[Failure of critical infrastructures in German hospitals : Online survey on crisis management structures and exercises in hospitals].

backgroundHospitals are critical infrastructures and essential for healthcare provision, yet they heavily depend on the continuous availability of other parts of the critical infrastructure, such as electricity and water supply. In emergencies, organizational aspects often play a crucial role as hospitals need to shift from routine organizational structures to specialized crisis management frameworks. This survey investigates the organizational structures used by German hospitals in crisis management, focusing on the frequency and types of exercises related to critical infrastructure failures, particularly water and power supply as well as sewage disposal.

objectiveWhile organizational preparations for mass casualty incidents are common in German hospitals, insufficient structures are implemented for critical infrastructure failures as well as how often these scenarios are practiced. This study aims to address these gaps by examining hospital crisis management structures, the frequency of related exercises and the interplay among hospital size, ownership and regional factors. The research is part of the NOWATER project, funded by the Federal Ministry of Education and Research (BMBF, 13N15281), which investigates these aspects.

methodsThe survey conducted from November 2022 to April 2023 and targeting hospitals across Germany, gathered 72 fully completed responses, representing 3.8% of Germany's total hospitals.

resultsThe findings reveal a diverse range of crisis management structures employed across hospitals, with 47% adhering to the federal recommendation for the Feuerwehr-Dienstvorschrift 100 (Fire Department service regulations 100) framework; however, many hospitals, especially those with fewer than 200 beds, opt for regular organizational structures or hybrid models. The survey also highlights a significant variation in the frequency of exercises across hospitals. While annual exercises for power failure scenarios are common, training related to water and wastewater disruptions is rarely conducted. Additionally, hospitals with fewer than 200 beds tend to conduct fewer exercises than larger hospitals, with significant disparities in resources influencing exercise frequency and type.

conclusionThe results suggest that while larger hospitals are more likely to follow recommended crisis management structures and conduct regular exercises, smaller hospitals often lack the personnel and financial resources necessary for such preparations. This disparity underlines the need for tailored crisis management strategies that account for hospital size and available resources. In conclusion, the study underlines the importance of regular crisis management exercises to improve resilience and preparedness for infrastructure failures. It also calls for increased focus on water and wastewater contingency planning, which currently lags behind emergency power supply preparations in most hospitals. Policymakers and healthcare managers are encouraged to support hospitals, particularly smaller ones, with the necessary resources to implement effective crisis management structures and exercises.