Healthcare delivery and the wider public infrastructure should be considered an integrated whole when planning for or responding to disasters such as Hurricane Sandy, according to an article published online in the New England Journal of Medicine.

Authors Irwin Redlener, MD, and Michael J. Reilly, DrPH, MPH, of Columbia University’s Mailman School of Public Health in New York City, noted that the experiences of New York University—Langone Medical Center and others in the path of Sandy provide an example of what challenges can be expected after a large disaster.

Identifying and treating urgent storm-related casualties should be a priority, according to the authors. “Initial reports indicate that emergency care systems in New York and most of the affected region functioned well during and immediately after the storm,” they wrote. “However, when major medical centers are incapacitated, the stress on remaining facilities may be extreme. Accommodations must be made for both a disaster-related surge in patients and the usual intake of patients with unrelated urgent medical and surgical needs.”

After a storm or other disaster with extensive flooding, Redlener and Reilly explained that secondary public health threats become a major concern. “Dangerous debris can clog streets and pose serious hazards to pedestrians. Breakdowns or overflows in sewer systems and water-treatment plants can result in contaminated drinking water and waterways. Toxic wastes and miscellaneous carcinogens from Superfund sites can spread over wide areas, exposing storm survivors to latent dangers."

Maintaining essential supply chains is another major concern of providers. Medical imaging in particular has high demands for power and facilities must plan for backup power and for situations where gas stations aren’t able to supply fuel.

“Although experience is a great teacher, science can and should also inform disaster policy. Too often it does not,” wrote the authors.

They explained that preparation is especially important considering two realities that have combined to make the healthcare system more vulnerable to future disasters. The first is the fact that the U.S. infrastructure is aging, frail and increasingly more likely to breakdown. Climate change is the other factor, and means that storms will be stronger and more frequent in the future.

“Since these two powerful factors represent imminent threats to the public health, it's fair to ask what role our profession will play in influencing the political process to ensure that we invest in upgrading critical infrastructure and implement policies that will slow the process of climate change," the authors concluded.