The damage inflicted by Hurricane Sandy was far reaching, flooding homes and businesses across the East Coast and forcing people and even hospitals to evacuate. Now that the flood waters have subsided and the healing from Hurricane Sandy has begun, what are the next steps that need to be taken to resuscitate a hospital impacted by the storm?

There isn’t a book that provides step-by-step directions, but there are organizations that can help hospitals through the process of rebuilding and preventing future flooding risk to their facility. 

In 2008, a 500-year flood struck Columbus Regional Hospital in Columbus, Ind., forcing the hospital to evacuate 157 patients, causing $171 million in damages to the hospital, and shutting it down for four-and-a-half months. Working in conjunction with the hospital and the Federal Emergency Management Agency (FEMA), BSA LifeStructures designed a 2,400-foot flood wall system that requires no human interaction to trigger the rising of the passive flood gates. 

The flood wall is composed of a series of 15 flood gates that line each pedestrian and vehicular entrance point into the hospital. The design was recognized by FEMA as a best practice in flood mitigation design.

Columbus Regional Hospital is a perfect example of a facility that overcame devastation and now operates with a mitigation strategy that will protect them in future flooding events.   

For healthcare facilities that have experienced damage from Hurricane Sandy, time is of the essence and knowing proper procedures and steps to restore operations is of the utmost importance.

Below are five steps that will help hospitals get back on their feet and mitigate future flooding risk to their facility. 

1. Remediation and assessment of operational systems
Water might be the greatest threat to the operations of mechanical and electrical systems in a healthcare facility. More often than not these systems, which are vital to the operation of the facility, are stored in the basement, an area that’s obviously very susceptible to flooding.

Engineers will need to assess the damage water has done to these systems and then recommend whether they need to be replaced. Facilities with water damage to their electrical equipment might be closed for months as crews work to demolish and replace the equipment.

A thorough inventory of the hospital’s medical equipment and spaces will also need to be conducted to evaluate their condition. Based on this assessment, a phasing strategy can be put in place to open all or parts of the facility.

2. Expedite the build-back
In rapid-response design situations, the need for clear lines of communication and definition for the project is vital. In most rapid-response scenarios the architecture and engineering firm is a crucial member of the build-back team, which consists of the contractor, restoration clean-up crew, and insurance personnel.

Based on previous experience, we’ve identified five elements that any rapid-response project must account for when working with a distressed healthcare facility: 

• Mission definition.Clearly define the roles and responsibilities of all the parties involved in the project. This creates trust and accountability, which is crucial in a build-back scenario.   
• Cultivating relationships.The healthcare architecture and engineering firm, construction manager, and owner must be in full coordination to ensure decisions are made collaboratively and quickly. Each party should have its own role and responsibilities to efficiently establish the framework for fixing the problems at hand. The healthcare architects and engineers should maintain an active presence on-site to coordinate restoration activities. 
• Control the flow of project information.Communication is crucial when design and construction work is being done concurrently on a tight timeline. Daily situation reports should be available to the project team and data on the project should be stored in one location to ensure good project communication. 
• Organizational operations.Rapid-response projects need to establish an overall project schedule at the beginning and assign an on-site project manager who oversees the completion of milestones. In the same vein, a clearly defined chain of command is needed to provide structure and clear paths of communication at all levels. 
• Quality control.Quality control procedures are also important in these situations because tasks are often performed at an expedited rate. While this should not detract from the performance and quality of the work, sometimes working under a shortened schedule requires extra manpower to assure quality is achieved. It’s also important that the design team have field verification personnel on the ground to perform verification checks regardless of the schedule.

3. Flood risk assessment
Once the hospital is operating, a flood risk assessment needs to be conducted to identify possible mitigation techniques. Architectural and engineering experts can survey the facility and identify weak points around the facility where water can infiltrate.

