Beyond the Hazard Vulnerability Analysis: Preparing Health Systems for Climate Change.

INTRODUCTION: Climate change is heightening both long-term adverse risks to human health and the immediate-term risk of injuries and illness following climate-related disaster events that are becoming more frequent and severe. In addition to its direct health effects, climate change poses new threats to the nation's health care infrastructure - with potential to negatively impact healthcare capacity amidst increasing demand - through risks of flooding, wind damage, heat stress, power outages, and other physical harm to facilities. The typical Hazard Vulnerability Analyses conducted annually by hospitals use historical data to assess risks; these analyses are likely now inadequate for future preparation due to the impact of climate change. This article describes one approach to how healthcare leaders can better assess both near-term and long-term risks due to climate change, to mitigate against unprecedented but foreseeable threats. METHODS: In our large health system in the US Northeast, a process was undertaken to gather updated data and expert projections to forecast threats faced by each of our facilities in different climate-related disaster scenarios. Hazards examined in our setting included precipitation-based and coastal flooding events, heat waves, and high wind events, in addition to seismic events. Probabilities of occurrence and extents of different hazards were projected for the near term (2030) and the long term (2070). We then performed detailed vulnerability analyses for each facility with the predicted amount of rainfall, storm surge, heat stress, and windspeed, in collaboration with leaders at each facility. This was followed by a process to understand what would be needed to mitigate each vulnerability along with the associated costs. Ultimately, a cost/benefit analysis was performed - incorporating the relative likelihood and impact of different scenarios - to decide which improvement projects to embark on immediately, and what to defer and/or incorporate into future building plans. RESULTS: In our system, all facilities were vulnerable to the effects of increased temperatures, and multiple hospitals were noted to be vulnerable to extreme precipitation, storm surge, and high winds. Specific damaging scenarios identified included flooding of basements and building infrastructure spaces, water entry through windows during high winds, and overheating of power systems during heat waves. Potential solutions included improved power redundancy for cooling systems, enhancements to roof and window systems, and the acquisition of deployable flood barriers. We identified four categories for prioritization of action based on projected impact: 1) priorities in need of urgent mitigation, 2) priorities in need of investigative study for medium-term mitigation, 3) priorities for planned capital improvement projects, and 4) priorities to integrate into new facility construction. DISCUSSION: While the specific risks and vulnerabilities for each facility will differ according to its location and structural features, the approach we describe is broadly applicable. By forecasting specific risks, diagnosing vulnerabilities, developing potential solutions, and using a risk/benefit approach to decision making, hospitals can work toward protecting facilities and patients in the face of potential climate related natural disasters in an economically sound manner.

Academic Institutions' Critical Guidelines for Health Care Workers Who Deploy to West Africa for the Ebola Response and Future Crises.

The unprecedented Ebola Virus Disease (EVD) outbreak in West Africa, with its first cases documented in March 2014, has claimed the lives of thousands of people, and it has devastated the health care infrastructure and workforce in affected countries. Throughout this outbreak, there has been a critical lack of health care workers (HCW), including physicians, nurses, and other essential non-clinical staff, who have been needed, in most of the affected countries, to support the medical response to EVD, to attend to the health care needs of the population overall, and to be trained effectively in infection protection and control. This lack of sufficient and qualified HCW is due in large part to three factors: 1) limited HCW staff prior to the outbreak, 2) disproportionate illness and death among HCWs caused by EVD directly, and 3) valid concerns about personal safety among international HCWs who are considering responding to the affected areas. These guidelines are meant to inform institutions who deploy professional HCWs.