A recent New York Times Op-Ed (When ‘Do No Harm’ Means Evacuating Hospitals In California) by Dr. Stephen Parodi, Associate Executive Director of The Permanente Group, describing the devastating effects of the recent California fires, truly brings climate change one step closer to all patients, hospitals and healthcare providers.
Parodi, responsible for emergency management of 21 hospitals, is now performing duties that he never typically did in the past: evacuating patients from hospitals that are threatened by the flames and torrential winds driving them.
His thesis, that “medical evacuees are the new refugees of climate change”, has a powerful impact and provides an ongoing wake-up call that we must act now to institute measures to reduce our carbon footprint in order to save our planet and future generations.
Patients requiring evacuation for devastating fires are now a primary concern for at-risk hospitals in California. Planning for such an evacuation and the important steps in the process is now a critical aspect of emergency disaster preparedness planning, as Parodi vividly describes in his piece.
“Throughout the night, critically ill babies were bundled up, placed in incubators and then put in ambulances, writes Parodi. “Laboring mothers and their families were presented with unimaginable choices: Should we wait for the baby to be born while fires rage outside? Should we move now and risk delivery in the ambulance? Surgeries underway in the operating room required battlefield-like urgency. Close the patient. Stabilize. Get everyone out.”
Parodi raises an important point for future planning for such natural disasters: Should this be part of our “new normal”–adding training for such evacuations to the curriculum of medical schools and making them part of residency training?
Unless we can reduce the effects of climate change, it certainly looks like we won’t be removing this curriculum addition anytime soon, argues Dr. Paul Biddinger, Associate Professor of Emergency Medicine, Chief, Division of Emergency Preparedness, Director, Massachusetts General Hospital Center for Disaster Medicine, Harvard Medical School. “We’re facing changes that we just aren’t prepared for,” he cautions.
“We are talking about climate change in the [residency and fellowship training curriculum] on two fronts,” says Biddinger. These include the health effects of climate change leading to adverse health effects, and extreme climate events such as severe heat waves or superstorms, creating immediate threats to health leading to spikes in asthma, heart failure and coronary heart disease.
Biddinger has been on the front lines of multiple natural disasters, including Hurricanes Katrina and Sandy and the Nepal Earthquake in 2015. His hands-on experience allows him to reflect on the effects of climate change, with a reminder that unless we update our infrastructure, we must be prepared for the deadly consequences associated with climate change.
“I think that these recent fires have taught us that the infrastructure around us is more vulnerable than we ever thought it was”, offers Biddinger. “I don’t think we had ever thought we would intentionally be turning off the power to hospitals and communities to try and protect them from the effects of climate change—but that’s what we need to do in certain circumstances.”
“Many of us in hospital emergency preparedness are worried that the grid and other utilities are less reliable than we had thought they were because of climate change, and therefore we’ve had to really reassess our plans for when and how we need to try for independence and/or we need to improve our evacuation plans and systems,” adds Biddinger.
But it’s not only wildfires we need to be concerned about, Biddinger explains. “I think it’s not just wildfires—increasingly both at the coasts for flooding, as well as inland, we are seeing flooding forcing the evacuation of more and more hospitals,” the result of more powerful superstorms and hurricanes over the past decade.
Biddinger adds that “we are seeing this pattern with these storms with predictability and recurrence, either because of hurricanes and storms that come off the sea or due to greater amounts of precipitation over longer periods of time.”
These are several reasons, likely directly related to climate change, that we can expect to see both hospital and patient populations displaced, he offers.
Beyond winds and torrential rains associated with such powerful storms, the ability to sustain power in the midst of such natural disasters is a key challenge.
“It was definitely floods, but also power loss” emphasizes Biddinger, who worked in a shelter in Queens during Hurricane Sandy in 2012. “Part of it was flooding, but also electricity failures that we confronted in a medical shelter.”
Biddinger also cites the voluminous amounts of rainfall and duration of Hurricane Harvey in Houston in 2017 as evidence that you don’t have to live on the coast to be at risk for severe effects of such powerful storms.“
“We saw this around Houston, that you don’t necessarily just have to be coastal—a lot of the flooding is coming from the severity of precipitation and the length of the storms, lasting longer and moving more slowly so they dump a greater volume of rain,” he explains.
Parodi’s warnings that we must enact change now to combat climate change, and improve upon existing hospital protocols for such disasters is a reminder of the key role that health care institutions serve as climate change continues to affect our lives.
He also describes the sheer devastation from the recent fires and their impact on normal hospital operations, requiring a large scale effort to transfer all types of patients and illustrating how fragile life can truly be. It shows how natural disasters, including hurricanes and tornadoes, can interrupt scheduling of planned or elective surgeries and medical care we typically take for granted.
“It’s an incredibly complicated calculation of risk when you know a threat is coming,” explains Biddinger. “You want to pare down your hospital operations to the absolute minimum so that you don’t have people in the operating room or intensive care unit (ICU) who will be at risk if you have to evacuate.”
But it’s not an interruption of “elective” care or even scheduled care, Biddinger argues–-its the continuum of all patient care. These are important and life-sustaining elements of patient care, whether it’s a cancer-related surgery or even a scheduled cardiac bypass surgery.
That necessary “calculation” that Biddinger eloquently describes–-not to do scheduled procedures and surgeries as a natural disaster approaches due to a greater risk–ultimately has downstream consequences impacting patient care and outcomes. This disruptive aspect to patient care is the “new normal” that we must contain in the throes of climate change. It’s akin to “choosing between the lesser of 2 significant evils,” he warns.
Biddinger also stresses that all physicians, not just emergency and disaster physicians, should be well aware of the effects of climate change on health care delivery and patient outcomes.
“Because we know it adversely affects the health of our patients, as well as undermines the ability of the medical system to deliver care, we really all have to pay attention and advocate for change.”