Hospitals can still be better prepared for natural disasters

The ongoing impacts of climate change have meant an increase in the frequency and severity of storms. A recent study from the Massachusetts Institute of Technology in Nature Communications looking at the past 150 years found that major hurricanes are more frequent than in the past, and those that make landfall are more powerful and destructive. Within the past 20 years, we have experienced the destructive power of Hurricanes Katrina (2005), Irene (2011), Sandy (2012), and Maria (2017), which left massive devastation and death across the Southern US, East Coast, and Puerto Rico.

Fire-related threats are on the rise as well, driven by rising temperatures and drought. According to the National Interagency Fire Center, the most destructive wildfires have all occurred since 2004.

And climate change has changed the sorts of storms that hit, which can leave states woefully unprepared. This happened in February 2021, when Winter Storm Uri hit Texas, unleashing frigid temperatures and historic snowfall—including up to 6 inches in Austin. Ice blocked all means of electrical generation—from natural gas pipelines to wind turbines—and left 3.5 million without power. As the power shut down across the state, so, too, did people’s dialysis and oxygen machines. Hospitals did not have usable water. When Texas’ more than 400 dialysis centers closed, those 34,000 patients went to hospitals, which had to keep machines running around the clock and ration services in an attempt to meet demand.

“In Texas, they are prepared for heat and tornadoes, not for frozen water,” says Gail Horvath, MSN, RN, CNOR, CRCST, patient safety analyst and consultant with ECRI, the nation’s largest federally designated patient safety organization. When hospitals were affected by winter storm Uri, ECRI was able to help them manage an unexpected emergency. “We created step-by-step job action lists to perform once the boil alerts had been lifted to guide them in safely bringing sterilization and high-level disinfection equipment back online. By following these actions, the hospitals were able to then resume elective surgeries.”

During natural disasters, the number of elective surgeries drops by as much as 20% for the most severe hurricanes, according to one study from the National Bureau of Economic Research. But hospitals are at the same time faced with a surge of patients seeking emergency services and may be themselves restricted in their capacity due to weather conditions, lack of supplies, or shortage of beds. And studies have found that patients remain in hospitals longer following a post-casualty event.

When Hurricane Sandy hit the Northeast in 2012, some hospitals were left in chaos. “It didn’t really occur to me that the hospital was going to be in trouble,” Robert Berg, MD, an obstetrician at NYU Langone Medical Center, told the local news affiliate. “I thought, ‘We’ll have power upstairs. We’re an operating room.’” Instead, he found himself assisting with carrying patients downstairs on med sleds. In all, 300 patients had to be evacuated, including to neighboring states. Outdated building design and poor flood management had shut down their backup generators.

The ability to quickly transfer patients—including those recovering from surgery—and their records to nearby facilities is crucial, experts say.

It requires a healthcare coalition, or “a group of state, local, and hospital-based administrators working together to think critically about preparedness and what they can do to pool resources in a time of disaster,” says Sue Anne Bell, PhD, MSN, FNP-BC, a clinical associate professor of nursing at University of Michigan who specializes in disaster preparedness. She notes that Michigan, for instance, has “a clear plan to share access to ventilators.”

On the federal level, there has been a major push to support more domestic suppliers to prevent the sorts of supply chain breakdowns and counterfeit products that happened during the COVID-19 pandemic.

During BARDA Industry Day in December 2021, Dawn O’Connell, assistant secretary for preparedness and response, spoke as part of a fireside chat on securing the supply chain about the need for assurance around domestic manufacturing capabilities. “When the whole world needed the same thing at the same time last spring, we saw how difficult it was for our healthcare responders to access the [PPE] they needed and many of the other medical supplies,” O’Connell said.

That, she said, has pushed the organization to take a number of steps, including investing in domestic manufacturing, restocking the Strategic National Stockpile with domestic manufactured goods, and ensuring that adequate supplies are coming from numerous domestic manufacturers that “can provide what we need when we need it next.”

Part of this effort means embracing innovation and entrepreneurship.

“Crisis drives innovation,” says Andy Poole, business solutions manager for ECRI. Where healthcare systems initially operated with limited supplies and sole suppliers, they are now getting involved in manufacturing and partnering with distributors.

In Massachusetts, this innovation and coordination played out in April 2020, when the state offered over $10 million to small manufacturers to pivot their production lines to producing healthcare equipment—including ventilators, sanitizer, masks, gowns, thermometers, and swabs. The effort helped to protect jobs while providing the FDA-compliant supplies that healthcare systems so desperately needed.

“Building a stronger, more agile system of preparedness means supporting private sector partners to acquire needed raw materials, retool manufacturing machinery, and train the workforce,” said O’Connell at BARDA Industry Day. “Building a robust, domestic, industrial base and developing new countermeasures requires that we widen our engagement. We need the views of the innovators, entrepreneurs, health officials, first responders, and the people we are trying to protect.”