Natural Hazards: Look Beyond the Weather Event

As we continue through the Hazard Vulnerability Analysis process and begin categorizing risks, let’s start with natural hazards.

Natural hazards include weather, geological, and environmental events that could affect the hospital, its patients, staff, infrastructure, access routes, utilities, supply chain, or surrounding community.

These may include:

• Hurricanes and tropical storms

• Tornadoes and severe thunderstorms

• Flooding and flash flooding

• Winter storms and extreme cold

• Extreme heat

• Drought

• Wildfires and smoke

• Earthquakes

• Landslides and debris flows

• Tsunamis

• Volcanic activity

• Lightning

• Hail

• High winds

• Coastal erosion and storm surge

Not every hospital faces every natural hazard. However, nearly every hospital is vulnerable to the secondary effects created by natural events.

That is where the HVA committee needs to look more closely.

Do Not Stop at the Obvious Hazard

A hospital in Florida will usually consider hurricanes.

A hospital in the Midwest will usually consider tornadoes.

A hospital in California will usually consider earthquakes or wildfires.

A hospital in the Northeast may focus on winter storms.

Those are appropriate starting points, but they are not enough.

The mistake some hospitals make is identifying the hazard without fully examining what the hazard would do to hospital operations.

A hurricane is not only a wind event.

It may also create:

• Flooding

• Storm surge

• Fires caused by downed electrical lines, damaged equipment, fuel releases, or delayed emergency response

• Structural damage

• Extended power outages

• Water system failures

• Communication disruptions

• Fuel shortages

• Road closures

• Staffing shortages

• Delayed deliveries

• Patient evacuation

• Patient surge

• Damage to employees’ homes

• Loss of community healthcare services

• Delayed recovery lasting days or weeks

Similarly, a winter storm is not simply snow or ice.

It may prevent staff from reporting to work, delay patient discharge, interrupt food and medication deliveries, freeze pipes, damage heating systems, increase emergency department volume, and limit ambulance access.

A wildfire does not have to reach the hospital grounds to affect patient care. Smoke and poor air quality may increase respiratory complaints, threaten air-handling systems, affect outdoor equipment, require changes to ventilation, disrupt roads, displace nearby residents, and force evacuation decisions.

The committee should therefore move beyond asking: Can this hazard happen here?

It should ask: If this hazard happened here, what would it do to patient care and hospital operations?

Start With What Has Already Happened

The committee should first examine the hospital’s own history.

Ask:

• What natural events have affected this hospital?

• What natural events have affected other facilities within the health system?

• What events have affected nearby hospitals?

• What events have disrupted the surrounding community even when the hospital remained open?

• Which weather events have caused staffing shortages?

• When have roads, bridges, tunnels, or public transportation become unavailable?

• Have utility interruptions occurred during storms, flooding, heat, or extreme cold?

• Have supply or vendor deliveries been delayed?

• Have patient volumes increased because physician offices, clinics, pharmacies, dialysis centers, nursing homes, or other community services were closed?

• Have previous emergencies required sheltering, relocation, or evacuation?

Past experience does not predict every future event, but it provides evidence of how hazards interact with the facility and community.

Hospital incident reports, emergency operations center logs, after-action reports, corrective action plans, facilities work orders, staffing records, utility outage histories, and patient-volume data may all help reveal patterns.

A storm that caused only minor physical damage may still have exposed serious operational weaknesses.

Perhaps the facility remained functional, but:

• Staff could not reach the hospital.

• Generators operated longer than expected.

• Fuel deliveries were uncertain.

• Cellular service became unreliable.

• Employees had no childcare.

• Food deliveries were delayed.

• Discharged patients had nowhere safe to go.

• Community pharmacies were closed.

• Home oxygen vendors could not make deliveries.

• Dialysis patients arrived seeking treatment.

• The emergency department became a refuge for people whose medical equipment required electricity.

• A nearby nursing home evacuated residents to your emergency department. The facility had identified your hospital as its intended destination, but that expectation had never been coordinated with your organization. Another organization’s emergency plan can become your emergency.

Those consequences belong in the HVA discussion.

Examine the Entire Operational Chain

Natural hazards frequently create cascading failures.

A cascading failure occurs when one disruption produces additional disruptions across other systems.

For example:

Heavy rain leads to flooding - Flooding closes roads - Closed roads prevent staff from reporting - Staffing shortages reduce available inpatient capacity - Reduced inpatient capacity causes emergency department boarding - Emergency department boarding increases crowding, stress, workplace violence risk, and delays in care.

The original hazard was heavy rain. The operational consequences reached much further.

