While it is difficult to anticipate exactly when or how hospitals will face the next emergency, providers need to be prepared for all types of threats, including pandemics, natural disasters, and security risks. Writing for TIME, Elizabeth Millard describes the top five emergency preparedness challenges hospitals currently face—and how they plan to overcome them.

The top 5 emergencies hospitals may face

According to Yves Duroseau, chair of emergency medicine and co-chair of disaster planning services at Lenox Hill Hospital, health care facilities must regularly evaluate and revise their emergency preparedness plans to address potential threats. Currently, the top five challenges hospitals face include:

1. Future epidemics

Many hospitals were not fully prepared for the Covid-19 pandemic, which demonstrated how rapidly an infectious agent can spread. Moving forward, hospitals must prepare for future epidemics and pandemics.

"No one believes we're past current and future threats when it comes to epidemics and pandemics," said Eric Alberts, senior director of emergency preparedness at Orlando Health. "Every hospital is still on high alert when it comes to trying to anticipate what's next."

2. Violence against health care workers

From 2011 to 2018, the rate of injuries from violent attacks against medical professionals increased by 63%, according to the U.S. Bureau of Labor Statistics. However, the Association of American Medical Colleges (AAMC) noted that violence against medical professionals has become even more common in recent years.

According to a recent survey from National Nurses United, nearly half of the respondents reported experiencing violence in the workplace, which was primarily initiated by patients.

In particular, violence has increased in EDs. For example, one AAMC study found that nearly half of ED physicians have been assaulted, and 70% of ED nurses have been hit or kicked in the workplace.

3. Extreme weather

According to the U.S. Environmental Protection Agency, rising global temperatures are associated with drastic changes in weather patterns, which can trigger extreme weather events, including heat waves, droughts, intense hurricanes, frequent tornadoes, flooding, and wildfires, Millard writes.

While extreme weather can lead to an increase in the number of people seeking medical care, "it also sets hospitals up for more disruption and possible closure," Millard adds.

4. Cybersecurity threats

During the pandemic, ransomware attacks increased significantly. According to an AAMC estimate, roughly one in three health care organizations around the world experienced a ransomware attack in 2020.

"These incidents don't just put organizations at risk—they can also affect patient care," Millard writes.

5. A lack of resources

Russ Kino, an emergency medicine specialist and medical director of the Weingart Foundation Emergency Department at Providence Saint John's Health Center, noted that hospitals often struggle with limited resources. 

"Most hospitals already work on thin margins, and those are contracting as insurers reduce coverage," Kino said. "Financially and organizationally, we're in a tight and difficult place."

In addition, he noted that the average tenure of a hospital CEO is around 18 months. "So you tend to have turnover in leadership, and that can reset all emergency preparedness plans."

How hospitals are preparing for future emergencies

When creating emergency preparedness plans, many hospitals:

• Anticipate worst-case scenarios
• Conduct training exercises
• Increase internal and external collaboration
• Keep climate change in mind during renovations

At Providence Saint John's, staff regularly participate in unplanned drills for active-shooter situations, ensuring that staff can lock down the facility in just a few minutes.

Similarly, Lenox Hill conducts drills and trains its staff for mass-casualty events that could bring dozens of severely wounded patients into the ED at the same time. "These types of drills let us see where the gaps are with process and staffing," Duroseau said. "That's particularly important during times of high staff turnover, which we experienced over COVID."

Lenox Hill also conducts drills for cyberattacks that would disable the entire computer system or pose a threat to patient care. "It's hard to play offense on a cyber situation," Duroseau said. "At least we can train people to handle downtime disruptions in a way that protects patients. In general, we all know the areas of vulnerability we have with every kind of threat, and there's only so much we can do to counter that. But we can try."

According to Alberts, a key part of threat management is collaborating with local and national services, including fire departments, law enforcement, state health departments, and the Federal Emergency Management Agency.

"If you take threats seriously, there's a lot you can do ahead of time if you plan in advance," Alberts said. "Coordination internally and with these external stakeholders truly helps us better prepare for and respond to crises of all types and sizes. Having the right people in the right place at the right time is a big factor for any hospital system's response to a threat."

Meanwhile, "[p]lanning for weather events can be more straightforward," Millard writes. "Hospital staffers might analyze the type of weather issues that have caused problems in the past—and then magnify those to an extreme degree."

Ultimately, hospitals cannot be fully prepared for every contingency. "But there's always the hope that when a threat evolves, it can be handled with resiliency and efficiency," Millard adds. (Millard, TIME, 11/25)