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Hospitals should not only plan for emergencies that might directly impact their immediate area, but also consider emergencies that may impact their suppliers of critical services located in adjacent communities. A couple of the hospitals at the debriefing were not under the “do not use” water directive because they received their water from a different supplier. However, those hospitals were still impacted because their supplier of laundry services was within the impacted area. Thus, the hospitals needed to quickly make alternate plans to ensure their supply of clean linen continued uninterrupted. This concept of considering the impact of potential emergencies on contracted service providers adds a level of complexity to an organization’s Hazard Vulnerability Analysis, but the work is worth it, based upon the recent experience in West Virginia.

People will always gravitate to the local hospital during a community crisis. During the onset of the water emergency, state and local public health agencies sent non-stop messages through the media, telling the community where to go (e.g., schools, churches, shopping centers) to obtain water for drinking and cooking. Hospitals reinforced this message on their websites and through social media. However, people still showed up at their local hospital, assuming that water would be available for distribution. We have observed this phenomenon in virtually every disaster debriefing. Whether it was a hurricane, power outage, tornado or act of terrorism, when in need, people will follow the blue “H” sign looking for warmth, shelter, food, electricity or in this case, water. Disaster plans need to reflect this inevitability.

Improvisational skills are mandatory during an emergency. For the most part, hospitals were able to quickly obtain water from various public and private sources. However, the challenge came when trying to figure out how to get water from a tanker truck, into their piping system, and up to patient care areas throughout the hospital. Building engineers and facility managers at the hospitals demonstrated incredible ingenuity, creativity and innovation in crafting together delivery systems that would get water to where it was needed, with sufficient pressure to operate various types of medical equipment. In one instance, a hospital teamed up with its dialysis provider and the local fire department to pressurize the system so that patient care could continue uninterrupted. This type of problem-solving under duress is a unique characteristic that exemplifies organizations that are able to weather the storm during any emergency. High reliability experts would call this “organizational resiliency.” Whatever you call it, they have it in West Virginia, and we need to figure out how to bottle it and spread it to other health care organizations.