Preparing health care facilities for climate change hazards by assessing resilience

Preparing health care facilities for climate change hazards by assessing resilience

Linda VaranguExecutive DirectorCanadian Coalition for Green Health Care

EMERGENCY PREPAREDNESS SESSION #1CANADIAN PUBLIC HEALTH ASSOCIATION

MAY 27, 2014

Outline

• Climate change impacts on health • Climate change impacts to health care facilities• Toolkit for health care facilities to assess resiliency• Questions

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Health Risks in Canada from Climate Change

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Psychosocial impacts from

droughts

Permafrost melt

damaging infrastructur

es

Health impacts from more severe storms

Water-borne diseases from

floods

Changes in drinking water quality and quantity

Food security - changing animal

distributions

Respiratory illnesses from forest fires

Dangerous travelling conditions

Expansion of Lyme Disease vector

Heat–related

illnesses and deaths

http://publications.gc.ca/collections/collection_2008/hc-sc/H128-1-08-528E.pdf

http://publications.gc.ca/collections/collection_2008

http://publications.gc.ca/collections/collection_2008

Weather-Related Disasters in Canada 1900-2011

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Canadian Disaster Database, 2012

Temperature projections – Select Canadian cities

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Establishment and spread of the Lyme disease vector Ixodes scapularis under current climate (2000) and projected future climate (2020 to 2080).

Ogden et al., 2008

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Ogden et al., 2008

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Infectious Disease Management

Health of Northern Populations

Air, Water Quality

Emergency Preparedness

Travel Medicine

Mental Health

Occupational

Health

Food Safety

Adaptation

Impacts Mitigation

Seniors’ Health

Health care system capacity

Children’s Environmental

Health

Sustainable Development

Seguin, 2008

Climate Change Impacts on Health Programs

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Impacts to Health Care

• Damage to health infrastructures such as hospitals, clinics and nursing homes.

• Inadequately trained personnel or lack of an emergency plan.

• Hospitals that contract out certain essential services (e.g. laundry and food) may have them interrupted during an emergency.

• Overcrowding in emergency shelters during a disaster may increase exposure to infectious diseases (e.g. influenza) of health care workers.

• Electronic medical records could face access delays of up to days or weeks in the event of a power outage during a disaster.

Source for Text: Health Canada, 2008

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Ice Storm, Sunnybrook Hospital, Dec 2013

Mowat web site, 2014http://mowatcentre.ca/wp-content/uploads/pdfs/WHN_conference_presentations/McRitchie.pdf

National Post, June 21, 2013, http://news.nationalpost.com/2013/12/23/when-torontos-sunnybrook-hospital-lost-power-six-of-the-tiniest-most-fragile-patients-were-sent-packing/?utm_source=dlvr.it&utm_medium=twitter

• Sunnybrook lost power and 5 back-up generators activated• Power off for 39 hours• Power available to hospital reduced from 8 MW to 4.3 MW• Medical Imaging patient appointments cancelled• Lab tests delayed• Food delivery to inpatients delayed• Retail food operations without power• Network email system disrupted• Lighting, elevators, air handling units function diminished• Lost power from 4 back-up generators for 2 hrs• Neonatal Intensive Care Unity (NICU) without power and 6 vulnerable

babies evacuated to other hospitals• Vulnerable people in the community went to Emergency for warmth

http://news.nationalpost.com/2013/12/23/when-torontos-sunnybrook-hospital-lost-power-six-of-the-tiniest-most-fragile-patients-were-sent-packing/?utm_source=dlvr.it&utm_medium=twitter









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Alberta Floods Impacted Health Care Facilities

Calgary Herald, August 28, 2013, http://www.calgaryherald.com/clinics+leaving+flood+damaged+Holy+Cross+good/8840473/story.html

Flood waters surround a Canmore Hospital on June 21, 2013.

