Healthcare resilience in the face of hazards. 3. Impressions from the AMS workshop.

It’s one year on from Sandy’s landfall and devastating impact. All along the New York and New Jersey coasts, residents and workers continue to deal with the aftermath. Some face years of struggle. Perhaps it’s fitting to mark the somber anniversary with a look at healthcare continuity during and following disasters. In fact, that’s been the subject of two recent posts on LOTRW. The impetus? A run-up to an October 17-18 workshop hosted by the American Meteorological Society, and entitled A Prescription for the 21st Century: Building Resilience to High-Impact Weather for Healthcare Facilities and Services.  Shalini Mohleji, Ph.D., the AMS Policy Fellow who organized the workshop, did a brilliant job of convening experts from a broad range of disciplines. Prescription? Perhaps unsurprisingly, participants offered more than one. Some vignettes from the sessions:

The case studies. Folks at the University of Texas Medical Branch, looking at Hurricane Ike’s damage and destruction in 2008 to their facilities, located on Galveston’s barrier island? They opted for rebuilding in place, despite the billion-dollar price tag, the inherent vulnerability of the site, and the likelihood of more storms and storm surge in future years. Furthermore, the fix differed for the health treatment facilities per se, the academic structures, the buildings housing the research, and the Medical Branch’s common infrastructure. In fact, the effort was in actuality more than 400 distinct projects. Speaking of Sandy, three hospitals nearly adjacent in Manhattan took three approaches to the evacuation. The VA hospital evacuated early. NYU evacuated during Sandy’s onset proper. Bellevue tried to hold on, but was forced to decamp a few days in when the emergency power failed. Following a 2011 tornado, Joplin’s Mercy Hospital abandoned any thought of recovery. They bulldozed the original site, and have erected a succession of interim facilities of ever-greater capacity to meet urgent needs while a hardened hospital is being built several miles down the road. Disasters and subsequent recoveries at any hospital? They’re like snowflakes. No two are the same.

Insurers. Those of us not in the sector tend to see insurers as monochromatic, coming in a one flavor, as it were, and content to simply underwrite risk at actuarial rate. In fact, insurers, reinsurers, and other managers of risk such as the Joint Commission (a unique entity accrediting, certifying, and developing standards for the healthcare sector) are diverse in their approach and vigorously proactive when it comes to identifying, reducing, and managing risk. This is true whether they work independently or band together in efforts such as The Institute for Business and Home Safety, which has gone to the extreme of building a full-scale multi-hazard facility for destructive testing of buildings.

Development. Speaking of physical structures, it was interesting to hear from folks in the business of urban planning and architecture, broadly construed. As mentioned, one architectural approach discussed was that of hospital-as-fortress, but others at the meeting spoke to ways and means of distributing healthcare throughout communities; the design and manufacture of transportable/packable temporary medical-care facilities that could be quickly erected at emergency sites; of green approaches to hospital architecture that also favored resilience to hazards; and more.

Continuity of service.  This topic also led to fascinating presentations and discussion. Turns out during Sandy that Barnabas health facilities in New Jersey found themselves deluged not just by water but by area residents, still living at home but chronically ill and seeking critical pharmaceuticals because their normal drugstore suppliers had been shut down, or simply without electrical power and looking for food. The hospital served thousands of meals to the community’s well even while struggling to meet patient needs. Researchers on supply chain disruption spoke to the complexities of these supply chains when thousands of different pharmaceuticals are involved and the suppliers are global. One speaker, from a teaching hospital, spoke to how the work allocation shifts during such events. The academics and the students are reassigned different roles to meet critical healthcare staffing needs.

Innovation. Several speakers invited their fellow participants to rethink the entire problem. One, citing the Haitian cholera outbreak, pointed out that the challenge shouldn’t and couldn’t be met by public health experts, working alone; it required urgent attention from civil engineers who could be brought to bear to upgrade the water supply infrastructure that was a vector for the disease. Others spoke to the challenge as health reform, not just healthcare reform, citing the importance of addressing chronic disease and the health needs of the community’s poor prior to any hazardous event.

Big picture. It’s impossible to summarize the discussion in a few hundred words, but this gives the flavor. For more details, look for the upcoming workshop report, which we hope will be available in a month or two. Some closing thoughts:

First, healthcare is not simply an isolated facet of community life; it’s threaded throughout. This is hardly surprising given that healthcare is now 18% of US GDP, and given the importance of health on an individual level (“if you’ve got your health, you’ve got everything”), but nevertheless bears repeating. Second, as we go forward, continuity of healthcare during and after disasters will be achieved only if we use tomorrow’s tools and capabilities rather than continue to rely on yesterday’s technology and approaches. Third, learning from experience versus rebuilding as before (or other failures to adapt to new realities) is vital. Fourth, it doesn’t matter whether you start with the goal of building hospital resilience to hazards, or public school resilience, or business community resilience – whatever the starting point, it turns out the problem quickly becomes that of community-wide resilience, in all facets (and for that matter, depending on a supportive state and federal context).

Finally, improved weather, water, and climate forecasts, though vital, are not the center of this universe. Our role is best compared with that of the insurance sector – taking care of that risk remaining after all other mitigation measures – land use, building codes, resilient critical infrastructure and more – have been applied.

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