Hurricanes set new normal for hospital disaster prep
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Back-to-back superstorms have tested health systems' ability to turn tabletop crisis exercises into reality on a dime as they raced to keep their facilities operational in the face of dangerous storm surges.
Why it matters: They largely passed the test. But the one-two punch of Hurricanes Helene and Milton exposed the need for better preparations and costly infrastructure upgrades.
The big picture: Climate change is making weather more unpredictable and deadly due to soaking rains and unexpected effects like tornado outbreaks.
- It can be difficult to determine which facilities to evacuate and which to shore up to ensure they can stay open amid shifting flood patterns and uncertain track forecasts.
- "That is the new normal, and that is what health care organizations are not necessarily ready for," said Attila Hertelendy, lead author of a study on hospital preparedness published in The Lancet last month.
Between the lines: Health systems in Florida are accustomed to hurricanes and largely avoided heavy damage this time by hardening their facilities, said Mary Mayhew, CEO of the Florida Hospital Association.
- But in increasingly flood-prone areas, it's gotten more difficult and expensive to stay dry and safe.
Case in point: Tampa General Hospital's deployment of an Aqua Fence, a massive temporary barrier erected around its main hospital building, kept dangerous storm surges from swamping the facility.
- Other health systems have invested in other forms of mitigation. But even so, an HCA hospital in the Tampa Bay area had to evacuate patients after flooding from Milton into the facility's basement cut off power.
Go deeper: Health systems are also also facing aging and fallible public infrastructure, which can complicate emergency responses.
- Sewer and water systems had to be taken offline to protect against damage from storm surges during both hurricanes and, in some cases, failed altogether.
- A similar situation in the wake of Hurricane Ian, in 2022, led some hospitals to begin investing in on-site wells to ensure they have enough water for cooling and fire suppression, Mayhew said.
Between the lines: While teaching a class on crisis preparation with the American College of Healthcare Executives this summer, Hertelendy said the majority of executives polled did not feel adequately prepared for large-scale emergencies.
- Helene especially drove home how areas further inland that aren't used to the extreme rain and flooding need to reevaluate their risks.
- 54 patients at a hospital in Blue Ridge Mountains east of Knoxville, Tennessee, had to be evacuated to a rooftop to avoid unexpectedly fast rising waters that made escape impossible.
While many hospitals may be meeting the minimum emergency preparedness requirements of their accrediting body, the Joint Commission, they are not performing frequent-enough or realistic-enough drills to identify gaps and keep staff well versed in the plans.
- "You cannot be prepared by just doing a tabletop exercise, we have to actually do real, live simulations," Hertelendy said.
- All of this is important to maintain resilience at a time when hospitals are dealing with constricted budgets and a drained workforce, he said.
- "This ability for people to recover is is really challenging," he added, noting many hospitals haven't yet recovered from the pandemic.
What to watch: Among the concerns Hertelendy raised is the threat of what are known as "poly events," where organizations could be simultaneously hit with a natural disaster and a nefarious event such as a cyberattack or even a terrorist attack.
- "Hospitals have not drilled for this," Hertelendy said. "We are not ready."
Editor's note: This story has been corrected to reflect that hospitals invested in wells to ensure water for cooling (not cooking).
