How hospitals today need to prepare for unprecedented crisis scenarios

Climate disasters, cyber attacks or military conflict: Hospitals today must be prepared for crisis scenarios that were still considered exceptional just a few years ago. At the annual conference of the Bavarian Surgical Association (Vereinigung der Bayerischen Chirurgie (VBC)), a separate meeting is being dedicated to the crisis resilience of hospitals. We spoke to Prof. Dr. Robert Grützmann, Director of the Department of Surgery at Uniklinikum Erlangen at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Chairperson of the VBC, about how well prepared Bavaria is for extraordinary crises.

Our healthcare system is considered effective and robust, even in many rural regions. But natural disasters, large-scale power outages, or even a wartime scenario can pose extreme challenges to the healthcare system. How well are our hospitals prepared for such exceptional situations?

This is a question that has been on our minds for quite some time and I believe we’ve treated it a bit too lightly up to now. After COVID, the impression emerged that while it was certainly tough, our healthcare system managed to cope. But we need to think these scenarios through far more thoroughly. Resilience isn’t primarily about bombs suddenly falling on Erlangen. In a wartime scenario for example, you have to consider questions such as our ability to continue providing healthcare, even if we have to treat the wounded from our NATO allies. Depending on the specific scenario, this could involve treating up to 1000 wounded every day over the course of several days. This can push a system to its limits very quickly. But also, when we think about resilience to heat, cold, or power outages, we are a long way from achieving our targets. We are preparing ourselves for something that we will hopefully never experience. But our infrastructure must be able to withstand an emergency.

Resilience is currently a popular buzzword in many areas. What does resilience mean for a hospital specifically? Where does much more work need to be carried out and what needs to change during the next few years?

Effective communication channels are extremely important, so that the authorities and various institutions can coordinate everything quickly. Who has to communicate with whom? Who is responsible for what? Military hospitals, such as the one in Koblenz, currently have the most experience with this. In an emergency, they can operate completely self-sufficiently for up to 14 days. Civilian hospitals are currently a long way from achieving this.

Of course, we learned a lot from the COVID pandemic, for example how to allocate ICU beds effectively and how to overcome the problems that arose in supply chains for drugs, masks or dressings. But communication is one of the most important aspects: How are staff rotas drawn up? How do we get in touch with people? How is medical personnel called in?

Collaboration across all sectors is essential – between the emergency services, disaster management and hospitals. But I’m a cultural optimist. It’s true that uncertainty tends to dominate at the beginning of a crisis. However, time and time again, we see how incredibly creative people can suddenly become in an emergency, such as during in the war in Ukraine, for example. It’s often during crises like this that people’s strength comes to the fore. I am hopeful that our society would be able to respond well. Even if we will hopefully never encounter a situation that calls for this ability.

In a crisis, it’s not just hospital infrastructure that’s important, but also the considerate behavior of the public. What can patients do today to ensure they receive the best possible care in an emergency?

I believe it’s important to avoid panic as much as possible. There are recommendations about which foods, how much water and which medication everyone should have at home. These recommendations are well thought out and make sense. Of course, we should all ensure we have the specific medication we need at home. However, this medication must be used and replaced regularly to make sure it doesn’t expire.

In an emergency, anyone seeking medical care in a hospital or from a doctor should have all the information doctors need at hand, from current medication lists to allergies and medical history. This ensures that more people can be treated more quickly. Most of this advice is just pure common sense. We should listen to it.

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