Flooding and climate change: the impact of flooding on hospitals

Climate change is expected to increase the risk of extreme weather conditions (and the associated risk of flooding). This means that hospitals must explicitly take into account a situation in which severe weather jeopardizes continuity of care. They must therefore include a water test in their technical design and take this into account in their contingency plans, whereby an evacuation is only proposed as the very last. Coordination with other hospitals, the government, the fire service, the Red Cross, the military and other actors in the emergency services, as well as multidisciplinary exercises are crucial. In the summer of 2021, this turned out not to be a distant future, but pure reality. This article describes the impact of an imminent flood on Belgian and Dutch hospitals along the Meuse, as well as their experiences and approach to this precarious situation in the summer of 2021. Since the Covid-19 pandemic, the contingency plans and evacuation protocols used must also take into account specific hygiene measures, which makes the response to such calamities even more complex. In this article, the authors discuss the risks of flooding for the healthcare sector and make policy proposals for day-to-day practice.

Double impact: can our health care system deal with a terrorist attack during the COVID pandemic?

Health care organizations have been challenged by the COVID-19 pandemic since the first half of 2020. Both hospitals (especially emergency and intensive care departments) and ambulance services were overwhelmed by surging patient numbers during the 2 pandemic waves in 2020. In this study, the data of the 2016 multisite terrorist bombing attacks in Zaventem (Brussels International Airport) and Maalbeek (subway) are reviewed. It is simulated what the impact of similar attacks would be on an already challenged health care system and which COVID-19-specific measures would be favourable for the outcome. The limited access of ICU beds, operating rooms and surge capacity, as well as the number of COVID-positive victims are cardinal features challenging the medical response to mass casualty incidents of this magnitude. During the COVID-19 pandemic, disaster management is affected by the limited availability of intensive care beds and operation rooms, and the faltering reverse triage negatively influencing the response capacity. On the other hand, the impact of the COVID pandemic can also be favourable. Special concerns on a COVID-19-safe response are discussed. It must be avoided that the medical response and gathering of stranded passengers would become a superspreading event. Multisite terrorist attacks during a pandemic are possibly catastrophic for a health care system which is already beyond its limit in terms of surge capacity. COVID-19-specific recommendations for disaster management in case of terrorist attacks are provided.