Ask yourself the following questions: What would happen to patients and staff if your hospital’s electricity went out for an hour, a day or a week? What would you do if an infectious and deadly disease started affecting the patients and staff in the hospital at an alarming rate? What would be your response to rising flood waters around your hospital?   

Hospitals need to be able to operate during the worst of conditions. They serve patients that are not capable of healing at home. By the nature of their illnesses, they are not able to just get up and walk to safety. Most are in a compromised state, and their welfare is guarded by the people around them and the environment that protects them. Hospitals are also the place where the injured go when a catastrophe strikes. The hospital must continue to operate. 

It is prudent to have the tough conversation about the building’s infrastructure systems and their role in protecting patients and staff during emergency conditions. Codes govern some of the minimum requirements, but in many cases those requirements are still vulnerable. 

For example, the loss of electricity due to a natural disaster or just plain bad luck can cause havoc. Some patients are on ventilators, or in surgery, and in critical condition when the electricity suddenly stops. What if it is below 10 degrees or above 100 degrees outside when this happens?

If the hospitals back-up power system is designed correctly, starts correctly, and runs flawlessly, the damage can be minimal. However, if the back-up systems are not designed correctly or will not operate properly, then the loss of electricity becomes costly and life threatening. And this is just one scenario.  

It is important that a risk assessment be completed on each hospital facility to determine what will happen when a serious event occurs that can affect the infrastructure of the hospital. This means playing the “what if” game to determine the effect of a failure on the hospital if either the utility systems fail or the emergency back-up system components fail.

Ultimately, it will cost money to buy the infrastructure to mediate the effects of these types of bad situations, but the questions need to be asked: How much money and lives might be lost when experiencing one of these horrible events? After all, it’s not if it will happen but when it will happen.

John Sauer, PE, LEED AP, is Senior Director Engineering Design at BSA LifeStructures in Indianapolis. John is a strong advocate for sustainability and the use of energy-efficient design in traditionally high-consuming healthcare environments. John has leveraged his knowledge of heating, ventilation, vacuum, air conditioning, steam distribution, energy centers, and piping design to identify cost efficient and sustainable solutions for all types of healthcare facilities. He can be reached at For more information, please visit