Another example:

Extreme heat increases regional electrical demand - Electrical demand contributes to power instability - The hospital transitions to emergency power - Some systems are not connected to generator circuits - Cooling becomes difficult in certain areas - Patient temperatures, medication storage, food safety, IT equipment, and staff working conditions become concerns.

The event may eventually require patient relocation even though the hospital building itself was never physically damaged.

The HVA committee should look for these chains rather than evaluating each hazard as a single, isolated event.

Consider the Hospital’s Dependence on the Community

Hospitals are not islands.

They depend on an extensive network of people, organizations, infrastructure, vendors, and utilities. A natural hazard may leave the hospital intact while damaging the systems that support it.

Consider dependencies such as:

• Electric power

• Water and wastewater

• Natural gas

• Fuel

• Telecommunications

• Internet connectivity

• Medical oxygen

• Pharmacy and medication delivery

• Food and nutrition services

• Linen and laundry

• Medical waste removal

• Garbage removal

• Laboratory couriers

• Blood products

• Medical supplies

• Staffing agencies

• Home health providers

• Dialysis services

• Ambulance services

• Public transportation

• Road and bridge access

• Childcare and schools

• Long-term care facilities

• Behavioral health services

• Community pharmacies

• Funeral homes and mortuary services

The committee should ask what happens when several of these systems fail at the same time.

For example, a hospital may have adequate emergency power but depend on fuel deliveries after a certain number of hours. If flooded roads prevent the fuel vendor from reaching the hospital, generator capacity alone does not eliminate the risk.

A hospital may have an adequate water supply but rely on municipal wastewater service. Loss of wastewater capability could still significantly limit operations.

A hospital may be structurally safe after an earthquake but unable to function because roads, communications, water systems, and vendor distribution centers are damaged.

The HVA must evaluate both the hospital and the ecosystem that allows it to operate.

Do Not Overlook Supply Chain Disruption

Supply chain disruption is often one of the most underestimated consequences of a natural hazard.

Hospitals may spend considerable time discussing wind, flooding, structural damage, and emergency power, while assuming that supplies will continue arriving as needed.

That assumption can quickly become a critical weakness.

Hospitals depend on frequent and often tightly scheduled deliveries of:

• Medications and pharmaceuticals

• Intravenous fluids

• Blood and blood products

• Medical gases and oxygen

• Personal protective equipment

• Sterile supplies

• Surgical instruments and implants

• Food and drinking water

• Linen and laundry

• Fuel

• Laboratory supplies

• Dialysis supplies

• Cleaning and disinfection products

• Waste removal services

• Medical equipment and replacement parts

A natural hazard does not have to damage the hospital to interrupt these resources.

Flooded roads may prevent delivery vehicles from reaching the facility. A regional power outage may close a vendor warehouse. A wildfire may force a distribution center or transportation route to shut down. Severe winter weather may stop trucks hundreds of miles away. A hurricane may disrupt ports, fuel supplies, manufacturing facilities, and regional distribution networks long before it reaches the hospital.

The committee should also consider where supplies originate, not just who delivers them.

A hospital may use a local vendor, but that vendor may depend on a regional warehouse in another state. A distributor may have multiple warehouses, but all of them may receive products through the same port, manufacturer, highway, or transportation hub.

What appears to be a diverse supply network may actually contain several hidden single points of failure.

The HVA committee should ask:

• Which supplies are essential to maintaining patient care?

• How many days of each essential item are normally kept on hand?

• Which supplies are delivered daily or several times per week?

• Which products have no practical substitute?

• Which items come from a single manufacturer, distributor, or warehouse?

• Which deliveries depend on one road, bridge, port, airport, or fuel source?

• Which vendors are likely to be affected by the same hazard as the hospital?

• How quickly would shortages begin to alter clinical operations?

• Which departments would be affected first?

• What conservation measures could be implemented?

• Which alternate products have already been approved?

• Are backup vendors identified, contracted, and capable of delivering during a regional emergency?

• How will the hospital prioritize limited supplies?

• Who has authority to approve substitutions, conservation measures, or changes in clinical practice?

The committee should be cautious about relying on statements such as, “The vendor has a disaster plan,” or, “We have a backup supplier.”

Those statements should be validated.

A backup supplier may use the same distribution center as the primary vendor. A vendor’s emergency plan may prioritize larger customers or facilities under existing emergency contracts. Transportation may be unavailable even when the product itself is in stock.

Supply chain risks also extend beyond physical products.

