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United States
Environmental Protection
Agency
    Water &  Healthcare Sector
         Interdependencies:
Working Together Towards Resiliency
What are Water Sector Interdependencies?
Water is a basic human need, fundamental to the well-being of individuals and society; and the protection
of our nation's drinking water and wastewater supplies is vital to human health. In addition, all other critical
infrastructure sectors rely on water services to operate and the Water Sector relies on these other sectors
in order to provide safe, reliable drinking water and wastewater services. This relationship is known as an
infrastructure inter dependency.
                                                The Water and Healthcare Sectors have both been
                                                designated by the U.S. Department of Homeland
                                                Security (DHS) as Critical Infrastructure/Key
                                                Resource (CI/KR) sectors. The protection of these
                                                critical infrastructures is a top priority for DHS
                                                and the Sector-Specific Agency (SSA) responsible
                                                for overseeing each sector's critical resources.
                                                Recognizing the interdependencies between CI/
                                                KR sectors, such as those between the Water and
                                                 Healthcare Sectors, can help to strengthen the
                                                 overall resiliency of a community in the face of all-
                                                 hazards threats, including natural and man-made
                                                 disasters, crimes, and acts of terrorism.
   Overview of Healthcare Infrastructure
   The healthcare sector consists of over 6,600
   hospitals, 492,000 ambulatory care facilities,
   and 70,000 nursing and residential care
   facilities. Other healthcare-related facilities
   include pharmacies, blood and organ banks,
   pharmaceutical manufacturing sites, and public
   health laboratories. The Healthcare Sector relies
   on drinking water and wastewater for a variety
   of services and functions, including:
   • Infection control
   • Renal dialysis
   • Heating and air conditioning
   • Manufacturing and  storage of Pharmaceuticals
   • Sterilization
   • Maintenance of blood and organ banks
   • Drinking water for patients and staff
   • Transportation of supplies and equipment
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       WATER & HEALTHCARE SECTOR INTERDEPENDENCES: Working Together Towards Resiliency • Page 2

Demonstrated Need for Water and Healthcare Sector Partnership

A variety of natural and man-made disasters, contamination
episodes, and other incidents demonstrate the impacts
water service interruptions can have on hospital and
other healthcare services. As the SSA for the Water
Sector, the U.S. Environmental Protection Agency (EPA)
has considered the potential impacts that water service
interruptions could have on the Healthcare Sector and is
working with other sectors to reduce these impacts. Some
recent incidents that have impacted water services include:

• 2003 Northeast Blackout
  As a portion of the approximately 50 million people affected by the Northeast Blackout in 2003, hospitals
  throughout the northeastern United States experienced power-outages, compromising water services.
  This resulted in a lack of heating, ventilation, and air conditioning (HVAC) services, complications with
  sterilization, and the breakdown of certain equipment that required water to cool.

• Hurricane Katrina
  Patients in New Orleans area hospitals could not be released or transported due to overcrowding at other
  area hospitals and congested or collapsed roadways. Newborns, ICU patients, and those receiving routine
  dialysis, amongst other critical services, required continued hospital stays. Area hospitals experienced hot,
  uncomfortable climates, wastewater back-up, as well as staff and supply limitations.

• 2008 Hospital  and Water Sector Interdependency Summit - Keeping Patients Safe
  U.S. EPA Region 5 and a Chicago-area medical group co-sponsored a day-long summit to discuss water
  safety, security, and preparedness measures, particularly in relation to hospitals. Recommended next steps
  included developing and distributing notification procedures and regional response plans for water service
  interruptions; identifying alternative water sources that serve multiple facilities; and facilitating discussions
  between hospitals and their water suppliers to understand capabilities and limitations.

Tips for Strengthening Healthcare and Public Health Sector Resiliency

• Identify the services that must remain in operation to ensure the health and continued care of patients
• Conduct a water audit to help determine the quantity of water that would be necessary to continue operating
  during a water service interruption
• Plan for the potential impacts of water loss on all aspects of healthcare (patient and  supply needs,
  transportation, financial, etc.)
• Determine alternative water sources and incorporate these into emergency response planning
• Communicate with other local and regional infrastructure sectors to coordinate sharing resources in the
  event of a water - or other critical resource - service interruption
   CONTACT US  For more information on Water Sector interdependences and the Community-
   Based Water Resiliency (CBWR) initiative, please contact WSD-Outreach@epa.gov or visit
   us at http://water.epa.gov/infrastructure/watersecurity.
           Office of Water (4608-T) |  EPA817-F-10-019  | December 2010 |  http://water.epa.gov

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