National Post, June 21, 2013, http://news.nationalpost.com/2013/06/20/pictures-and-videos-of-massive-flooding-in-canmore-and-southern-alberta/

http://www.calgaryherald.com/clinics+leaving+flood+damaged+Holy+Cross+good/8840473/story.html




http://news.nationalpost.com/2013/06/20/pictures-and-videos-of-massive-flooding-in-canmore-and-southern-alberta/



http://wpmedia.news.nationalpost.com/2013/06/alberta-flooding-11.jpg

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Hurricane Sandy, June 2013

New York Daily News, 2013 , http://news.nationalpost.com/2013/12/23/when-torontos-sunnybrook-hospital-lost-power-six-of-the-tiniest-most-fragile-patients-were-sent-packing/?utm_source=dlvr.it&utm_medium=twitterMOWAT websitehttp://www.huffingtonpost.com/2012/11/01/babies-born-during-hurricane-sandy_n_2050462.html

http://en.wikipedia.org/wiki/File:Sandy_Oct_25_2012_0400Z.JPG









http://www.huffingtonpost.com/2012/11/01/babies-born-during-hurricane-sandy_n_2050462.html



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Experience in Nova Scotia, 2003

Hurricane Juan (category 2) passed through Nova Scotia in late September 2003• Major hospitals affected• Victoria General in Halifax – part of roof ripped off• Flooding and water damage to 8 floors• 200 patients relocated• Operating theatres closed for 4 weeks• 78% scheduled surgeries cancelled Hospital on June

21, 2013.

Status of CC Adaptation / Action Plans in Hospitals

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Climate Resilient Indicators for Health Care Facilities

Addressing climate change in healthcare settings

(WHO, 2009)

Energy efficiency

Green building design

Alternative energy generation

Transportation

Food

Waste

Water

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HC Facility Climate Change Resiliency Toolkit

Health Care Facility Climate Change Resiliency Toolkit

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www.greenhealthcare.ca/climateresilienthealthcare/

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Project Objectives:• Increase awareness of the impacts of climate

change on health care facilities in Canada• Develop a toolkit to enable health care facility

officials to assess resiliency to climate change • Develop resources to help health care facilities

become more resilient to climate change

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Methods & Activities• Advisory committee• Literature review• Develop resiliency toolkit• Expert reviewers• Tested the toolkit with 6

pilot health care facilities• Ground-truthing workshop

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RESEARCH PARTNERS• Canadian Coalition for Green Health

Care• Health Canada, Climate Change and

Health Office• Canadian Healthcare Engineering

Society – Maritime Chapter• Guysborough Antigonish Strait Health

Authority (GASHA), NS

ADVISORSCapital Health District Health

Authority, NSNova Scotia Climate Change

Directorate Department of Health and

Wellness, NS

REVIEWERSSustainable Development Unit,

National Health Service, United Kingdom

World Health Organization, WHO-PAHO

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Pilot Sites

Nova Scotia• St. Martha’s Hospital, Guysborough Antigonish Strait

Health Authority (GASHA)• Soldiers Memorial (Annapolis Valley District)• QE II (Capital Health District) • Aberdeen Hospital (Pictou County District)Ontario• The Ottawa Hospital (Ottawa, Ontario)Manitoba• Stonewall Hospital (Stonewall, Manitoba)

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Resiliency Definition

Resistance• The ability of a community to withstand a disaster and

its consequences Recovery

• The ability of a community to “bounce back” to its pre-disaster level of functioning

Creativity• The extent to which a community learns from the

disaster experience and transforms this knowledge into more advanced EM functioning

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Resiliency Indicators

• Extreme weather emergency• Food-born contamination• Water-borne contamination• Air quality• Infections diseases

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Health Care Facility Resiliency Toolkit:

Facilitator Presentation

The Resiliency Checklist

Resources

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Toolkit Questions



General (4 questions)Assessing Climate Related Risks (19 questions)Risk Management to Reduce Climate Related Risks (45 questions)

o Procurement of health care resources and supplieso Notifications, monitoring and surveillanceo Clinical risk managemento Infrastructure and systems risk managemento Energy supply and use

Building Capacity to Adapt to Climate Change (14 questions)o Sustainable health care and climate change mitigation

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1. Please record your name and role at your health care facility and the date you completed the checklist.

Name Role Area of Work

Date

1.

2.

3.

4.

5.

6.

7.

8.

9.

GENERAL INFORMATION It is recommended that the facilitator invites senior level officials (e.g. directors or managers) to participate in reviewing and completing this tool. Individuals in the following areas may be best suited to participate:

• Emergency Management• Human Resources • Occupational Health and Safety• Pharmaceuticals, Medications and Vaccines• Director of nutrition and food services• Public Health Representation• Green Team Director / Manager• Environmental waste management• Electrical manager• Logistical services (managing supply flow in)• Waste management (managing waste flow out)• Director of purchasing• Clinical services• Housekeeping and laundering• Green team / sustainability

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Climate Change Resilient Health Care Facilities

1. Current and future climate variability can pose a variety of risks to people and infrastructure that could affect continuity of care at your health care facility. Please indicate if your health care facility considers the following climate-related hazards when conducting risk assessments.

