"We Don't Have Tornados Here": A Look at Severe Weather Events and the Enhancement Impact of Deferred Infrastructure Capital Investment

Saying the past five years of weather in southeast Pennsylvania have been extraordinary is almost an understatement. When I arrived here from the Midwest about five and a half years ago, I started removing rooftop ballast rocks and decorative rocks from hospital grounds.

Why? Because on May 22, 2011, an EF5 tornado in Joplin, Missouri lifted ballasted roofing and landscaping items—turning rocks into deadly projectiles that shattered nearly every hospital window.

Shifting Weather Patterns in Southeastern Pennsylvania

Initially, many locals told me, “We don’t really have tornadoes here.” From 2014 to 2018, only six tornadoes touched down in our region. Since 2019, though, that number has jumped to 64 confirmed tornadoes, according to FOX 29. Even weak tornadoes, packing winds of 86–110 mph, can cause significant structural damage.

Southeastern Pennsylvania is no stranger to snow and inland hurricanes—but flooding is becoming more extreme. What were once considered “500‑year floods” now occur roughly every 50 years and 10‑year events happen virtually every three years. Urban density and scarce space make critical stormwater infrastructure, like retention basins, increasingly difficult to implement…and the gap in facility preparedness extends to virtually every part of the US.

Infrastructure Deficit in Healthcare

Emergency preparedness is only as strong as the facilities behind it—but US hospitals face a staggering infrastructure challenge. ASHE’s 2024 Hospital Operations Survey reports a $390 billion deferred maintenance backlog, with 80% of facility managers citing aging infrastructure as their top concern. As recently as June 2021, about 41% of MEP assets were in deferred status; current estimates suggest that figure has ballooned to 53%.

The table above shows the 2024 figure of $390B in deferred capital investment (estimated) in US hospitals. If major weather events and other natural disasters increase that trend by just 5% and if no increased investment occurs, that number balloons to $732.45B by 2054 without accounting for inflation.

The 2024 Hospital Construction Survey found that nearly half of healthcare organizations experienced construction delays or cost increases on 76–100% of their projects. Driven by inflation, supply chain issues, and labor shortages, these unforeseen cost escalations further exacerbate the infrastructure deficit and delay remediation.

While recent decades have seen hospitals routinely defer infrastructure upgrades, deferred maintenance proves exponentially more costly in the long run, both in terms of safety risks, and with the erasure of positive ROI once these antiquated systems are eventually upgraded.

Spotlight: Lessons from Katrina

After Hurricane Katrina in 2005, hospitals like Ochsner were retrofitted with robust backup systems—well water capable of producing 950 gal/min (their demand rate is closer to 650 gal/min), generators as a microgrid system powering entire hospitals for at least five days before fueling (traditional practice has called for 4 days). Command centers were relocated above historic flooding levels by an extended safety margin of physical elevation. Alternative cooling systems were added utilizing pumping stations that can draw and filter river water directly to chillers, bypassing the need for condensing cooling towers, which are exposed to ha high level of damage risk in a hurricane. These implemented measures turned disaster outcomes into operational resilience.

The” All Hazards Approach” Must Mean All Hazards Including the Traditionally Unlikely

Emerging threats like wildfires and smoke infiltrating supply chains are now a reality. In 2023, smoke from Canadian wildfires blanketed much of the Northeastern US and hospitals struggled to attain supplies and staff to replace ventilation filters every few days—a process costing tens of thousands of dollars and involving thousands of filters. Normal filter schedules range from 90 days to 5 years (depending on the filter type, application, and porosity), underscoring the financial strain when systems aren't built for such extremes.

A Call for Proactive Infrastructure Planning

Building for a future where 500‑year storms happen every 50 years and 10-year storms happen triennially requires systemic change. Hospitals must:

1. Remove ballasted roofs and replace with mechanically or chemically fastened systems. Replace decorative rock landscaping with mulch or another non-ballistic item. Some solutions have addressed this by bonding the rock together with a clear adhesive epoxy.

2. Treat loose items on campus as potential foreign object debris (FOD). Remove and replace those items that are vulnerable to becoming projectiles. A base model to follow is that the greater the surface area and the lower the weight, the greater the probability it could become airborne in extreme winds.

3. Invest in innovative stormwater solutions, even in tight urban footprints. Include extreme event considerations and surge capacity modeled with n+1 volume calculus.

4. Design flexible HVAC systems that can pivot to temporarily operate with minimal outdoor air and include filtration systems exclusively dedicated to outdoor air pre-pre-filtering to protect AHU filter systems.

5. Operations leadership must treat facility upgrades as non-negotiable routine capital, not wait-and-see or post-crisis fixes (proactive vs reactive).

Key Factors to Remember

• Deferred maintenance dollar backlogs (ASHE: $390 billion, rising from 41% to 53% of assets) do not account for the compounding increasing disaster occurrence rate and upward trend of severe event acuity.

• Hospital construction delays and cost increases (by percentage of projects impacted) will also impact that backlog at an increasing cost trajectory and must be preemptively assumed and planned for.

• Frequency of disaster-related aid (e.g., Pennsylvania’s ~$87 million in storm disaster funding over the past 20 years) is also beginning to increase and this increase must be considered positively aggregating. In today’s climate, this is true anywhere a disaster can occur.

Why It Matters

Hospitals are more than care centers—they're community pillars. We can't rely solely on FEMA and local all‑hazards protocols. Resilience must be embedded in hospitals in their design, OPEX & CAPEX budgeting and disaster plans before devastation strikes. The move from reactive to proactive is no longer best practice; it is imperative.