with the necessary information and experience in these areas, can identify gaps in preparedness and inform resiliency activities to reduce climate change risks. The online version of the checklist provides a facility resiliency score and can help identify areas for improvement. The Facilitator’s Guide is an electronic

presentation deck for hospital officials leading the assessment, which can be tailored to the specific needs of their organisation. It provides instructions for conducting a resiliency assessment and can be used to engage facility officials, promote discussion around questions and results, and capture information. The Assessment Checklist was

developed using information obtained from an international literature review and input from an advisory committee of Canadian health care executives; facility managers and engineers; and climate change ‘impacts and adaptation’ experts. It was designed for use by officials within the health care setting to obtain data on current efforts to prepare for the impacts of climate change. The checklist questions are based upon

key indicators of resilience and respond to the needs of specific health care facilities. To ensure the checklist was formatted and presented so that it could be completed by officials with relevant expert and practical knowledge, a draft version of the checklist was piloted in six Canadian facilities including St. Martha’s Hospital (Antigonish, NS), Soldiers Memorial Hospital (Kentville, NS), the Queen Elizabeth II Hospital (Halifax, NS), Aberdeen Hospital (New Glasgow, NS), the Ottawa Hospital (Ottawa, ON) and the Stonewall and District Hospital and Health Centre (Stonewall, MB). “Participating as a pilot site has been

an invaluable experience for our team,” said David MacKenzie, VP – Operations with the Guysborough Antigonish Strait Health Authority. “The toolkit challenged how we are planning for events and with the recent experience of Sandy in New Jersey and New York, reinforced our conviction in these strategies. Extreme weather events are happening more frequently and can be catastrophic for communities that don’t understand or prepare appropriately.” Support for the initiative was also

received from the Maritime Chapter of the Canadian Healthcare Engineering Society (CHES). Representative Robert Barss, who was Manager, Facility Services, South Shore District Health Authority at the time, spoke on their behalf. “As the managers of health care’s infrastructure, CHES Maritime was excited to help the Coalition and its partners develop the assessment tool and explore opportunities to make our hospitals more resilient and more sustainable in the face of growing


climate change and worsening climactic incidents. It is incumbent upon us to be as prepared as possible and to be ready to deliver the best possible patient care from a safe and functional healing facility during times of disaster.”

Climate change Some health care facilities have already begun to factor climate change into their strategic planning and are making strides in efforts to increase resiliency. A few years ago, the Ottawa Hospital

(TOH) had an incident where a main sprinkler line in a service tunnel ruptured and water began to fill the tunnel, rapidly encroaching upon the room housing their backup emergency generator and main electrical distribution system. The City of Ottawa repair crew was able to stop the leak and restore service just short of the water breaching the doors to the emergency generator set, which, if it had, would have resulted in the loss of emergency power to 17 operating suites, curtailed the emergency provision of water and sewer services to two million square feet of building space, and would have shut down the HVAC services for 100 percent of the campus. Patient care would have been seriously impacted by a forced shut down of all power. This incident got TOH engineering staff thinking about the far-reaching implications of the loss of emergency power and their preparedness for other serious disaster response necessities and was a catalyst for the rethinking of future generator placement. TOH’s Director of Engineering &

Operations at the time had attended a

conference where one of the speakers presented on the impacts Hurricane Katrina had on his hospital in New Orleans sharing that their generators were in a bunker twenty-one feet above sea level but when Katrina hit, all he could see were the exhaust stacks poking out above the water. The net effect was the complete evacuation of the building. TOH’s generators are now being housed on the third floor of their powerhouse, well above any anticipated flooding threat. According to Peter Whiteman, Energy

Centres Manager at Regina Qu’Appelle Health Region (RQHR), during the summer months in Saskatchewan there are, historically, one or two periods of high temperatures coupled with high humidity every year. “However, these occurrences were typically short-lived; usually lasting no more than a day or two, and our building could ride through them without developing any significant adverse reactions. Unfortunately, these events have a tendency to last much longer now.” During the summer of 2007, however,

RQHR experienced a period of ten consecutive days with the temperature index rating exceeding 45 degrees Celsius. These environmental extremes created uncontrolled humidity conditions throughout RQHR facilities and Whiteman and his team had to shut down all operating rooms except for the most life- critical cases. To safeguard against future unplanned disruptions, RQHR upgraded and added cooling towers, replaced the cooling coils in many HVAC systems and added additional building automation controls to monitor and control humidity in real time with the aim of maintaining the humidity within acceptable ranges. For the most part, RQHR’s operating

room HVAC systems were designed for 100% outside air, which was the norm back in the mid-eighties. Medical, environmental and technical advancements since then have significantly altered how these critical care areas are ventilated and controlled. Mixed air or return air systems can significantly reduce operating costs and improve indoor environmental conditions. “We would have preferred to incorporate these modifications into our facilities years ago. However, space and resource limitations just didn’t allow for it at the time,” says Whiteman. “We would like to see humidity conditions monitored, recorded and reported in critical care areas by the building automation system (BAS) with the ability to modulate control within the desired range. “Subsequently, we designed a BAS to

automatically take control of the room temperature setting during periods of excess humidity, automatically increasing the spatial temperatures and reducing the relative humidity (RH). Generally speaking, for every degree of temperature rise we


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