Flooding Advice for Managers of Healthcare Facilities

Overview

Flooding can happen at any time in a wide variety of locations, from a range of sources individually or combined. It is the most common and widespread of all natural disasters and is increasingly likely in Ireland as a result of climate change. It poses a number of risks to our health, and can cause us damage, loss or harm in a variety of ways, such as:

• Physical injury, illness, stress and even loss of life
• Damage to homes and businesses
• Impacts on critical infrastructure and services, such as healthcare
• Environmental impacts

Healthcare facilities may suffer damage as a result of a flood event. The following information is intended to support managers and staff working in healthcare facilities with preparedness, response and recovery in relation to flood events. Response and recovery from flooding, and ultimately restoring a facility to its previous level of routine functioning, is a complex multidisciplinary process, often requiring input from manufacturers (e.g. of medical equipment). Safety is of paramount importance at all times, for all staff and service users.

Who is more at-risk from flooding?

Certain population groups are more vulnerable to the health effects of flooding compared to others, and require special consideration in the event of a flood. For example:

• People aged > 65 years of age
• Babies and children < 5 years of age
• People with long-term health conditions, particularly those with chronic cardiovascular and/or respiratory disease, or those receiving complex healthcare interventions
• People with pre-existing mental health conditions
• People taking medication that affects their behaviour or cognition
• People with cognitive impairment, such as dementia, or other physical or sensory impairments
• People who are bed-bound, and those dependent on others for routine activities
• People with drug and/or alcohol addictions
• People in socioeconomically disadvantaged groups
• People with language, cultural or other vulnerabilities
• People experiencing homelessness
• People that are temporary residents of a flood-affected area

Facility Preparedness for Flooding

Action Plan

Providers of healthcare services have a duty of care towards their service users and staff to be aware of the potential impacts of a flood event, and to take steps to ensure preparedness for such events. Protecting the health and safety of service users and staff is paramount at all times. It is also important that providers are aware of more vulnerable service users, who may need additional supports in the event of flooding.

Maintenance of business continuity should be carefully considered by management of healthcare facilities, as part of preparedness for flood events. In the event of a flood affecting a healthcare facility, if business continuity cannot be maintained a contingency plan that incorporates a system of triage for the facility will be needed, particularly for primary care and acute healthcare settings. Arrangements for diversion of service users to other facilities may need to be considered in the event of emergencies – this is described further below.

In addition, management of facilities should consider any factors that increase the vulnerability of their facility to flooding, and the preventability of these factors. Learning from past experiences of dealing with a flood event may help inform future preparedness. Actions to address any preventable factors should be included in a flood action plan, as noted further below.

The development and maintenance of a service- or facility-specific action plan in place for flooding is the foundation for adequate preparedness for flood events. Preparing an action plan in advance can help ensure awareness among staff of their roles and responsibilities in a flood event, and supports staff training exercises in this regard. This proactive approach can help mitigate the impact of flooding on the facility, staff and service users. www.Flooding.ie provides advice on assessment and management of flood risks. As a general point, it is also important for managers of facilities to identify and stay informed via resources that provide regular updates and information on the weather and flooding risk e.g. Met Éireann.

Key details that should be considered for a flooding action plan*

Named management lead(s)

• For the facility response in the event of flooding

Structural details for the facility

• Including an up to date facility map which details access and egress routes, as well as car parking and loadings zones

Occupancy of the facility

• E.G. Residents of a long-term residential care setting

Contact details

• For key facility personnel/management and next of kin of service users
• For relevant local contacts e.g. Local Authority, local Garda station, local health services, emergency services, insurance company

Location of practical items of particular use acutely in a flood event

• Such as the first aid kit for the facility, a torch, torches, rubber gloves, and blankets

Plans for evacuation and transfers

• The ground floor of the facility is the most vulnerable in a flood event
• Access and egress routes for the facility should be clear on the facility plan for all floors of the facility
• Agreed evacuation routes and destinations of service users and staff should also be included, if required during a flood event. Plans for transfer of patients if required to alternative settings, in the event of evacuation, should also be included
• Plans for evacuation of vulnerable service users should be clear e.g. the very elderly, those with disabilities or mobility issues, those who are bed-bound

Communications plan

• E.G. With staff, and service users’ next-of-kin

Records of medical equipment, devices and medication on-site

• Medical equipment, devices and medication on-site, including manufacturer details – particularly all equipment located on the ground floor of the facility. Measures to mitigate the impact of floodwater on these items should be considered e.g. storage at higher levels of shelving or facility floors, if possible

Food safety management

• Including details of catering company, if applicable

Flooding preparedness training and testing

• Details of historical and latest training and preparedness exercises undertaken with staff, and any testing of potential vulnerabilities (e.g. drain maintenance)

Location of medical records

• E.G. Paper and e-records as applicable

Lessons from previous flood events

• If applicable, including any recommendations made following the event and status

Review of plan

• Dates and interval for regular review of the action plan, and person(s) responsible for this

*Please note this list is suggested and non-exhaustive - any other details considered locally relevant by the facility should be included in the preparedness action plan.

