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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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