Hospitals in the U.S., already facing daunting challenges from evolving health care reimbursement models, now have another item on their to-do list: prepare for increased health care demands and weather disasters caused by climate change.

President Obama designated May 2016 as National Building Safety Month to highlight the need for infrastructure “resiliency” against extreme weather events. I was a speaker at this conference and witnessed firsthand the urgency in this national endeavor.

In addition, the Federal Emergency Management Agency (FEMA) now recommends that states implement their own disaster prevention actions, such as building codes for resiliency, emergency funds, and building protection in flood-prone regions. FEMA’s proposal would reduce federal dollars spent on emergency aid, as the number of disaster declarations by the president has increased from an average of 13 up to 137 per year in the last half-century.

Extreme weather clearly threatens all buildings, but hospitals are doubly affected by climate change. In addition to immediate risks to the building per se, higher temperatures and rainfall over time worsen many illnesses, increasing the need for hospital services.

According to the Center for Disease Control, climate change will affect our health in the following ways:


1. Higher temperatures and rainfall allow disease-transmitting mosquitos and ticks to expand their territories.

2. Rainfall with flooding can overwhelm local sewage systems, causing water contamination and increased threat of water-borne illnesses.

3. In areas with severe droughts and restricted water use, more people will suffer from dehydration, heat stroke, and aggravated respiratory and cardiovascular conditions.

4. Warmer temperatures increase allergens (i.e. pollen) and pollutants such as ozone, increasing the risk of respiratory and cardiovascular diseases.


In addition to providing increased day-to-day medical services, hospitals must be protected from incapacitation by the same hurricanes, floods, heat waves, and earthquakes that injure the people flocking to their doors.

How do we design hospitals for future events which may be different from anything previously experienced? One strategy is to examine failures during previous disasters such as Hurricane Katrina, where the New Orleans Memorial Hospital survived the initial storm only to be devastated by prolonged isolation from flooding when the levee broke. After the floodwaters receded, a doctor and several nurses were brought to trial for accusations of euthanizing more than 45 patients too weak to be evacuated. In my mind, this possibility summarizes the nightmare that patients, families, and clinical staff must have endured, one which cannot be repeated.

A resilient hospital must remain independently operational for at least 72 hours during a weather disaster.


• Design the structure to resist maximum predicted earthquakes, wind, and flood loads.

• Raise critical electrical, HVAC, water, and data systems above the maximum computed flood elevation.

• Locate space which can be sacrificed during a flood on the ground floor and medical care units on higher, safer levels.

• Design redundant primary and emergency backup power to operate the facility off grid for a week.

• Maintain a seven-day backup supply of potable water.

• Locate opiate and anesthesia medications in high-security areas to discourage looting.


History has taught us that building resilience into hospitals is much less costly than the human life and economic burden of a hospital that fails. ES