Many hospital services are provided through outside organizations, including:

• Laundry

• Food services

• Medical waste removal

• Pharmacy support

• Laboratory testing

• Equipment maintenance

• Oxygen delivery

• Dialysis support

• Sterile processing

• Staffing agencies

• Patient transportation

• Home health services

• Information technology support

If those services are interrupted, hospital capacity may decline even when staffing, utilities, and the building remain intact.

The HVA should therefore consider how long the hospital can operate without routine deliveries and contracted services.

For each essential resource, the committee should understand:

• Normal consumption rates

• Current on-hand inventory

• Increased use during emergencies

• Minimum operating levels

• Available substitutions

• Resupply timelines

• Vendor emergency procedures

• Alternate delivery routes

• Regional competition for the same resources

Demand may increase at the same time supply decreases.

A respiratory event may increase oxygen, medication, and ventilator use while transportation disruptions delay resupply. A flood may increase emergency department volume while preventing linen, food, and medical waste vendors from reaching the hospital. Extreme heat may increase patient demand while also creating regional strain on fuel, electricity, water, and refrigeration.

This is why supply chain disruption should not be treated as a purchasing department issue alone.

It is a patient-care, continuity-of-operations, and emergency management concern.

A hospital may have beds, staff, and electricity, but still be unable to provide care if it lacks the medications, oxygen, food, sterile supplies, laboratory materials, or support services needed to operate safely.

The HVA committee should not simply ask: Do we have enough supplies today?

It should ask: How long can we continue operating if the supply chain stops tomorrow?

Look at Staff Vulnerability

Staff availability is often one of the most significant consequences of a natural hazard.

The committee should consider:

• Where employees live

• Which roads and bridges they use

• Whether they rely on public transportation

• Whether they live in flood-prone, wildfire-prone, or evacuation zones

• Whether schools and childcare facilities are likely to close

• Whether employees may need to protect or evacuate their families

• Whether staff members may lose electricity, water, transportation, or housing

• Whether relief staff can safely reach the facility

• How long employees already at the hospital may need to remain

• Whether food, sleeping space, medications, hygiene supplies, and behavioral health support will be available for extended operations

A staffing plan that assumes the next shift will arrive on time may collapse quickly during a regional disaster.

The committee should not interpret this as a failure of employee commitment.

Employees may be willing to report but physically unable to reach the hospital, unable to leave vulnerable family members, or affected by the same disaster as the community.

Another consequence of natural disasters is the closure of stores and gas stations.

Vehicles still require energy. Gasoline and diesel may become unavailable, while electric vehicles may be unusable when charging stations lose power. If staff cannot refuel or recharge, even employees who are willing and able to report may eventually lose transportation. If gas stations are closed, or electricity is off, staff may not be able to get to work. Can the committee predict this? Yes. Can arrangements be made to provide fuel in disasters? Yes, but only if the committee thinks about it ahead of time and includes this in the planning process.

The HVA should help leaders identify these limitations before an emergency.

Consider Patient Surge and Changes in Demand

Natural hazards can increase patient demand even when the hospital itself is not damaged.

Possible surge populations may include:

• People injured during the event

• Patients with respiratory problems caused by smoke, dust, heat, or poor air quality

• Individuals dependent on electrically powered medical equipment

• Dialysis patients whose usual treatment sites are closed

• Residents evacuated from long-term care facilities

• Patients from other facilities that were more heavily affected, exceeded their capabilities, or had not adequately coordinated their evacuation and transfer plans

• Patients unable to obtain medications

• People experiencing heat- or cold-related illness

• Patients whose home health services have been interrupted

• Individuals experiencing anxiety, trauma, or behavioral health crises

• Community members seeking shelter, electricity, food, water, or information

• Staff members and family members who remain at the hospital during the event

Hospitals should consider both the number of people who may arrive and the types of services they may require.

Surge does not always arrive through the ambulance entrance. People may come through the lobby seeking power for medical devices, replacement medication, oxygen, shelter, transportation, or basic information.

Consider the Possibility of Evacuation

Natural hazards may require sheltering in place, partial evacuation, phased evacuation, or complete evacuation.

The committee should ask:

• What conditions would make the facility unsafe?

• Who has authority to order evacuation?

• Which patients would move first?

• Which patients would be most difficult to transport?

• What transportation resources are available?

• Are receiving facilities likely to be affected by the same event?

• Could roads or bridges become unusable?

• How would medications, medical records, oxygen, equipment, and staff accompany patients?

• Could elevators become unavailable?

• How would patients be moved vertically?

• Where would staff and families receive information?

• How would security and access control be maintained?

• How long would it take to evacuate the facility under realistic conditions?

