Element 3: Infrastructure Protection and Resilience

Tasks for Element 3:

  • Construct and retrofit critical facilities with sustainable communications, energy, water, and waste infrastructure in appropriate locations and to a standard of climate resilience to withstand events over the anticipated life of the structure. Infrastructure resilience measures reduce disruption, incapacitation, or loss of use of critical health care facilities.
  • For less critical facilities: design for safe closure prior to an event with the ability to resume services within 48 to 96 hours following a major event.

Examine facility infrastructure

Photo of NYU Medical Center along East River in New York

New York University (NYU) Medical Center (in center of photograph) sustained significant infrastructure damage from the storm surge that accompanied Hurricane Sandy. Now, the Center is working with federal agencies to coordinate plans for improving its flood resilience. As they work to develop protection for the facility, the groups may come up with options that can improve the surrounding ecosystem.

Infrastructure protection and resilience is a key element of health care facility operation through extreme weather events. In Hurricane Sandy, the failure of both grid power and emergency generators forced hospital evacuations. While generators were located above flood elevations, critical infrastructure components—fuel pumps, fuel tanks, electrical switchgear—were not. This element examines energy, water, and waste infrastructure, as well as fire protection and communication systems. All of these components are necessary to continue to provide care and/or safely “shelter in place” during and after an extreme weather event.

Uninterrupted energy supplies are required to maintain operational health care facilities during and following an extreme weather event. While all hospitals include emergency generators for temporary emergency power supplies, extended grid power outages are testing the limits of this technology, and emergency generator plants may be situated in vulnerable locations. Increasingly, hospitals are investing in on-site power generation through combined heat and power technologies to improve resilience. In addition to power interruption, loss of climate control systems (heating and air conditioning), air filtration, building pressurization, and other key mechanical performance measures may lead to the need to evacuate the facility.

Secure access to water

Access to reliable potable and process water supply is a key element of health care resilience. There is no national standard for quantity of reserve backup; one of the key challenges with fixed-quantity emergency water supplies is accurately estimating demand. Storage of large quantities of water is often difficult and impractical, but ensuring 24/7 availability of water delivery is equally challenging. A range of measures can improve water supply resilience: dual water sources (i.e., on-site wells), water conservation, on-site rainwater harvesting, and reclaimed water reuse systems. Municipalities in drought-prone regions are installing large-scale municipal reclaimed water systems to meet the process (non-potable) water needs of their communities. In hospitals, up to 70 percent of total water use is for non-clinical care uses. Finding reliable alternative sources of water is a key element of enhanced resilience in a future with stressed potable water supplies.


Element 3 Checklist

Download the Element 3 Checklist: PDF or Excel

The Element 3 Checklist assists health care organizations in understanding key mechanical/electrical/life safety infrastructure vulnerabilities. The Element 3 Checklist includes questions about communications, energy, water, and waste system infrastructure at both building and campus levels.

Download the Element 3 Checklist:

Key resources (external links)

Combined Heat and Power: Enabling Resilient Energy Infrastructure for Critical FacilitiesThis report provides information on the design and use of combined heat and power (CHP) for reliability purposes, as well as state and local policies designed to promote CHP in critical infrastructure applications.

ASHRAE Advanced Energy Design Guide  (for Large Hospitals)  (for Small Hospitals). The series provides an approach to easily achieve advanced levels of energy savings without having to resort to detailed calculations or analysis. The Guides offer contractors and designers the tools, including recommendations for practical products and off-the-shelf technology, needed for achieving a 50 percent energy savings compared to buildings that meet the minimum requirements of ANSI/ASHRAE/IESNA Standard 90.1-2004. 

Targeting 100! Envisioning the High Performance Hospital: Implications for a New, Low Energy, High Performance Prototype. This research provides a conceptual framework and decision-making structure at a schematic design level of precision for hospital owners, architects, and engineers. It offers access to design strategies and the cost implications of those strategies for new hospitals to utilize 60 percent less energy.

National Renewable Energy Laboratory AtlasThese maps show renewable energy resources in the United States. They illustrate the geographic distribution of wind, solar, geothermal, and biomass resources, as well as other pertinent information.

U.S. Department of Energy—Renewables Make a Powerful Case as Hospital Energy SourceThis short primer offers an introduction to tools and resources for assessing sites' potential for tapping renewable energy. The guide includes short case studies of hospitals that have integrated renewables into their energy portfolios.

Planning for Water Supply Interruptions: A Guide for Hospitals and Health FacilitiesThis short primer highlights tools and resources for assisting hospitals and health facilities in preparing for water supply interruptions.

Emergency Water Supply Planning Guide for Hospitals and Healthcare FacilitiesHealth care facilities should develop an Emergency Water Supply Plan (EWSP) to prepare for, respond to, and recover from a total or partial interruption of the facilities’ normal water supply. Because a health care facility must be able to respond to and recover from a water supply interruption, an EWSP provides the guidance to assess water usage, response capabilities, and water supply alternatives.

Download a document (PDF) with these and additional Element 3 resource links.
Last modified
6 August 2021 - 11:29am