The other health care challenge: resilience in the face of hazards

October 17-18 (this coming Thursday-Friday) the American Meteorological Society will host a workshop at AAAS headquarters in Washington DC, entitled  A Prescription for the 21st Century: Building Resilience to High-Impact Weather for Healthcare Facilities and Services. Live and work in the DC area? You can get more details and register here.

And you should.

To explain why, we need to start with the larger context (bear with me)…

In recent days, news commentators have noted that Republicans miscalculated in choosing to use Obamacare as a political hostage in forcing a government shutdown. Better to have voted at the end of September to keep the government open. Then the big news story in early October would have been the bugs and gremlins in the Affordable Care Act; Republicans could have said, “we told you so.” Instead that latter story has been submerged in media coverage of the Kafka-esque, totally unnecessary and wholly-contrived decisions to cut off funds to widows and families of deceased servicemen, deny the seriously ill access to experimental, possibly life-saving protocols at the National Institutes of Health, close national parks, reduce cyber security, and strangle the economies of cities across the land. That hasn’t been enough to satisfy our leaders. To increase the adrenalin rush they’ve constructed an additional crisis on a second, equally manufactured front: the national debt ceiling. An anxious world, knowing they’ll be collateral damage resulting from any missteps at this point, is asking “what on Earth has become of America?”

At least for the moment, the indispensible nation is looking more like the inexplicable nation.

In the same way, the birth pangs of the Obamacare launch are themselves hiding another big healthcare story: the vulnerability of our healthcare infrastructure – the hospitals, assisted living centers, professional partnerships, the pharmaceutical supply chains and more – to extremes of nature.

In recent years, hospital system after hospital system has succumbed to the ravages of earthquakes, hurricane and riverine flooding, storm surge, tornadoes, wildfires, and other hazards.

The vulnerability isn’t limited to a single location or region. What’s more, it’s consequential. Healthcare is now 15-20% of U.S. GDP. The demographic is aging. Moreover, in any city at any given moment, some 1% of the population is too sick to move. Hospital administrators tell us the system has little or no surge capacity. Should a disaster increase the need for hospital beds, or in the event one or more hospitals loses functionality due to power outages or worse, there’s no margin or surplus to accommodate the special demand. In a word, healthcare is least likely to be there just when we most need it.

The proximate reasons for the vulnerability are well-known. Start with poor land use. Too often, hospitals are located on seismic fault zones, in floodplains, in areas prone to storm surge, etc. Then there’s deficient building design and construction. This goes beyond the structural integrity of the exterior walls and roofing. For example, elevator safety and function are more critical to hospitals than ordinary office buildings or apartments. But the challenge of building and maintaining disaster-resilient healthcare facilities is far more complex and context-dependent. It requires that doctors, nurses and other staff live in homes that survived the disaster; that their kids have schools to go to, that police, fire, and other services are functioning. It requires that community infrastructure – roads, electricity, water supplies, communications, sewage and more – remain viable. It requires that the supply chains for pharmaceuticals and other healthcare goods are uninterrupted. Insurers play a vital role… not just in redistributing the hospital risks – to property damage, loss of business continuity, and more – but also in reducing risks, through identification and analysis of vulnerabilities and developing engineering or procedural options for eliminating or limiting these.

Next-week’s workshop “addresses the goal of building resilience for healthcare facilities and services by engaging the insurance and healthcare accreditation sector as the stakeholders assessing associated risk; the development sector of city planners, building engineers, and land developers who decide on the vulnerability level of facilities; and the healthcare “continuity of services” sector of partners who make health services possible such as pharmaceutical companies, healthcare supplies, and IT. By convening these diverse but connected stakeholders, this workshop encourages collaborative discussion and promotes new knowledge and understanding of perspectives, ultimately exploring innovative systems solutions to building resilience to high-impact weather for healthcare facilities and services.”

The workshop, made possible through a grant from NOAA’s Office of Oceanic and Atmospheric Research, aspires to contribute in a small but significant way to building a Weather Ready Nation.

And you can do your part by showing up and sharing your perspective. See you there this Thursday.

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3 Responses to The other health care challenge: resilience in the face of hazards

  1. Bill:-

    While I’m really tempted to compare the promise of Obamacare to the practical potholes embedded in the ACA – I won’t. Instead, I echo your call for people to attend the workshop. In Charleston, SC (both an earthquake and a hurricane zone), if an earthquake hit, only one wing of the three major medical institutions in the city would likely remain standing. I doubt whether any would remain standing in Memphis. And when we think of healthcare facilities, we also need to think about the infrastructure which they rely on: water, electricity, and now telecommunications. The latter really concerns me because of the growing importance of the latter in terms of both monitoring and record keeping. In many older facilities, the telecommunications lines and equipment aren’t “built in” but rather added on. Who knows how many of the servers are stuck in basements that will be flooded, or in attics where the roof may blow off exposing them to the elements. The same thing holds true for generators that weren’t originally thought of. And as we learned in Katrina and again in Sandy, too few hospitals have emergency plans that have been exercised so that staff can work out the kinks (like directing staff to remove patients down stairwells not wide enough for hospital beds).

  2. James Correia Jr. says:

    When we had the Joplin EM speak in the National Weather Center, he went through quite a list of things that had not been thought about with a direct hit by a tornado to a hospital, including the generators (outside) being damaged by falling debris. Something similar was discussed in the wake of the Moore Med center being hit, where their plan was turn the hospital into the triage center. But that had to be abandoned in favor of the Warren theater across the parking lot.

    In some sense, most plans would have failed because they had not accounted for being in the damage path. This human induced vulnerability should be discussed at length. That said, one wonders whether any plan serves a good purpose. It is very much like triage, where there are things you need to know, things you need to do, and an order to establish when you have lost your ability to do all the things you could normally do, and you need to buy time until help arrives. Enjoy your meeting!

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