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.

In 2001, Tropical Storm Allison left a path of destruction that started in Texas and continued through the Southeastern United States and the Mid-Atlantic, resulting in $9 billion of damage and 41 deaths across six states. Houston was hit hardest, where a deluge of almost 40 inches of rainfall over five days caused devasting flooding that affected 2 million people in the metropolitan region.

At the time of the storm, Mark Kenneday, CHFM, FASHE, CHC, director of market strategy and development, health care at Gordian, was the director of facilities operations at Texas Children’s Hospital, Houston, part of the Texas Medical Center. The aftermath and devastation of Tropical Storm Allison are etched in his memory.

“You could see water had been up on the side of the building 7 and a half feet high,” Kenneday says. “All the basements of the surrounding institutions were flooded. The only lights on in the west side of the medical center were at the hospital. Every other facility was dark. All of the infrastructure, all the diagnostic and therapeutic equipment, all the research animals, years of research, everything was completely destroyed. It was a catastrophic event at the largest medical center in the world.”

The damage to Texas Children’s Hospital was substantial, even though Kenneday foresaw the flood threats and his facility had just completed a series of flood protection projects, including carbon fiber-reinforced waterways and pneumatic flood doors. The rainfall in Houston resulted in fast-moving and tremendous quantities of water pouring into the three-level basements of adjacent facilities, which included space leased by Texas Children’s Hospital for operations.

“Tropical Storm Allison drove a number of changes — such as the installation of flood doors, flood gates and flood hatches — because of the amount of damage the facilities sustained due to water intrusion,” says Bert Gumeringer, CHFM, FASHE, senior vice president of facilities operation and supply chain at Texas Children’s Hospital.

Gumeringer says the experience of Tropical Storm Allison also led to the creation of a flood management group where certain hospitals that were along a common below-grade pedestrian tunnel would work together to close watertight doors to essentially partition off facilities to keep water out.

In the aftermath of the storm, changes in the design of facilities became one long-term strategy for addressing flood threats, says Michael Hatton, FASHE, CHFM, vice president of facilities engineering and construction at Memorial Hermann Health System, Houston. For example, hardening at existing facilities meant raising critical systems and equipment as well as completely eliminating basements in the design of new facilities.

“Utility systems have traditionally always been placed in basements of hospitals,” says Hatton, “Numerous storms in the last 20 to 25 years have proven that that is not a good strategy for longevity and for being able to continue operations because if you get a weather event and you’re near any sort of river-type system or along a coastal area, you’re probably going to have some flooding.”

While the impacts of hurricanes and storms can be devastating, they are not the only cause of flooding events. Winter Storm Uri brought a combination of freezing temperatures, ice and snow to Texas in 2021. Facilities experiencing power outages due to the storm subsequently had internal water leakage or flooding due to burst pipes.

“It can be very debilitating if that flooding is on a clinical floor,” says Gumeringer. “Very quickly, in a matter of minutes, you can have a whole floor inundated with 4-6 inches of water. But the team here [at Texas Children’s Hospital] is really good at managing those events, and it’s an all-hands-on-deck approach. Our housekeeping staff come with wet vacs, and our engineers turn off valves. We’ve got a couple of contractors on standby, and we have a water remediation company or water restoration company on retainer.”

Gumeringer says the leadership of his organization was very forward-thinking around flood mitigation, and flood mitigation measures were put in place early. As a result, Texas Children’s Hospital facilities have been able to able to effectively contend with storm threats. He notes, however, that local and regional flood preparation beyond the facility itself can greatly influence the impacts and outcomes of flood-related events.

“Over the years, the Army Corps of Engineers continued to widen the bayou [in Houston] so it could handle more flow, and all of that work has been completed,” Gumeringer says. “During Hurricane Harvey [in 2017], which was another major significant event, the bayou never overflowed and it was able to handle all of the water coming through. But other parts of the city were inundated from that storm.”

For Memorial Hermann, experience with more recent hurricanes indicates that the facilities are prepared to deal with the impacts of flooding, but the broader regionwide impacts can hamper response and recovery. In fact, the most significant challenge after Hurricane Harvey was that Houston’s major roads and thoroughfares were flooded, the city shut down and access to the hospitals was difficult, Hatton says.

“During Hurricane Harvey, we actually needed boats to get to and from one of our campuses because there was so much flooding around the perimeter of the hospital that you couldn’t get supplies to and from it,” he says. “If you have basic toiletries, sleeping arrangements, and food and water for people and [standard operating procedures] in place, people can stay at the facility for an extended duration.”

Key to planning and preparing for flooding is understanding the intricacies of the facility and its location, particularly what is needed for longer-term, shelter-in-place responses.

“Know where your weaknesses are, and understand where you can [fortify] potential water intrusion points,” Gumeringer says. “But also know where resources are within the community. It might be something as simple as bottled water. Where do you go to get that? It’s too late to ask that after the storm, and once these events hit, you cannot buy any of those things.”

Gumeringer says that having all the needed resources on hand has been a priority for leadership at his facility. While he realizes that smaller community hospitals might not have the same resources and support, he believes those facilities can nevertheless take essential steps necessary to prepare for flood threats.

“They still can plan to sequester sheet rock and to buy plywood in advance of any of these major events,” Gumeringer says. “They can understand water patterns and water flow, where the bayou is, where the Corps of Engineers has a diversion channel. And then you’ve got to know who your contacts are in city and state agencies and within your own institution.”

For new construction, flooding preparation starts early in the planning process.

“When you’re buying land or getting ready to site a hospital or an office building, you need your civil engineer to study the flood maps,” Hatton says. “We typically site every one of our new buildings above the 500-year floodplain. On a coastal plain, it’s a real issue because sometimes as little as 18 or 24 inches of elevation can get you out of those flooding risks.”

In the more than 20 years since Tropical Storm Allison, many lessons have been learned about protecting health care facilities from flooding. Still, the process will continue to evolve as climate change leads to more extreme climate events and greater flooding threats.

“The preparation and recovery strategies that we developed before and after Tropical Storm Allison have been used across the country,” Kenneday says. “With climate change, there’s a legitimate concern that all coastal areas and areas near large waterways should be focusing on [flooding], regardless of their geographic location. Anyone who doesn’t believe in a climate action plan just needs to see what’s actually going on in the world.”

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 a collection of resources for health care facilities preparing for flood threats, including lessons learned and planning and response tools.
• The Federal Emergency Management Agency’s Flood Map Service Center provides flood hazard information, including flood maps, flood hazard products and risk assessment guides.
• The World Health Organization’s floods and health fact sheet for health professionals reviews flood threats, flood preparedness and response and recovery during and after floods.
• The U.S. Climate Resilience Toolkit includes resilience information for flooding, sea level rise, high tide flooding and inland flooding.
• An article by the National Oceanic and Atmospheric Administration looks at the National Climate Assessment and the impacts of hospital flooding from hurricanes.