Element 4: Essential Clinical Care Service Delivery Planning

Task for Element 4

  • Ensure that essential clinical care services remain operational during and immediately following extreme weather events.
Photo of FEMA Administrator Fugate visiting Coney Island Hospital to view damage from Hurricane Sandy

FEMA Administrator Craig Fugate (right) and FEMA Federal Coordinating Officer Michael Byrne (left) on a tour of damage caused by Hurricane Sandy at the Coney Island Hospital.

Often, hospitals must both shelter inpatients in place as well as handle patient care surges related to a weather event. Emergency departments, urgent care centers, laboratory, and imaging services must remain operational. Nursing homes and residential care facilities house medically fragile, vulnerable populations. Research facilities may lose irreplaceable samples and data. In addition, health care settings may serve important non-traditional disaster response roles in their communities: sources for clean water, food, and shelter for a larger affected population.

Despite disabling situations, be ready for a surge in demand

Hospital facilities, in emergencies, are responsible for more than sheltering inpatients or residents in place—they are often called upon to deliver medical services to large numbers of injured people. It is imperative that hospitals maintain not only operational infrastructure services, but also vital medical care delivery services.

Photo of evacuees in the Houston Astrodome in Texas

Many of the evacuees from Hurricane Katrina who were housed at the Houston Astrodome Red Cross Shelter required medical attention.

Even if vital mechanical and electrical infrastructure is out of harm’s way, medical care delivery—from submerged imaging departments to flooded corridors connecting egress and transfer pathways—can be severely hampered. Surges of patients often follow weather disasters; with disrupted transportation, patients with minor injuries may be unable to leave safely following treatment. Ground-level helipads may be unusable because of debris or flooding, hindering evacuation or transfer. At the same time, search and rescue operations may necessitate debris removal and route clearance, traffic control (including personnel restricted movement), fuel distribution for response vehicles, and assistance in maintaining civil order from hospital personnel. 

Ensure adequate supplies and staffing

Hospitals must stockpile supplies in advance of events to remain operational through extended transportation and supply chain disruption. Just as critical, hospitals require personnel ranging from medical professionals to environmental services workers to deliver both direct patient care and necessary support services. Transportation systems may be damaged; travel restrictions and gasoline rationing may further stress personnel movement and re-supply. Hospitals and residential care facilities should have effective personnel recall systems coordinated with local and regional emergency management systems. During and following extreme weather events, hospitals and residential care settings may be required to house large numbers of workers, their families, and even their pets in order to continue to deliver high-quality, uninterrupted care while cut off from transportation systems and re-supply infrastructure.

Element 4 examines the organization of programs and buildings for uninterrupted health care service delivery and patient surge management both during and following extreme weather events.


Element 4 Checklist

Download the Element 4 Checklist: PDF or Excel

The Element 4 Checklist assists health care organizations in assessing clinical care and supply chain vulnerabilities. The Element 4 Checklist includes questions about provisions for patient surge, alternate care sites, staff accommodation and transportation, and provisions for community support to ensure that essential clinical services can continue without interruption during and immediately following extreme weather events.

Download the Element 4 Checklist:

Key resources for managing surge (external links)

The Joint Commission: It is crucial that health care organizations understand what surge hospitals are and how they can plan for and establish them. Where outside of its own walls does a health care organization go to expand its surge capacity? This paper provides the answers to these questions and offers real-life examples of how surge hospitals were established on the Gulf Coast.

Hospital Surge Capacity Toolkit: This toolkit is intended to assist healthcare facilities in thinking through critical issues related to healthcare surge, and to create comprehensive plans to address these needs.  All documents are available for download in a zip file.

Managing Mass Fatalities: A Toolkit: This comprehensive toolkit evolved from recognition of the need for communities to increase their preparedness for managing mass fatalities. Toolkit materials are based on lessons learned from actual events, including the Oklahoma City bombing, 9/11, and Hurricane Katrina. The toolkit provides scalable, operational direction and tools to guide jurisdictions in creating a local plan.

Download a document (PDF) with these and additional Element 4 resource links.
Last modified
27 September 2019 - 4:56pm