From hurricanes to wildfires, hospitals must plan for climate disasters

Within the past few months, hospitals have faced disasters that have forced systems to alter care and, in some cases, evacuate their facilities.

Rising waters forced more than 50 Unicoi County Hospital workers to seek shelter on the roof in the wake of Hurricane Helene last fall. They were on the roof for hours until they could be evacuated by helicopter. The Joint Commission has urged hospitals to plan for climate disasters.

The wildfires in the Los Angeles area prompted several hospital systems in the region to close clinics and outpatient facilities in emergency zones.

When Hurricane Milton hit Florida, more than 400 healthcare facilities were forced to evacuate, including more than 20 hospitals. Hurricane Helene disrupted hospitals in Florida, North Carolina and Tennessee. At a Tennessee hospital, staff fled to the roof to escape calamitous flooding before being rescued by helicopter.

With such events in mind, the Joint Commission issued a sentinel alert event in November urging hospitals and health systems to develop comprehensive plans to prepare for environmental disasters, including flooding, fires, hurricanes, tornadoes and extreme heat.

Hospital and health system leaders need to make planning for disasters a high priority, says Elizabeth Mort, vice president and chief medical officer of the Joint Commission.

“Appreciate that it's not something that happens to somebody else,” she says. “It could happen to you. The environmental risks are changing.”

Kevin Zacharyasz, director of healthcare sustainability at the Joint Commission, says there’s no avoiding the reality that climate change is amplifying the impact of natural disasters.

“Environmental and natural disasters and their severity are definitely on the rise,” Zacharyasz says.

Mort and Zacharyasz spoke with Chief Healthcare Executive® about preparing for disasters and ways hospital leaders must think differently. For context, the conversation took place after Hurricane Helene and Hurricane Milton, and before the wildfires that have scorched southern California over the past week.

• Read more: Joint Commission CEO talks about new sustainability program for hospitals

More damaging and costly

The U.S. is seeing more destructive and expensive natural disasters. In 2024, there were 27 weather or climate events with losses surpassing $1 billion, according to the National Oceanic and Atmospheric Administration. That’s just below the record 28 weather/climate disasters with $1 billion in losses, which was set in 2023.

Several hospital systems in the Los Angeles area have had to close clinics and outpatient facilities due to the wildfires ravaging the region. Some elective surgeries have been delayed.

“These disasters are not only causing significant financial losses, but also lead to displacement, loss of life, and long-term social and environmental impacts,” Zacharyasz says.

Climate change is causing more potent storms and raising the risks of more damaging wildfires, he says.

“As we see global temperatures rising, it's leading to more frequent and severe heat waves and droughts. These conditions are just drying out vegetation, making wildfires more likely in areas that we just didn't expect to see,” Zacharyasz says.

“Warmer ocean temperatures are leading to the fuel to powerful storms and hurricanes, but then higher temperatures increase evaporation rates, leading to more intense and frequent rainfall events. This can cause more severe flooding, especially in areas that are not typically prone to such events,” he adds.

The Joint Commission sets emergency management standards that set a foundation in preparing for disasters. The standards call for hospitals to conduct a hazard vulnerability analysis to identify and prioritize risks.

Hospitals need to examine their risks in disasters and devise plans to maintain patient care amidst disruptions. Health systems need to figure out how to communicate in the event of power losses, and they must have detailed evacuation plans.

Mort says health systems must make plans for events that may be very rare in their area, noting the devastation in western North Carolina from the remnants of Helene.

“As a C-suite person, you really need to make sure that your hazard analysis is thorough, accurate, and that you don't ignore things that don't happen frequently, because you never know,” Mort says.

“There's just too much variability in the threats,” she says. “So do your hazard analysis. Take it seriously. It's really part of your obligation to take care of patients safely and with high quality.”

Mort says the Joint Commission had been planning the sentinel alert for months, which became all too timely after the arrival of Helene and Milton.

“It's a wake-up call to make sure that our C-suites are focused on what we want them to focus on, which is an all-hazards approach to an emergency management program,” Mort says.

Since hospitals had to evacuate due to Helene and Milton, Mort says those experiences should guide other systems in their disaster planning.

“You don't want to just let that become yesterday's news. It needs to become today's concern and tomorrow's planning,” Mort says.

Zacharyasz stresses the need to prepare contingencies for climate events.

“Develop scenarios based on different climate change models to predict potential impacts on your facility, and the overall sector, including supply chain,” he says. “This isn't just going to affect that one facility right there. It's going to have an impact on the overall community around your hospital and your healthcare organization.”

• Read more: Hospitals and the environment: Pressure to do better

Think beyond the hospital

Health systems also need to think about more than their hospitals. They need to have robust plans for clinics and outpatient facilities, along with rehabilitation centers and long-term care facilities.

“It applies to ambulatory surgical centers, nursing homes,” Mort says. “What do hospitals do if they have a hospital-at-home program? So parts of the continuum that are not in the four walls of the hospitals, it's not enough to get that right. What about the other parts?”

Mort says health systems must make time for planning and running drills to respond to disasters.

She says the consequences of not planning for disasters is similar to falling short in caring for a hospital patient.

“If the nurses and the doctors don't attend to that patient doing poorly, we call that a failure to rescue,” Mort says. “Well, think about that from the perspective of a hospital or a nursing home or a community center. You don't want to ever be in a situation where you fail to rescue.”

Hospitals need to collaborate with local and state governments to prepare for disasters. Mort says hospitals need to build good relationships with state emergency management officials and local leaders before there’s a crisis.

“There's different jurisdictions in your communities,” Mort says. “You need to understand who's got authority over what, and how to bring those people together. Do drills together, develop relationships. Because when you pick up the phone in the middle of a disaster, you don't want to start your relationship with that phone call.”

Mort also offers what she admits is an old-school tip: Print out the list of key contacts in an emergency. If there’s a power outage and the list is only stored electronically, it’s not going to do much good.

With more frequent and foreboding weather and climate events occurring, hospitals and health systems can’t delay developing and practicing response plans, Mort says.

Judging from her conversations with healthcare leaders, and the experiences learned during the COVID-19 pandemic, Mort says hospitals and health systems recognize the need to prepare for the worst.

“I think C-suite executives know that they need to pay attention to this,” Mort says.