Facility Response after Flooding

Overview

The advice outlined on this page focuses on the assessment and management of contents of a healthcare facility after a flooding event. After such an event, there may be significant contamination of healthcare facility structures, supplies and equipment, with microorganisms such as mould or mould spores, bacteria and/or chemicals. Therefore, prior to re-opening, the facility itself should be evaluated by an appropriate accredited service, in order to determine the extent of structural damage, and whether it may be restored, repaired and re-opened, or condemned.

If the healthcare facility is deemed safe to enter, the process of assessing all medical equipment, devices, records and other items can be commenced to ascertain what can be salvaged, and what should be discarded. Advice to support facility staff in the process of this assessment is outlined under key headings below. Please note however, if any items are likely to be the subject of insurance claims, the insurance company for the facility should be contacted in the first instance.

Reducing risk of infection during assessment

From floodwater

All floodwater should be considered contaminated i.e. dirty.

• Wherever possible, try to avoid coming into direct contact with floodwater, especially if it is obviously contaminated with sewage.
• If you have to go into the water, wear appropriate protective clothing, especially waterproof gloves and rubber boots, and remember to be careful of hidden dangers. If hosing or pressure washing, both of which cause a lot of splashing, you may use a face mask and/or goggles.
• Wash your hands before and after any clean-up activities - this is the most important way to get rid of harmful bugs:
• Use clean, warm water, if available, with soap.
• Wash and dry your hands:
• after going to the toilet,
• before eating or preparing food,
• after being in contact with floodwater, sewage or with items that have been in the water.
• Use cold water if there is no warm water.
• Use wipes or alcohol gel if there is no water or if the supply is contaminated.
• Keep any open cuts or sores clean and prevent them from being exposed to floodwater - wear waterproof plasters.

From a contaminated water supply

• Floodwater can damage the public water supply for drinking water. In the event of contamination of the public water supply, you will be advised by the water services authority, Uisce Éireann, who may issue a “Do not Consume” or “Boil Water” notice.
• If the water supply to the facility is sourced from a private supply, it should be checked that this has not been affected by floodwater.
• Consider water unsafe to consume if it has been covered by floodwater or if the smell, colour, or taste has changed.
• Water that is considered unsafe to consume should not be used to wash dishes, wash food, wash hands, shower or bathe in, make ice with, or used in baby formula.
• If you are concerned that the public water supply might be contaminated, contact the water services authority, Uisce Éireann.

Risk of Carbon Monoxide Poisoning

During the cleaning-up and drying-out phases of responding to flooding, which would be undertaken by the professional accredited service contracted by the facility, there is a risk of carbon monoxide poisoning which all persons involved in responding to flooding must be aware of. Carbon monoxide can be produced when ANY fuel is burnt, including oil, gas, wood, coal, petrol and diesel. If a person is exposed to carbon monoxide over a period of time it can cause illness and even death.

Protecting yourself and others

Petrol or diesel generators and other fuel driven equipment should never be used in unventilated spaces:

• The exhaust gases contain carbon monoxide which, without good ventilation, can quickly build up to poisonous levels.
• The same risk is carried by portable grills, camp stoves, paraffin- fuelled heaters or other devices using gasoline, propane or natural gas.  These should only be used in well-ventilated spaces.   

If you experience dizziness, headaches or disorientation, the appliance should be switched off immediately, you should move to a well-ventilated area and seek medical advice.

Assessment and Management of Facility Contents

Facilities may require structural assessment and restoration. Water and electrical utilities, gas networks, heating, ventilation, and air conditioning (HVAC), and fire safety systems may also need to be evaluated. Affected facilities should be assessed by suitable professionals. HSE Capital and Estates and facilities services might be in a position to advise on building review and restoration and need for emergency water decontamination.

Helpful advice is available on the CDC Website

Medical equipment and devices

All medical equipment and devices should be assessed for their current condition and any potential safety risks arising from flood damage. Ensuring safety for all individuals involved in the assessment should be the first priority before conducting any assessments, particularly for any electronic equipment. Wet electronic equipment should not be connected to an electricity supply. The electricity should not be used by facility staff until deemed safe following formal assessment by the relevant accredited professional service for the facility.

