The water started coming in from the ceiling. As a historic cold front swept into Boston in early February, an inactive sprinkler line in Boston Medical Center’s emergency room froze, blowing the cap off the end of the two-and-a-half-inch pipe. By the time the source of the leak was identified that Saturday night, 70 percent of the emergency room was flooded.
The hospital was one of at least three to stop accepting ambulances in its emergency room on Feb. 4 due to burst pipes, forcing EMS to divert ambulances elsewhere. Tufts Medical Center, the closest emergency room to BMC, was one of the hospitals to accept patients, but on Sunday morning it, too, had a pipe burst and temporarily shut its ER to ambulance traffic.
While the emergency department closures were short-lived, experts say health systems need to pay closer attention to the risks of extreme weather and the resilience of their infrastructure as the effects of climate change spread and grow more intense.
“There have been a record number of hospital evacuations and closures [nationally] in the last decade due to climate,” said Paul Biddinger, chief preparedness and continuity officer at Mass General Brigham. “Those events are a harbinger, and [climate readiness] is something that needs attention.“
The hospitals affected by burst pipes said they were diligent about maintaining their facilities and blamed the severity of the freeze for what happened. Dr. Margaret E. Kruk, professor of health systems at the Harvard T.H. Chan School of Public Health, said that all infrastructure has a built-in failure rate that is to be expected.
But continued investment to deal with climate change will be essential for hospitals as they confront growing numbers of weather emergencies, she said. Many hospitals defer capital investments when financial times are tight, and the tenure of top executives making investment decisions is often much shorter than the lifespan of the buildings they manage, Kruk said. As a result, state leaders should get involved in helping plan investment to prepare for climate change.
“It’s a bigger interest than simply for that local hospital,” Kruk said. “It is the business of the state to get involved and help nudge leaders to plan or try to secure other sources of funding to make those capital investments.”
Dr. Gaurab Basu, co-director of the Center for Health Equity Education & Advocacy at Cambridge Health Alliance, said that climate-related demands and the planning to manage them come at a time when the effects of the COVID-19 pandemic, including worker shortages and sicker patients, continue to overwhelm health systems.
“The health system is under tremendous strain, and you add on these additional strains, it’s a recipe for great challenge,” Basu said. “We will need some systematic approaches and a vision of how to be responsive.”
Mass General’s Biddinger said health systems might not adequately be preparing for climate threats. While the federal government requires hospitals to assess their hazards on an annual basis, it doesn’t dictate how, and many hospital executives look to historical analyses to understand what future climate risks will be.
Even for hospitals that consult forward-looking climate data, it is difficult to get information that is accurate, comprehensive, and detailed. Mass General Brigham self-funded its own risk analysis at all its major clinical sites in 2014 to identify storm surge, precipitation, temperature, wind, and seismic threats.
The new clinical tower being constructed at Massachusetts General Hospital is designed to be resilient in the face of sea level rise, severe precipitation, and severe heat — including over 90 days a year of greater-than-90-degree temperatures predicted by 2070. While many hospitals in New England haven’t previously thought about connecting cooling systems to generator power, the hospital has that in mind if the electrical grid gives out in the face of excess demand. The system is looking at that analysis as it plans updates to existing buildings as well.
“There is an imperative for new construction to build beyond code and take into account what climate change looks like,” Biddinger said. “A lot of hospitals can’t get access to that data, [and] we need to make that data more available. We have to require them to use that data to look forward and not back.”
In addition to infrastructure investments, some experts have suggested hospitals also need to improve the way they work together to respond to crises.
Several systems are already in place. Hospitals and others in the health industry communicate and coordinate through regional coalitions, and hospitals have guidance from the state for capacity crises that calls for them to exchange information and choreograph who has room for patients.
The Department of Public Health is also actively involved in planning and communication around crises, and the agency convenes calls for facilities around capacity issues.
When a fire forced Brockton Hospital to evacuate 176 patients on Feb. 7, the Department of Public Health activated its operations center to support the hospital and made a statewide request to all acute care hospitals in Massachusetts and Rhode Island for information on available beds. The state also provided the hospital with call center resources for patients’ families.
The hospital doesn’t expect to reopen for three months.
Many hospitals also have their own internal emergency management teams that respond to disasters. In the case of Brockton’s evacuation, for example, Mass General Brigham medical providers were accepting transferred patients, as IT leaders at MGB were working with experts at Brockton to retrieve medical records from a system without power.
“Many of us have been working together for years,” said Biddinger. “We have each other’s cell; we were calling back and forth and sharing information.”
Dr. Aaron Bernstein, interim director of the Center for Climate, Health, and the Global Environment at the Chan school of public health, said Massachusetts’ response system could still be more comprehensive.
“Whether these cold snaps are a function of greenhouse gases or not, they give us an indication, a canary in the coal mine view, of what a destabilized climate means for access to care for people who need it,” Bernstein said. “In this case a broken pipe [affected just] the emergency room. But what if the power goes out, or the roads are flooded around a hospital?”
Such proactive planning is underway. DPH has drafted a plan for when two or more hospitals have to be evacuated and the DPH needs to get more involved, helping match patients with available beds so there isn’t a competition for resources.
But climate resilience needs to be holistically embedded in health care and go beyond hospitals, some experts say. Notably, 81 percent of primary care clinic staff in a national survey said their clinic experienced some kind of disruption due to weather within the past three years. Fewer than one fifth of those staff felt their clinic was “very resilient”.
“We have to have a more nimble ability to make sure we can get care for people who need it,” Bernstein said. “The system will be strained.”