A plan stating that patients will be transferred to another hospital is not enough. During a regional disaster, neighboring hospitals may be damaged, full, inaccessible, or facing the same utility and staffing problems.

Use Reliable Sources

The HVA committee should combine hospital experience with credible external information.

Possible resources include:

• Local hazard mitigation plans

• County or city emergency management offices

• State emergency management agencies

• National Weather Service local forecast offices

• NOAA historical storm-event data

• FEMA flood maps

• FEMA disaster declarations

• USGS earthquake and landslide information

• Local fire department wildfire or brush-fire data

• State forestry and wildfire agencies

• Public works and transportation departments

• Utility outage histories

• Regional healthcare coalition information

• Hospital and health-system after-action reports

• Local news archives documenting past events

The National Weather Service operates local forecast offices that issue forecasts, watches, warnings, advisories, river information, and other location-specific hazard information. Local offices can also provide valuable context about recurring regional weather conditions.

NOAA’s Storm Events Database contains records collected by the National Weather Service and can be searched by state, county, date, and hazard type. It includes information about events such as tornadoes, floods, high winds, hail, lightning, winter weather, drought, heat, and other significant conditions. The database currently includes records beginning in 1950, although the available period varies by event type.

USGS resources can help hospitals evaluate earthquakes, landslides, debris flows, volcanic activity, and related geological hazards. USGS notes that earthquake effects can include ground shaking, fault movement, ground failure, and, in some locations, tsunamis. Its landslide tools include historical inventories and maps showing areas of potential susceptibility.

These resources should support local analysis, not replace it.

A national map may identify that flooding is possible. Hospital experience may reveal that just a few inches of water at one intersection can prevent ambulances and employees from reaching the facility.

A weather database may document repeated winter storms. Facilities records may show that the more serious vulnerability is an aging heating system or exposed water line.

A wildfire map may identify a nearby hazard area. Local emergency management and fire officials may know that the hospital’s primary access road could be included in an evacuation route.

The most useful HVA combines broad hazard information with local operational knowledge.

Ask About Severity, Duration, and Timing

The committee should not evaluate only whether an event could occur.

It should consider:

Severity: How intense could the event become?

Duration: Could the disruption last minutes, hours, days, or weeks?

Timing: Would the consequences differ during the night, weekend, shift change, holiday, tourist season, or period of peak census?

Geographic reach: Would the event affect only the facility, or the entire region?

Warning time: Would the hospital have days to prepare, or only seconds?

Recovery time: How long would it take to restore full operations?

A moderate event lasting several days may create more serious hospital consequences than a severe but brief event.

Duration is especially important when evaluating generator fuel, water, food, pharmaceuticals, staffing, linen, waste removal, oxygen, and other essential supplies.

Avoid False Precision

HVA scoring tools often ask committees to assign numerical values to probability, impact, preparedness, and response capability.

Those numbers can create the appearance of precision.

But a score is only as reliable as the discussion behind it.

The committee may not know the exact probability of a major flood, tornado, earthquake, or wildfire. It should still be able to document:

• What credible sources show

• What has happened previously

• What infrastructure is exposed

• What hospital systems could fail

• What protections are already in place

• What limitations remain

• What assumptions require validation

The goal is not to predict the future perfectly.

The goal is to make better preparedness decisions.

Move From Hazard Identification to Action

A completed HVA should lead somewhere.

When a natural hazard receives a significant score, the committee should consider what action is required.

Possible actions may include:

• Reviewing emergency power capacity

• Confirming generator fuel contracts

• Evaluating water-loss contingencies

• Strengthening severe-weather notification procedures

• Reviewing shelter-in-place locations

• Testing staff recall procedures

• Establishing transportation arrangements

• Evaluating flood protection

• Reviewing roof, window, and building-envelope vulnerabilities

• Confirming alternate communication systems

• Reviewing air-quality and smoke procedures

• Developing employee shelter and family-support plans

• Exercising evacuation procedures

• Validating receiving-facility agreements

• Increasing essential supply levels before predictable events

• Coordinating with emergency management, utilities, EMS, fire, law enforcement, and healthcare coalition partners

A high-risk score without a preparedness action is only a number on a spreadsheet.

The Central Question

The HVA committee should not stop at: What natural hazards occur in our area?

It should ask: How could those hazards interrupt our ability to care for patients?

That question changes the conversation.

It shifts the committee’s attention from the weather map to the emergency department, patient units, loading dock, boiler room, pharmacy, data center, staffing office, ambulance entrance, supply chain, and roads surrounding the hospital.

Natural hazards begin outside the building.

Their consequences quickly move inside.

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