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3.8.2
Capacity during and after flooding
Health facilities in Europe have not experienced extreme increases in patient loads as a direct consequence of flooding, perhaps because of small numbers of patients with serious injuries or near-drowning. If flooding is widespread and has disrupted infrastructure, patients who are usually cared for in the community may be admitted to hospital, either because the usual care structures have been disrupted or because the patient’s condition has deteriorated due to the absence of vital routine care, such as for dialysis patients and people with cystic fibrosis. This could create pressure on capacity but would be unlikely to trigger emergency plans. Situations that would trigger emergency plans include the following. •
After population displacement, health facilities may have an increased patient load as they admit emergency cases or take on the routine care of displaced people. The frequencies of both “major” and “minor” injuries may increase, disrupting the standard triage system. People with injuries may continue to present during clean-up.
•
Emergency patients may be transferred to neighbouring facilities if the nearest one is incapacitated by flooding; however, patient transfer and emergency services can be affected if the transport infrastructure is disrupted.
•
The case load may increase after an event if outpatient clinics have been disrupted.
To meet increasing population numbers, more health infrastructure is being built in at-risk areas. Thus, local community clinics may be sited in areas that are vulnerable both in terms of risk for flooding and the population they serve. Therefore, all health facilities should have plans to create “surge capacity” (198), which is defined as “The ability to manage a sudden, unexpected increase in patient volume that would otherwise severely challenge or exceed the current capacity of the health care system” (199). It is important to understand the role of health facilities in the wider public health response to flooding and to ensure surge capacity in less obvious places, such as laboratories (198).
3.8.3
Facilities and infrastructure
Power supply Electrical power is vulnerable to failure during a flood event. Both internal and external communication systems in a health facility may be affected, jeopardizing the internal functioning of the hospital and the transfer of patients within it or communication between facilities, especially with emergency services. In most facilities, emergency generators are located in the basement, and many medical physics departments are located below ground level. Therefore, expensive, vital pieces of equipment can be put out of action in a flood, disrupting diagnostic care and the electricity supply of the entire hospital. Emergency power can often be connected to selected areas, such as intensive care and laboratories, and in some hospitals emergency generators are surrounded by flood walls and kept dry (200). It is recommended that the location of strategic facilities and services be reviewed and if necessary relocated. When Tewkesbury hospital in England was under threat of flooding in 2007, an early decision was taken to evacuate it and transfer about 20 patients to other facilities (201). Collaborative plans with other hospitals are important, so that patient care can be assured if one becomes incapacitated (202). Availability of water A clean water supply and sanitation systems are a priority, as the excess of water in flooding can lead to a shortage of clean, drinkable water. This affects not only health systems but entire communities and can cause outbreaks of e.g. Legionella (201. Bringing in bottled water can be difficult when transport systems have flooded. During the floods in Gloucestershire,