Preparing health care facilities for climate
change hazards by assessing resilience
EMERGENCY PREPAREDNESS SESSION #1
CANADIAN PUBLIC HEALTH ASSOCIATION
MAY 27, 2014
Linda Varangu
Executive Director
Canadian Coalition for Green Health Care
Outline
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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
Dangerous
travelling conditions
Permafrost
melt damaging
infrastructures
Changes in drinking water
quality and quantity
Food security changing animal
distributions
Heat–related
illnesses and
deaths
Health impacts from
more severe storms
Psychosocial
impacts from
droughts
Water-borne
diseases from
floods Respiratory illnesses
from forest fires
Expansion of Lyme
Disease vector
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http://publications.gc.ca/collections/collection_2008
/hc-sc/H128-1-08-528E.pdf
Weather-Related Disasters in Canada 1900-2011
Canadian Disaster Database, 2012
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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
Ogden et al., 2008
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Climate Change Impacts on Health Programs
Food Safety
Seniors’ Health
Sustainable Development
Health care
system capacity
Infectious Disease
Management
Children’s
Environmental
Health
Adaptation
Mental
Health
Impacts
Mitigation
Health of
Northern
Populations
Travel Medicine
Air, Water Quality
Seguin, 2008
Occupational
Health
Emergency
Preparedness
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Impacts to Health Care
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Damage to health infrastructures such as
hospitals, clinics and nursing homes.
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Inadequately trained personnel or lack of an
emergency plan.
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Hospitals that contract out certain essential
services (e.g. laundry and food) may have them
interrupted during an emergency.
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Overcrowding in emergency shelters during a
disaster may increase exposure to infectious
diseases (e.g. influenza) of health care workers.
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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
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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
National Post, June 21, 2013, http://news.nationalpost.com/2013/12/23/when-torontossunnybrook-hospital-lost-power-six-of-the-tiniest-most-fragile-patients-were-sentpacking/?utm_source=dlvr.it&utm_medium=twitter
Mowat web site, 2014
http://mowatcentre.ca/wpcontent/uploads/pdfs/WHN_conference_presentations/McRitchie.pdf
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Alberta Floods Impacted Health Care Facilities
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-ofmassive-flooding-in-canmore-and-southern-alberta/
Calgary Herald, August 28, 2013,
http://www.calgaryherald.com/clinics+leaving+flood+damaged+Holy+Cross+good/
8840473/story.html
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Hurricane Sandy, June 2013
http://en.wikipedia.org/wiki/File:Sandy_Oct_25_2012_0400Z.JPG
New York Daily News, 2013 ,
http://news.nationalpost.com/2013/12/23/when-torontos-sunnybrook-hospital-lost-power-six-of-thetiniest-most-fragile-patients-were-sent-packing/?utm_source=dlvr.it&utm_medium=twitter
MOWAT website
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.
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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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HC Facility Climate Change Resiliency Toolkit
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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HC Facility Climate Change Resiliency Toolkit
Methods & Activities
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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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HC Facility Climate Change Resiliency Toolkit
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
ADVISORS
 Capital Health District Health
Authority, NS
 Nova Scotia Climate Change
Directorate
 Department of Health and
Wellness, NS
REVIEWERS
 Sustainable Development Unit,
National Health Service, United
Kingdom
 World Health Organization, WHOPAHO
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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
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Extreme weather emergency
Food-born contamination
Water-borne contamination
Air quality
Infections diseases
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HC Facility Climate Change Resiliency Toolkit
Health Care Facility Resiliency Toolkit:
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Facilitator Presentation
The Resiliency Checklist
Resources
HC Facility Climate Change Resiliency Toolkit
www.greenhealthcare.ca/climateresilienthealthcare/
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HC Facility Climate Change Resiliency Toolkit
2
www.greenhealthcare.ca/climateresilienthealthcare/
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HC Facility Climate Change Resiliency Toolkit
HC Facility Climate Change Resiliency Toolkit
www.greenhealthcare.ca/climateresilienthealthcare/
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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 supplies
o Notifications, monitoring and surveillance
o Clinical risk management
o Infrastructure and systems risk management
o Energy supply and use
HC Facility
Climateto
Change
Resiliency
Toolkit(14 questions)
 Building Capacity
to Adapt
Climate
Change
o Sustainable health care and climate change mitigation
www.greenhealthcare.ca/climateresilienthealthcare/
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HC Facility Climate Change Resiliency Toolkit
GENERAL INFORMATION
is recommended
the facilitator
invites senior
level
officials
1. Please record your name andItrole
at your that
health
care facility
and
the
date
(e.g. directors or managers) to participate in reviewing and
you completed the checklist. completing this tool. Individuals in the following areas may be best
Name
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8.
9.
suited to participate:
Role
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Area of Work
Date
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
ASSESSING CLIMATE RELATED RISKS
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
Consult the Resources Guidebook and
with climate change experts who have
knowledge of current and future
climate related impacts in local region.
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
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Climate Change Resilient Health Care Facilities
ASSESSING CLIMATE RELATED RISKS
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?
Use the comments fields to provide information on:
 Yes
 Somewhat
Information gaps
Status of activities
Other key stakeholders that may have primary responsibility
Other pertinent information you wish to record
 No
 I don’t know
COMMENTS:
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Climate Change Resilient Health Care Facilities
BUILDING CAPACITY TO ADAPT TO CLIMATE CHANGE
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?
Best Use of Results
 Yes
 Somewhat
 No
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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
 I don’t know
COMMENTS:
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HC Facility Climate Change Resiliency Toolkit
www.greenhealthcare.ca/climateresilienthealthcare/
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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
Integrating Climate Change into Canadian Hazard,
Risk and Vulnerability Assessments
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.
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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.
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Download Materials from Coalition web site:
www.greenhealthcare.ca/climateresilienthealthcare/toolkit/
Funding for this project was provided by:
:
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 - CCGHC
linda@greenhealthcare.ca
Jaclyn Paterson - HC
Jaclyn.paterson@hc-sc.gc.ca
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