Infrastructure Protection and Resilience Planning
Elements of infrastructure protection and resilience planning for heat waves include consideration of how communications, energy, water, and waste management capabilities could become vulnerable and which specific improvements would enhance their resilience to extreme heat, especially with regard to patient care. Hospitals should also consider how they can decrease their contribution to heat island effects, reduce their energy demands, and keep the inside of the hospital cooler by investing in green and cool rooftops. The U.S. Environmental Protection Agency (EPA) recommends green, or vegetative, rooftops, which can be 30–40°F lower than those of conventional roofs and offer a 0.7% reduction in building energy use.54 Other types of reflective rooftops (e.g., white China mosaic cool roofs) also offer cooling benefits. After successfully reducing heat stress using cool rooftops at its Shardaben Hospital in Ahmedabad, the Ahmedabad Municipal Corporation extended the initiative to all hospitals as part of its heat safety plan.55
As hospitals consider other interventions to keep patients safe from extreme heat, vulnerability assessments also can help identify specific at-risk populations. For example, as part of the Ahmedabad Heat Action Plan, infants in the postnatal ward were identified as a highly vulnerable population during periods of extreme heat because of their location on the top floor of the Shardaben Hospital. Like a majority of hospitals in India, Shardaben Hospital is not air conditioned. After higher NICU admissions during the warmer months were observed (N=24), the maternity ward was moved to a lower floor and observed just four admissions in 2011. The reduced NICU admissions could have been the result of either the intervention or that temperatures were on average lower in 2011 compared with the heat waves in 2010. To account for this, the authors used a study model to show at the best fit temperature (42°C), moving the maternity ward to a lower floor was associated with a predicted 64% reduction in heat-related admissions to the NICU (95% confidence interval, 3%–89%).