• An inventory assessment should be undertaken with careful and detailed documentation of the nature and extent of damage to each device and item of equipment.
• Undamaged and damaged items should be separated as a starting point.
• Damaged items that are visibly beyond potential salvage should be further separated for disposal.
• The original manufacturer should be contacted and consulted for guidance regarding cleaning, drying and disinfection of any damaged items that are deemed potentially salvageable. The manufacturer should also be consulted regarding any recertification that may be required following cleaning, drying and/or disinfection, and appropriate means of discarding items beyond salvage.

Medical records

• Any medical records maintained in paper format at the facility should be assessed for flood damage. Specialist advice may be required regarding management of flood-damaged records.

Medication

• Medication exposed to floodwater may have become contaminated.
• Generally, any medication that has come into contact with floodwater should be discarded, even if in the original container, due to the potential for discrete leakage and direct contact with the medication itself.
• However, for medications used to treat life-threatening conditions, if the medication appears unaltered (e.g. tablets appear dry within a wet container), these may be used if required, only until a replacement is available. Such medications should not be used if they appear wet in any way.
• An inventory assessment should be undertaken of all floodwater-exposed and non-exposed medication, noting discarded and retained items.
• Arrangements to restore medication stocks should be initiated via the usual facility process.

Food stored on-site

Floodwater may have been contaminated with sewage or waste of various kinds. Therefore, there is a risk of harmful bacterial or chemical contamination of food or food preparation/contact surfaces, if either come into contact with floodwater. 

• An assessment of all food that remains stored on-site for service user and/or staff consumption should be undertaken.
• Any food that was in contact with or covered by floodwater should be discarded, even if unopened. Food preparation equipment should also be assessed for damage, and arrangements made to repair or replace equipment as deemed appropriate.
• The original manufacturer may need to be consulted for advice in this regard.
• Any food preparation, contact or storage surfaces, if intact, should be cleaned thoroughly and disinfected.
• The potential for a power outage having occurred during a flood event should also be considered, which may have affected fridges and/or freezers. It can be hard to be sure when a power outage first occurred during a flood event. Because of this, you should check the temperatures of fridges and freezers. Any fully defrosted meat, fish or dairy products should be discarded. However, any food still frozen can remain as is once the temperature remains below -18º C. For food stored in the fridge, this must be kept at 0-5º C. Any chilled food that was likely to have been stored at above 5º C for longer than 4 hours must be discarded. If you are in doubt, throw it out. Lastly, all fridge and freezer units should be checked to ensure they are working properly in case they have been affected by floodwater, before re-use. You can find more advice from the Food Safety Authority of Ireland here .
• The local HSE Environmental Health Service may need to be advised of any issues with food preparation and storage facilities in the context of flood damage.

Facility Recovery after Flooding

Learning for Future Flooding Preparedness

Following the response to a flood event affecting a healthcare facility, learning from the event should be reviewed with key stakeholders, to inform enhanced preparedness for future,and especially with the increasing risk of flooding posed by climate change. The flooding preparedness action plan should be reviewed and updated, and re-training of staff undertaken to ensure all are aware of any changes.

Mental Health Impacts of Flooding

Flooding can be a frightening experience, and often causes significant disruption to our routines, and day-to-day activities. In addition, the physical stress associated with over-exertion in cleaning up premises, and the mental stress caused by loss of important equipment, personal possessions, temporary relocation and financial loss, may make staff or service users feel unwell.

Alongside facility-level impacts, individuals may also be dealing with the adverse effects of flooding on a personal level, such as to their homes or those of their loved ones. Tiredness, difficulty sleeping and anxiety are normal in these circumstances and may go away with time. It is important to remember that flooding can affect mental health in different ways for each individual. Managers should consider the effects a flooding event might have had on staff.

There are a number of reasons why flooding can be a distressing event:

• It can poses risks to our health and safety
• It can disrupt our everyday activities, such as going to work, school or childcare
• It can result in separation from family and friends for a period of time
• It can disrupt access to essential services such as healthcare
• It can contribute to a sense of loss of control, and concern for flooding recurrence
• Recovery after a flooding event may necessitate unanticipated consequences such as the need to re-build homes, submit insurance claims, and deal with loss of possessions, income and/or education

Staying in touch with your family, friends and neighbours is crucial to support your mental health during and after a flooding event. In addition, wider supports such as community groups, and other formally involved in flooding recovery (e.g. local authorities) may also be of benefit.

If you are concerned about yourself you are advised to contact your family doctor.

If you’re feeling overwhelmed, contact friends, relations or your family doctor.

• The Samaritans may also be contacted by ringing 116 123(Freephone day or night, 365 days a year).
• You can find more advice on coping with flooding, including helping children cope, in this leaflet produced by the Psychology Department, HSE Galway.

If you as a staff member are concerned about a servicer user of your facility, you should advise them, or their next-of-kin, as appropriate, to contact their doctor. For residents of residential institutions, it may be appropriate to contact their doctor on their behalf.

Last Reviewed February 22nd 2024