Code Yellow: Hospitals Under Growing Pressure to Increase Resiliency of Infrastructure

by Joseph Mizrahi, PE

As the nation grapples with a growing number and increasing frequency of extreme weather events, designing and building resilient structures is more important than ever. Critical infrastructure like hospitals and other healthcare facilities must be designed and built to withstand natural disasters, remaining in operation and safely caring for patients around the clock, despite external emergencies.

Extreme weather events have increased in the past few decades. Damaging storms are increasing in both frequency and intensity, resulting in flooding and widespread power outages in places that, two decades ago, were relatively unscathed. As a result, more and more hospitals are incorporating resilience into their capital plans, preparing their campuses to withstand a variety of environmental threats. While hospitals in the western United States have long built earthquake resiliency into their structures, and healthcare facilities in Florida routinely consider flooding in their infrastructure planning, more regions across the United States are experiencing unprecedented, unexpected weather events, including floods, severe winter storms, hurricanes, tornadoes, and fires.

Power outages can be catastrophic to hospitals and the patients they care for. It is not surprising then that nearly all the 274 U.S. hospitals surveyed in 2017 on their climate-related challenges cited power outages as their biggest concern. After Hurricane Sandy hit New York City in October 2012, hospitals were forced to evacuate their patients, and close parts (or all) of their facilities. It took some of these hospitals weeks and even months to get back up and running. While emergency generators are used to provide for life-safety power during outages, they rely on a limited supply of stored diesel fuel and moreover, they are not designed for “continuous duty” and prolonged periods of time. In recognition of these limitations, some hospitals are installing their own continuous power sources such as cogeneration plants that help supply electricity while also capturing and reusing waste heat to lower total energy costs. Other innovative energy technologies are being implemented to keep facilities operational, including fuel cells and large-scale batteries as backup to existing electrical service. Key facility systems and infrastructure such as mechanical rooms and electric switchgear are being relocated well above flood plains.

On Long Island, for example, one expanding hospital system is taking lessons learned from Hurricane Sandy. Burns is helping this hospital install a new cogeneration or “combined heat and power” plant that will supplement emergency generators to power the entire hospital, thus ensuring that full patient and medical services can continue during an outage. An integrated central boiler and chiller plant, and an associated thermal distribution system, will replace an existing system and be supported by a new 15-kilovolt substation on the site.

Similarly, Burns is working with a 1,500-bed Manhattan hospital forced to close during Hurricane Sandy due to historic flooding, to install a new on-site cogeneration plant to save on current energy costs and meet future challenges. And, in Brooklyn, Burns is designing an innovative, shared microgrid for three hospitals to ensure continuous power supply and simultaneously reduce the hospitals’ reliance on a constrained power grid.

Identifying strategies and solutions to enhance facility resilience can be very site-specific depending on a variety of factors, including the environmental threats endemic to the region, the age, condition and size of existing facilities, and the hospital’s capital budget.

Knowing where to begin can be overwhelming. A thorough utility system assessment is typically a good place to start, and is done to establish existing conditions and prioritize short- and long-term upgrades to improve resilience and optimize spending. Utility system assessments document the age and functionality of each system, including electrical, fire safety and security, IT, HVAC, water supply, and plumbing. Such assessments can also consider a facility’s dependence upon outside energy sources, including single points of failure and their ability to meet both current and future operational needs. Using master plans, capital initiatives, and maintenance budgets, the assessment helps prioritize resiliency needs and how to cost-effectively incorporate solutions within existing, often-constrained funding.

Hospitals are critical to the health and well-being of the regions they serve and are increasingly becoming vital “ports in a storm” during extreme weather events, providing both healthcare and shelter. Uninterrupted power is crucial to keeping hospitals open and functional during even the most dangerous and life-threatening conditions. While hospitals may be prudent to make resiliency a priority, they can realize both short- and long-term benefits by doing so and while also protecting the safety and welfare of the patients they serve.