Preparing health care facilities for climate change hazards by assessing resilience

1. 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

2. Outline Climate change impacts on health Climate change impacts to health care facilities Toolkit for health care facilities to assess resiliency Questions

3. 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 Expansion of Lyme Disease vector Respiratory illnesses from forest fires http://publications.gc.ca/collections/collection_2008 /hc-sc/H128-1-08-528E.pdf

4. Weather-Related Disasters in Canada 1900-2011 Canadian Disaster Database, 2012

5. Temperature projections – Select Canadian cities

6. Establishment and spread of the Lyme disease vector Ixodesscapularis under current climate (2000) and projected future climate (2020 to 2080). Ogden et al., 2008 Ogden et al., 2008

7. 7 Climate Change Impacts on Health Programs Seniors’ Health Sustainable Development Food Safety Health care system capacity Infectious Disease Management Children’s Environmental Health Adaptation Mental Health Impacts Mitigation Occupational Health Health of Northern Populations Emergency Preparedness Air, Water Quality Travel Medicine Seguin, 2008

8. Impacts to Health Care • Damage to health infrastructures such as hospitals, clinics and nursing homes. • Inadequately trained personnel or lack of an emergency plan. • Hospitals that contract out certain essential services (e.g. laundry and food) may have them interrupted during an emergency. • Overcrowding in emergency shelters during a disaster may increase exposure to infectious diseases (e.g. influenza) of health care workers. • 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

9. Ice Storm, Sunnybrook Hospital, Dec 2013 • 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-torontos-sunnybrook-hospital-lost-power-six-of-the-tiniest-most-fragile-patients-were-sent-packing/?utm_source=dlvr.it&utm_medium=twitter Mowat web site, 2014 http://mowatcentre.ca/wp-content/uploads/pdfs/WHN_conference_presentations/McRitchie.pdf

10. 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-of-massive-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

11. 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-the-tiniest-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

12. 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.

13. Status of CC Adaptation / Action Plans in Hospitals

14. 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

15. HC Facility Climate Change Resiliency Toolkit Health Care Facility Climate Change Resiliency Toolkit 2 www.greenhealthcare.ca/climateresilienthealthcare/

16. 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

17. HC Facility Climate Change Resiliency Toolkit Methods & Activities Advisory committee Literature review Develop resiliency toolkit Expert reviewers Tested the toolkit with 6 pilot health care facilities Ground-truthing workshop

18. 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 • GuysboroughAntigonish 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, WHO-PAHO

19. Pilot Sites • Nova Scotia • St. Martha’s Hospital, GuysboroughAntigonish 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)

20. 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

21. Resiliency Indicators • Extreme weather emergency • Food-born contamination • Water-borne contamination • Air quality • Infections diseases

22. HC Facility Climate Change Resiliency Toolkit Health Care Facility Resiliency Toolkit: Facilitator Presentation The Resiliency Checklist Resources 2 HC Facility Climate Change Resiliency Toolkit www.greenhealthcare.ca/climateresilienthealthcare/

23. HC Facility Climate Change Resiliency Toolkit 2 www.greenhealthcare.ca/climateresilienthealthcare/

24. HC Facility Climate Change Resiliency Toolkit HC Facility Climate Change Resiliency Toolkit www.greenhealthcare.ca/climateresilienthealthcare/

25. Toolkit Questions • General(4 questions) • Assessing Climate Related Risks (19 questions) • Risk Management to Reduce Climate Related Risks (45 questions) • Procurement of health care resources and supplies • Notifications, monitoring and surveillance • Clinical risk management • Infrastructure and systems risk management • Energy supply and use • Building Capacity to Adapt to Climate Change (14 questions) • Sustainable health care and climate change mitigation HC Facility Climate Change Resiliency Toolkit www.greenhealthcare.ca/climateresilienthealthcare/

26. HC Facility Climate Change Resiliency Toolkit 1. Please record your name and role at your health care facility and the date you completed the checklist. GENERAL INFORMATION • It is recommended that the facilitator invites senior level officials (e.g. directors or managers) to participate in reviewing and completing this tool. Individuals in the following areas may be best suited to participate: • 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

27. Climate Change Resilient Health Care Facilities 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. ASSESSING CLIMATE RELATED RISKS • Consult the Resources Guidebook and with climate change experts who have knowledge of current and future climate related impacts in local region.

28. Climate Change Resilient Health Care Facilities 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? ASSESSING CLIMATE RELATED RISKS • Use the comments fields to provide information on: • Information gaps • Status of activities • Other key stakeholders that may have primary responsibility • Other pertinent information you wish to record • Yes • Somewhat • No • I don’t know COMMENTS:

29. Climate Change Resilient Health Care Facilities 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? BUILDING CAPACITY TO ADAPT TO CLIMATE CHANGE • Best Use of Results • 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 • Yes • Somewhat • No • I don’t know COMMENTS:

30. HC Facility Climate Change Resiliency Toolkit www.greenhealthcare.ca/climateresilienthealthcare/

31. Health Care Facilities Building Resiliency

32. 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.

33. 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

34. 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 toolthat addresses risks from current climate variability and future climate change.

35. 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.

36. Download Materials from Coalition web site: www.greenhealthcare.ca/climateresilienthealthcare/toolkit/

37. Funding for this project was provided by: : The Nova Scotia Climate Change Adaptation Fund http://climatechange.gov.ns.ca/content/adaptation_fund

38. 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

39. THANK-YOU For more information please contact: Linda Varangu - CCGHC linda@greenhealthcare.ca Jaclyn Paterson - HC Jaclyn.paterson@hc-sc.gc.ca