The results of this assessment become the foundation for a more robust, permanent mitigation strategy that reinforces these weaker areas. There are four components that make up the assessment: 

• Study the risk.The initial step is to evaluate the future risk associated with the flooding source.  This risk can be characterized by three elements: severity (magnitude, duration, and the extent of the flooding), the probability of occurrence, and speed of the onset flood.
• Research the environmental history of the region.An analysis of the surrounding area is needed to properly forecast risk and probability of flooding. In the case of Hurricane Sandy, it’s clear that hurricanes and flooding are a legitimate risk to the area and plans must be made to protect against similar storms in the future.  
• Remove vital equipment from the basement.Basements increase a facility’s flood risk, particularly basements with loading docks, because they provide easier access for flood water to enter the facility at a lower elevation. For facilities that have vital MEP systems in the basement, it makes sense to build energy centers that house the equipment. This keeps the equipment out of harm’s way and makes it easier to maintain. The basement can then be used for soft space, like classrooms, offices, or meeting space, which are not essential to the hospital’s operations.   
• Identify the best mitigation strategy.Based on this assessment, a design strategy can be enacted that will protect the hospital and its patients. The mitigation options are explained in more detail in step five.

4.Navigating the FEMA process
Successfully navigating the FEMA grant process can be paramount in obtaining the funding necessary to implement a permanent hazard mitigation system to protect against future flooding events. During the 2008 flood at Columbus, FEMA funding ended up paying for 75 percent of the project’s cost. 

FEMA has five programs through its Hazard Mitigation Assistance (HMA) set up to reduce or eliminate the risk of flooding damages to property and to protect lives.  These programs are the Hazard Mitigation Grant Program (HMGP), Pre Disaster Mitigation (PDM), Flood Mitigation Assistance (FMA), Repetitive Flood Claims (RFP), and the Severe Repetitive Loss (SRL) programs. 

All of the Hazard Mitigation Assistance programs require t
hat the grant applicant be a state, territory, Indian tribal government, and or local government.  So after a disaster, a hospital damaged by the resulting flood, should contact the state’s Department of Homeland Security to help identify what FEMA HMA grant funding opportunities are available based on the provisions set forth by the Presidential Emergency declaration.      

Once the hospital has gathered the required grant information for the state, it’s reviewed by FEMA and evaluated based on the project cost and anticipated benefit, or cost-benefit analysis, to determine which projects are selectedto receive funding.  Then the funds are distributed to the applicant, typically the state, which will be responsible for administering the funds to the sub-applicant, the hospital.  

Several organizations provide grant application services to assist hospitals in the pursuit of FEMA grant opportunities. These organizations should have the necessary experience in environmental and historical preservation to complete the requisite documentation inherent to receiving federal grants. 

5. Build a permanent flood protection system
The culmination of these steps is a flood mitigation project that will protect the hospital from future flooding damage. As Hurricane Sandy demonstrated, a hospital cannot rely on a back-up generator to work in the case of an emergency.

A passive flood gate system, like the one used at Columbus Regional Hospital, removes the need for electricity or human interaction to trigger the system. The floodgate operates using hydrostatic pressure created by the rising flood water. During dry times the flood gates provide unimpeded access into the hospital, but in the case of a flood, an underground basin fills with flood water.

The water’s buoyancy will trigger the flood gates to protect the hospital, meaning no human or electrical interaction is needed to activate the system. There is no mechanical equipment needed to elevate the gate, only the force of the water, which is one of the main benefits of the system. The gates rise as the floodwater rises, so the elevation that the gate raises is dependent upon the actual flood event.

The system also incorporates a series of five large pumping stations that will remove any water that breaches the flood wall perimeter or rainwater that falls in the protected area. 

In high-density urban areas, like New York City, a flood wall would have to hug the outside of the building and a thorough investigation of the tunnels, subways, and underground infrastructure would have to be made to ensure the system didn’t cause any back-flow into the tunnels. Other solutions for keeping flood water out include designing new entrances at higher elevations and properly venting HVAC components that might be susceptible to water.  

One of the biggest negatives associated with a flood wall is its seeming unattractiveness. However, the wall designed in Columbus plays to the exterior aesthetics of the Robert Stern designed hospital and does not detract from the high design standard. Similar strategies can be used around New York City to preserve the integrity of the surrounding buildings and their design intent. 

Hospitals affected by flooding may be well served by applying these build-back and mitigation steps to ensure that the facility is prepared to resume care for patients. By applying a flood mitigation design, facilities that were affected by Sandy can avoid damage in future flood events. 

Andy Fish is a Project Architect for BSA LifeStructures and can be reached at afish@bsalifestructures.com. Andy Swanson is the Assistant Director of Sustainable Site Design for BSA LifeStructures and can be reached at aswanson@bsalifestructures.com.