Climate Risk Yes Somewhat No I don’t know This is not a risk for my region

a. Extreme heat

b. Extreme cold

c. Extreme rain and snowfall

d. Drought

e. Wildfire

f. Extreme weather – tornado

g. Extreme weather – freezing rain, ice storm, hailstorm

h. Extreme weather – thunderstorm, lightning

i. Extreme weather – hurricane and related storms

j. Extreme weather – avalanche, rock-, mud- and landslide, debris flow

k. Poor air quality and smog

l. Food-borne contamination and/or diseases

m. Water-borne contamination and/or diseases

n. Vector-and rodent-borne diseases

0. New and emerging infectious diseases

ASSESSING CLIMATE RELATED RISKS

Consult the Resources Guidebook and with climate change experts who have knowledge of current and future climate related impacts in local region.

4. Increasing resilience to climate change is an iterative process. Resilience today does not provide a guarantee that a facility will be resilient in the future under changing weather patterns. When identifying hazards that could pose a risk to your health care facility, is uncertainty around changing weather patterns, including future climate variability (e.g. use of future climate projections), considered?

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ASSESSING CLIMATE RELATED RISKS

COMMENTS:

Use the comments fields to provide information on: Information gaps Status of activities Other key stakeholders that may have primary responsibility Other pertinent information you wish to record

Yes

Somewhat

No

I don’t know

66. Many jurisdictions in Canada have begun to address climate change by developing climate change plans and undertaking vulnerability assessments. Some of these initiatives may have roles for health care facilities or information that is pertinent to them. Is your health care facility aware of climate change adaptation or mitigation initiatives in your jurisdiction and how your health care facility could be involved?

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BUILDING CAPACITY TO ADAPT TO CLIMATE CHANGE

COMMENTS:

Best Use of Results• Use resiliency score to inform gaps and needs• For resiliency areas where more information is needed:

Exchange information with other facilities Seek information from experts Refer to the Canadian Coalition for Green Health Care Use Resource Guide

Yes

Somewhat

No

I don’t know

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Health Care Facilities Building Resiliency

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Health Care Facilities Building Resiliency

• Relocating primary care facility from flood vulnerable lower levels to 9th floor (Veterans Affairs New York Harbor Healthcare System flood preparation strategy)

• Raising power and back-up power supplies above flood zones

• Operating windows• Maximize daylighting• Increase recycling• Increase use of alternative energy• Improve food security – explore local foods

Evans, Melanie (October 26, 2013). N.Y. hospitals shift focus to preparing facilities for future super storms. Modern Healthcare.

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Combined Heat and Power (CHP) for Resiliency

ENERGY RELIABILITY BENEFITS• Provide emergency power, • Provide supplemental capacity to allow

hospitals to maintain normal operations during periods of grid failure

• CHP plants have operated continuously during natural disasters such as Hurricane Sandy in New York

• Traditional backup generators do not always perform during emergencies

• Natural gas service is continuous and reliable (99.99% reliability in 2012)

• Diversifies the hospital’s fuel supply

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Mainstreaming Climate Change

The Province of Manitoba, in collaboration with Health Canada developed an online Hazard, Risks and Vulnerability Assessment tool that addresses risks from current climate variability and future climate change.

Integrating Climate Change into Canadian Hazard, Risk and Vulnerability Assessments

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Health Care Facility Resiliency Project - Phase II

• Health Canada, Manitoba Office of Disaster Management and the Canadian Coalition for Green Health Care is building on the "Health Care Facility Resiliency Toolkit" by tailoring it specifically towards smaller health facilities.

• The Long Term Care Resiliency Tool (LTCRT) will be a checklist for use by on-site long term care providers and officials.

www.greenhealthcare.ca/climateresilienthealthcare/toolkit/

Download Materials from Coalition web site:

Funding for this project was provided by::

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The Nova Scotia Climate Change Adaptation Fund

http://climatechange.gov.ns.ca/content/adaptation_fund

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Canadian Coalition for Green Health Care

is Canada’s premier green health care resource network; a national voice &

catalyst for environmental change

www.greenhealthcare.ca

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THANK-YOU

For more information please contact:

Linda Varangu - [email protected]

Jaclyn Paterson - [email protected]

mailto:[email protected]

mailto:[email protected]

Preparing health care facilities for climate change hazards by assessing resilience

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