As Hurricane Michael made landfall in Panama City, Fla., this past October, entire communities were levelled, their infrastructure destroyed. Within 48 hours, 10 hospitals planned to evacuate patients or had already done so, as did about two dozen nursing homes and assisted-living communities. Freestanding dialysis centers in the path of the storm gave evacuating patients essential medical information on how to receive dialysis services at their destination, while neonatal intensive care units (NICUs) airlifted their tiny patients to safer locations.

Panama City’s two largest hospitals—Bay Medical Sacred Heart and Gulf Coast Regional Medical Center—evacuated 330 patients after they sustained heavy structural damage. Bay Medical sheltered 1,500 people, including patients and staff, until the roof of their materials management building caved in, destroying supplies and forcing the facility to evacuate. Gulf Coast Regional evacuated approximately 130 patients because of the infrastructure challenges in their community, which included interrupted water supply, lack of sewage treatment, and impassable roadways.

While the losses from this year’s storms were still being tallied, the Camp Fire wildfire destroyed the entire town of Paradise, Calif., last month, forcing Feather River Hospital to evacuate patients while its roof was burning.

After each of these events, we wonder why our medical infrastructure isn’t better prepared.  Experience demonstrates that typically it’s only after an extreme event occurs that local practices, regulation, and public policy ramp up to reduce future vulnerabilities. Case in point:

During Tropical Storm Allison in 2001, Texas Medical Center (TMC; Houston) hospitals were devastated by flooding, causing structural damage and destroying irreplaceable research samples and records. Afterwards, TMC spent a decade making significant campus-wide infrastructure investments, including an elevated central cogeneration energy plant and storm water management systems, in partnership with the City of Houston and the Army Corps of Engineers. As a result, TMC sustained only minor flood damage and remained fully operational during last year’s Hurricane Harvey.

Likewise, CHRISTUS Health (Irving, Texas) focused on strengthening its buildings post-Allison, installing windows and roofing materials designed to withstand Category 4 and 5 storms. When Harvey hit, its hospitals were in good shape and even had a seven-day water supply on hand to distribute to Corpus Christi residents when a boil order was issued in the city. “We have to ensure that our facilities are better prepared to handle these storms,” said Ernie Sadau, CEO at CHRISTUS.

Hospitals have vital roles to play during an extreme weather event—sheltering patients and staff in place and serving as first responders to treat emergencies. But a hospital’s important role in the community persists even once the storm has passed. As large employers, a hospital’s ability to remain operational plays a critical role in recovery by stabilizing the workforce and supporting the local economy.

Following Hurricane Katrina, the extensive damage to hospitals and community infrastructure caused thousands of medical professionals to leave the region, severely impacting the community’s recovery. By contrast, while one in five CHRISTUS nurses in southeast Texas lost their homes during Harvey, the system was prepared to provide both financial and spiritual support to sustain its workforce through the long recovery period.

What Hurricane Michael and Camp Fire have in common is that they’re the most powerful extreme weather events to hit their respective regions in history. As we learned with Katrina, Allison, and Sandy, historical experience-based codes and regulations don’t prepare hospitals for these unprecedented weather events. The challenge that climate change puts before us is to be both proactive and aggressively forecast-based—to prepare for the extreme weather event that has never happened in our regions, cities, neighborhoods before it does happen.

A recent report, “Safe haven in the storm: Protecting lives and margins with climate-smart health care”, published in November 2018 by Health Care Without Harm and PricewaterhouseCoopers Advisory Services LLC, analyzed billions of dollars in losses and resilience-related savings to demonstrate how preparing for extreme weather can make or break a health system. The report also discussed how leading health systems are beginning to partner with policy makers, researchers, and their communities to improve facility, social, economic, and ecological resilience. For example, the new waterfront CHRISTUS Spohn Hospital in Corpus Christi, Texas, goes beyond local requirements to include numerous strategies, including enhanced wind-design performance, for hurricane resilience and future sea level rise.

Global analysis identifies extreme weather events as the combined most likely and highest economic impact risk of this year. In 2017, extreme weather events and natural disasters in the U.S. caused more than $300 billion in property damage as well as loss of life and displacement. With this year’s hurricanes and the recent fires in California, 2018 is shaping up to be yet another record-breaking year.

The lessons from extreme events is clear: Climate and weather models are strong predictors of future realities, and proactive investments in hospital infrastructure resilience are a new imperative. The health and future existence of our communities are at stake.

Robin Guenther is principal, Perkins+Will (New York) and senior advisor to Health Care Without Harm (Reston, Va.). She can be reached at Lance Mendiola is vice president of facilities management and construction at CHRISTUS Health (Irving, Texas). He can be reached at