Hospitals must rethink how they prepare for natural disasters as climate fuels stronger, slower and more destructive tropical cyclones, according to new research from Florida International University’s College of Business. The study, published in the August 2025 issue of The Lancet Regional Health- Americas, calls for hospitals to move from reactive disaster response to proactive resilience planning, particularly to protect vulnerable patients who depend on continuous care.
“The reality is that while immediate deaths from cyclones are decreasing, long-term health impacts are rising,” said Attila Hertelendy, assistant professor of information systems and business analytics at FIU Business and one of the researchers. “Disrupted access to dialysis, chemotherapy and other chronic care services can be just as deadly months after a storm.”
The team reviewed dozens of studies, reports, and real-world cases including hurricanes Katrina, Sandy, Maria and Harvey, looking at patient outcomes, hospital responses, and infrastructure failures. They organized this evidence into a framework that examines what happens before, during, and after storms, and both inside and outside the impact zone.
They identified seven critical areas for building resilience, including continuity of care, resource prioritization, climate adaption, cross-institutional coordination, health equity and closing research gaps, particularly in low- and middle-income countries where cyclone impacts are most severe.
Researchers identified the need to “harden” facilities, based not on past storm data, but on future climate projections. Hertelendy pointed to Tampa General Hospital’s installation of an Aquafence flood barrier last year as an example of how health systems can leverage infrastructure investments and insurance partnerships to reduce risk.
Hertelendy emphasized that resilience planning is not only about infrastructure, but also about equity and community integration. “Vulnerable populations like the elderly, or low income or those with chronic conditions are the ones most at risk,” said Hertelendy.
One urgent and low-cost step, he said, is testing emergency plans through both tabletop and full-scale exercises. “It’s one thing to simulate evacuation on paper and another to actually do it,” he explained. “Hospitals need to see in real time how effective their response is for patients with life-sustaining needs.”
“These strategies acknowledge that during extreme events, demand will outstrip supply. Planning for that can really save lives,” said Hertelendy.
Continuity-of-care planning remains central to resilience, he added. Models such as Crisis Standards, which many states enacted during the COVID-19 pandemic, can guide hospitals in allocating scarce resources during patient surges.
As policymakers consider how to measure hospital preparedness, Hertelendy recommends a straightforward resilience metric: can a hospital remain operational for at least 96 hours without state or federal support? “Accessibility and continuity are key. If a facility can stay online, keep backup generators running, and prevent downtime for four days, that’s a strong indicator of resilience,” he said.
With forecasts predicting more intense tropical cyclones in the coming decades, Hertelendy argues that investing in hospital resilience is not optional. “Preparedness saves lives. But resilience, measured in a hospital’s ability to function independently during disaster, protects communities long after the storm passes.”