The Conversation - Martin Loosemore | Anumitra Mirti Chand
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| Cyclone Oswald caused flooding that forced the evacuation of more than 100 patients from Bundaberg Hospital to Brisbane in January 2013. Dave Hunt/AAP |
As
southeastern Australia swelters through another heatwave, how well equipped are our hospitals to cope with severe weather events?
Hospitals lie at the heart of our ability to manage the significant
potential health impacts of extreme weather events. Many people would be
surprised to hear that the vast majority of our hospitals have not been
designed with these risks in mind. And they have
not been adapted to ensure they can maintain healthcare services during such events.
The recent
thunderstorm asthma outbreak in Melbourne, which was
linked to eight deaths
and put 8,500 people in hospital, is a vivid example of the health
impacts of extreme weather. Such events can be life-threatening,
especially for the aged, obese and critically ill.
Individually, health services workers do a remarkable job in coping
with such events. However, the buildings they work in and the
infrastructure that supports them often constrain their ability to
respond.
Stories of power outages and of sick people waiting hours for beds
and patients dying because hospitals were overstretched do not inspire
confidence in the health system as Australia faces the prospect of
more frequent extreme weather events such as
heatwaves,
floods and storms.
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A map of temperatures like this one for Wednesday, January 11, spells trouble for health services across Australia. Bureau of Meteorology LARGE IMAGE |
Warning bells are ringing
During the 2014 heatwave in South Australia, when Adelaide became the
hottest place on the planet, heart attack rates
increased by more than 300%. Other emerging extreme weather health risks include
asthma from bush fires, increasing waterborne and
vector diseases such as
malaria,
dengue fever and
typhoid,
dehydration and
heat exhaustion, and physical injury from flying debris and floods.
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Hospitals need power supplies that remain reliable even during extreme weather events. Dan Himbrechts/AAP
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There are many reports of hospital buildings and infrastructure
failing during extreme weather events in Australia. For example,
power outages have affected numerous hospitals and back-up systems reportedly failed during the 2004 heatwaves that swept Australia.
During the 2005 Sydney heatwaves,
hospitals were swamped. Many people were simply seeking respite in air-conditioned reception areas.
In 2006, Cyclone Larry
closed much of Innisfail Hospital.
Staff required medical support from Townsville and Cairns hospitals.
Herberton Hospital was without power until a generator was provided.
Leaking roofs resulted in emergency evacuations.
In 2009, one-in-100-year storms left more than
3,000 NSW residents stranded
by floods, many of them old and seriously at risk. Floodwaters isolated
Coffs Harbour, Dorrigo and Bellingen hospitals. People needing urgent
medical treatment had to be sent up to 80 kilometres away.
Most recently, after super-cell thunderstorms blacked out South Australia,
back-up generators failed at an Adelaide hospital. Seventeen patients had to be transferred from Flinders Medical Centre to Flinders Private Hospital.
What are the systemic problems?
These stories are worrying, but perhaps not surprising, given that
most of our hospitals were designed when these risks were not on the
horizon. In the quest for cheap land not suited to commercial
development, many hospitals have been built in areas prone to floods and
storms. And many are built out of materials and designed in a way that
could increase the risk to patients during extreme weather events.
Hospitals face many challenges in adapting to a changing climate.
Our research identified a long list of issues, including:
- underfunded building and infrastructure maintenance and capital works programs
- poor road access for new patients and back-up medical supplies
- generators built in basements prone to flooding
- lack of accommodation for staff trapped on site
- poor coordination with other emergency and health agencies such as aged care
- access roads being cut off
- managers who do not understand the role of buildings in healthcare delivery
- buildings and infrastructure that cannot adapt to changing healthcare needs and patient surges during extreme weather events.
The impacts of extreme weather on hospital buildings and
infrastructure and how these influence service delivery during such
events have been neglected. These aspects of disaster planning systems
need to be properly considered.
In the high-pressured, resource-stretched, highly politicised and
hierarchical health sector, current disaster management practices too
often overlook the role of buildings and infrastructure.
While severely limited resources are understandably directed towards
frontline health service needs, the current system is creating a stock
of health buildings and infrastructure that represent a risk, rather
than an asset, to quality healthcare delivery during extreme weather
events.
The designers and facilities managers of new hospitals are now
required to think about these risks, but our understanding of how to
mitigate the risks is poor. This means most of our hospitals and other
health facilities remain vulnerable to the inevitable extreme weather
events in the future.
It’s a matter of time before we see the next headline about needless
death and suffering due to a hospital being poorly designed to cope with
an extreme weather event.
How do we fix these problems?
The problems would be easier to overcome if we had a more holistic
approach to disaster management planning. Such planning needs to better
integrate the organisational and built environment aspects of hospital
resilience.
This will require a paradigm shift in hospital disaster management.
That, in turn, requires an emphasis on involving all hospital
stakeholders in disaster management planning.
Hospital infrastructure design, planning, construction and ongoing
maintenance need to be revisited. Robust quality control will be
required to ensure compliance with improved standards consistent with
changing needs.
We will inevitably need to redirect and find additional resources for
building adaptation and modification. However, this is probably why
nothing will change until we have a disaster big enough to force
policymakers to change. Such is life … and death.
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