Hospital Preparedness: A Critical Community Infrastructure

Hospitals are community symbols. Their ability to provide patient care is an indicator of a functioning society. During disasters their continued ability to provide patient care is essential, not only for disaster victims, but for their role in representing a resilient community that can withstand adversity.

Hospitals are also dependent upon critical infrastructures, e.g., power, water, information technology. The loss of their operational capacity during a disaster is devastating to a community and will call to question the confidence its members have in their jurisdictional leadership – at local, state or national levels. Many would argue that hospitals are critical community infrastructures in and of themselves.

The Hospital Preparedness Program (HPP), initiated by the Bush Administration and continued in the Obama Administration, is now in its eighth year of funding and represents an approximate $4 billion national investment. It is clear that strengthening hospitals’ resiliency is a priority, but given its competition with other national priorities, are preparedness levels improving fast enough? Will US hospitals be prepared not if, but when, our next disaster occurs?

We know that disaster frequency is increasing, both natural and human-caused threats, nationally and internationally. Since HPP was started, the US has experienced over 475 federally declared disasters of over 20 disaster types.[1] Most recently, the Haitian and Chilean earthquakes reveal a painful truth: any community is at risk, at any time, for abrupt devastation. Hospitals as critical community infrastructures must be strengthened.

Mitigation investment strategies that ensure hospital operational status in post-disaster periods are essential. In addition to power, water, information technology, hospitals must be designed architecturally to withstand threats. Expenditures that consider hospital security during its formation represent approximately 4% of the construction costs—far less than those of rebuilding, or redesigning existing construction.[2]

Further, mitigation strategies must stem from quantitative, high quality research efforts that accurately reflect ground truths of disasters—not just US disasters, but global disasters. The World Association for Disaster Emergency Medicine promotes the standardization of disaster terminology and research design. The United Nations International Strategy for Disaster Reduction promotes research agendas in economically disadvantaged countries. In “Safe Hospitals” the Pan American Health Organization underscores that “Protecting critical health facilities, particularly hospitals, from the avoidable consequences of disasters, is not only essential to meeting the Millennium Development Goals, but also a social and political necessity.”

Given the devastation that is now seen in both Haiti and Chile, and given the ongoing impacts of disasters that are of higher probability and of lower catastrophic consequence (e.g., flash flooding and severe storms) ongoing research and mitigation strategies specific to hospitals must emphasize their role as a critical community infrastructure.


Author: Erin Downey MPH, ScD, Senior Health Systems Analyst

[1] Retrieved February 16, 2010 from

[2] Boroschek, Krauskopf R, Retamales Saavedra R. Guidelines for Vulnerability Reduction in the Design of New Health Facilities. Washington DC: Pan American Health Organization; 2004.