 or 70 miles an hour and lifted up the fans and the water came straight down. So here at Moffitt, I made sure that all the screws on the exhaust fans were stainless steel so they won’t corrode, and we check every single exhaust fan to make sure all the fasteners are in place.”

Rubin is also familiar with utility outages, an expected occurrence that is part of emergency management and disaster planning at Moffitt Cancer Center.

“Tampa is the lightning capital of the United States, and we’re used to losing power,” he says. “You need power to run your sump pumps and lift stations, and so everything has to be on emergency power. We have quite a few generators, we’re prepared to run around the clock and we have the adequate amount of fuel for over 72 hours.”

Preventive maintenance is also key for hurricane preparation and planning, Rubin says. Clearing sewers and lift stations and checking any areas that could flood and take down the power are all essential activities.

“If you’re getting ready for a hurricane, you have to make sure that you’ve done all your preparation correctly,” he says. “At the beginning of the hurricane season, we go up and we take a hose and flood every roof drain to see if it’ll pass water. With a hurricane, it’s not just a lot of rain, but it’s sideways rain. So it can come in through your air handler intakes and do a lot of damage to your filters.”

Rubin says he and his team also make sure that everything is tied down correctly and pick up anything that can go flying. In May or June, before the hurricane season starts, they trim all trees and bushes in preparation for high winds and heavy rain. “Those are from lessons learned, and you don’t want to go into hurricane season not prepared,” he stresses.

However, the severe wind and rain impacts of a hurricane can affect a facility in some unexpected ways, even with the best planning and preparation in place. For example, Rubin says that his former facility used ballasted roofs with small pebbles to protect the asphalt.

“Unfortunately, they sometimes have loose pebbles so when you get a tornado or a hurricane with high winds, what do those little stones become? Machine gun bullets that will take out your glass and do a lot of damage,” he says. “I’ve always made sure we put down the right roofs that are the right design and will take 140- to 160-mile-an-hour winds. We’re very careful here and prepared as we know what’s going to happen.”

Rubin points out that hurricanes offer some advanced notice compared to other weather events such as tornadoes. Knowing a hurricane is coming helps immensely with preparation. In those three to five days before a hurricane hits, a facility can gather needed supplies, fuel, water and food as it implements a shelter-in-place protocol.

The advanced notice also allows time for evacuation, if needed. The well-being of patients is the priority and, as challenging as evacuation may be, remaining at a facility may not be feasible. As a result, health care facilities also need to prepare for evacuation scenarios, says Zachary Goldfarb, EMT-P, CHEP, CHSP, CHSO, president of Incident Management Solutions, Inc. and an emergency management consultant.

“The question often is, ‘Am I better off evacuating before the storm on a sunny day when there’s no threat and everything looks beautiful?’” Goldfarb says. “‘Or am I better off waiting until the storm comes?’ But if you wait until the storm comes, you could end up with devastating damage in the middle of the storm where patients are sheltering in the hallway and the roof is blowing off. At that point, evacuation may no longer be a safe option.”

Goldfarb also says the focus on coastal storm threats means that different weather patterns can lead to unanticipated impacts, even when it is clear a hurricane is on its way. For example, Hurricane Ida made landfall in Louisiana and then moved inland and toward the Northeast. It was downgraded to a tropical depression, and tropical storms are fairly routine in New York.

“No one was overly concerned about Hurricane Ida, and it certainly didn’t pose any coastal threat,” Goldfarb says. “But what happened was a tremendous amount of rain in a very, very short time period. If you were in any low-lying area, you were going to have extensive street flooding from stormwater inundation, possible overloading or backflow of your sewer systems, water flooding into the facility. Since those impacts weren’t foreseen, nobody was evacuating before the hurricane. One of the lessons from Ida was the inclusion of stormwater inundation as a new threat in many facilities’ hazard vulnerability analyses going forward, with resultant mitigation and preparedness activities.”

Ultimately, Goldfarb says, planning for hurricanes involves preparing for the most severe impacts imaginable.

“What we’ve learned from Hurricane Sandy and Hurricane Katrina is that whatever you think ugly could look like, it could be worse,” he says. “So your planning shouldn’t be for just shy of ugly because you think it’ll probably never happen here. It’s important to start considering what is a realistic, plausible, worst case scenario and to prepare for that.”

Learn More

The Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) has compiled resources and information related to hurricanes, including lessons learned and plans, tools and templates.

The Centers for Disease Control and Prevention (CDC) recently updated Hurricane Resources at Your Fingertips, an extensive resource guide that includes a section specifically for hospital facilities emergency managers.

The CDC has also compiled resources related to remediation and infection control for health care facilities reopening after extensive water and wind damage and disaster site management and hazards.

Weathering the Storm is a hurricane planning, response and recovery toolkit from the New Jersey Hospital Association.

The U.S. Department of Health and Human Services conducted a study looking at the experience of hospitals during Hurricane Sandy and challenges and gaps in preparedness and planning.