Introduction
Humans are a tropical species. That having been said, we have adapted fairly well to living in colder and even arctic conditions. Despite this, winter storms play havoc with our best-laid plans. This is particularly evident when it comes to the provision of healthcare and operational healthcare systems during winter storms. Let’s take some time to look at some of the clinical impacts of winter storms on healthcare providers, patients, and healthcare facilities.
Formation of Winter Storms
In the United States, conditions for winter storms usually develop from November through April. They have, however, occurred in early October and late May. The jet stream dips from the North down to the South, bringing frigid air across the continent. At the same time, moist tropical air continues to feed north into the United States from the Gulf of Mexico. It is the interaction of these two air masses that can result in massive precipitation in the form of ice and snow along with blizzard and frigid winter conditions.
Winter Storm Background
With below freezing temperatures, brutal winds, snow, and ice – winter storms disrupt travel, electricity, communications, critical infrastructure, and services over multi-state regions for days or weeks. EMS services are often unable to operate, emergency departments and hospitals become isolated, and healthcare infrastructure such as clinics and pharmacies are largely incapacitated.
Historic Perspective of Winter Storms
Although there have been more extensive, colder, and more disruptive winter storms – the blizzard of 1888 in New York City still ranks as the deadliest. That winter storm resulted in over 400 lives lost. In late January 1967, a winter storm struck Chicago, delivering 24 inches of snow in 29 hours. The city lay paralyzed for several days under an estimated 24 million tons of snow, killing 67 people.
Mortality rates are just the “tip of the iceberg” during winter storms. As example, over 350,000 residential customers across the Midwest and plains states lost power for over a week during early January 2025 from a winter storm. Thousands of individuals required emergency sheltering and medical assistance as a result of that event. And this winter storm was just the first of 2025.
In the following week, a very rare and significant storm caused blizzard conditions along 1,500 miles of the American Gulf Coast. This storm impacted areas of the South that rarely see winter conditions and are woefully unprepared for them. Most large cities in the South do not even own a single snowplow. Initial reports have put the mortality rate from this storm at 15 individuals as well as hundreds of thousands left without power.
Clinical Epidemiology During Winter Storm Events
The best way to understand the clinical impact of winter storms is to start by looking at what we know about the epidemiology of these events. Winter storm fatality reports are compiled annually by the National Weather Service (NWS). Obviously, the human impact of winter storms each year depends on several factors including:
- If a winter storm event actually develops during the year
- The severity of the storm
- The location of the storm
- The level of community education and preparation for winter storms
So, what are the basic characteristics of individuals who have died during winter storms?
Winter Storm Fatalities
The data reflect the significant variability of winter storm fatalities each year. As example, the most recent data from 2023 listed 10 fatalities. However, in 1997, 141 deaths were reported. In 2022, 55 winter storm-related deaths were reported. Of these deaths, the following is noted:
- Over 60% were male
- Over 60% were between ages 50 – 79 (>45% were ages 50 – 69)
This is consistent with reports dating back as far as 1995. The fatalities reported in 2022 can also tell us about where they were when they died. That location can help us determine what activities they were engaged in when they died. The reported locations of fatalities included the following:
- Outside unprotected – 38.18%
- In a vehicle or travel trailer – 31%
- In a permanently constructed home – 25.45%
- Other locations – 5.45%
Most fatalities from winter storms are related to motor vehicle crashes, carbon monoxide exposure, exacerbation of co-morbid conditions (e.g., myocardial infarction), hypothermia, or exposure mechanisms. Homeless and special-needs populations are at significant risk. It is important to note that over 25% of fatalities were located in permanently constructed homes. These were typically individuals stranded at home without power or heat who succumbed to the cold environmental conditions. This fact points out the importance of identifying elderly and other high-risk individuals in the community and proactively relocating them or otherwise ensuring their safety prior to the impact of the winter storm.
Winter Storm-Related Injuries
Injuries are more difficult to pin down as they are chronically underreported. What we know is that about 70% of injuries are secondary to motor vehicle collisions. An additional 20% of injuries occur from being caught outside in the storm coupled with being unprepared to travel outside during winter storm conditions.
Unfortunately, these injuries are disproportionately sustained by individuals who MUST travel as part of the critical workforce. These people are often “force-multipliers” such as police, fire, and healthcare workers. As such, their loss or incapacitation impacts multiple additional lives.
Winter Storm-Related Mechanisms of Injury
Now let’s take a moment to look at how people are injured by winter storm conditions. Understanding these mechanisms of injury can go a long way in planning for and preventing injury to critical staff, healthcare providers, and members of the community. The following mechanisms of injury are commonly reported during winter storms:
- Carbon monoxide poisoning (particularly non-English speaking groups)
- Falls secondary to slippery walkways
- Traveling in the dark (e.g., predawn travel to arrive at shift on time)
- Hypothermia and frostbite
- Being struck from falling objects (icicles, tree limbs, or utility poles)
- Electrical injury from downed power lines
- Fall from heights while removing snow from roofs
- Roofs collapsing under the weight of snow
- Dehydration or exhaustion
- Back injuries, musculoskeletal strain
- Myocardial infarction
Injury Prevention
We cannot go into detail about injury prevention in this short video, but from the previous information it’s obvious that simple steps in injury prevention can help. A few of these injury prevention steps include the following:
- Educating community members, particularly non-English-speaking segments, in the safe operation of portable electric generators as well as not using barbecue grills indoors for heat, will reduce carbon monoxide death and injury.
- Altering hospital work shifts so that travel occurs only during daylight hours is a beneficial risk reduction intervention for both clinical and administrative staff.
- Issuing winter travel safety kits and education to hospital clinicians and critical staff also helps prepare them for the risks of winter conditions. Other examples of injury prevention methods for winter storms are provided in the references for this activity.
Healthcare Facility Response and Impacts
Healthcare facilities should stand up their Hospital Incident Management Center when an approaching winter storm is detected in coordination with local and state disaster management agencies. More details on Hospital Incident Command is provided in the references for this activity.
There is a lot of good information available and sound planning recommendations that can be used by healthcare facilities during winter storm events. Links are provided to these resources as well. Good facility planning goes a long way in preventing injury to clinicians, healthcare staff, and in maintaining facility operations.
Emergency Power Generation
Emergency power generators should be in good working order. Understand that emergency power is usually only supplied to a few select critical care electrical outlets throughout the facility. Emergency power is never a replacement for community supplied power. In addition, a recent report demonstrated that 90% of hospitals studied are only able to sustain emergency power for 24 to 48 hours.
Emergency Water Supply
Winter storms frequently disrupted water supplies to healthcare facilities. Most healthcare facilities become essentially inoperable if water is lost. Facilities need to consider alternate water supply methods as needed should this happen.
Maintaining Facility Access (Snow and Ice Removal)
Equipment and supplies to maintain access and egress routes to the facility is a requirement. This might include snow machines, salt, snow shovels, and sufficient personnel to perform the necessary snow and ice removal tasks. Typically, hospitals are linked to the municipality’s emergency snow routes – specific streets that are cleared first and maintained. However, healthcare facilities cannot rely on municipal resources to open and maintain travel routes on their own campus.
Enhanced fall safety measures around facility entrances and exits is a must. Reports indicate these areas are common locations of injury related slip and falls on the part of healthcare staff, visitors, and patients.
Sufficient facility maintenance, support, and administrative staff must be available to meet the general hospital needs as well as clinical needs. The logistics to house, feed, and support these individuals needs to be part of the standard winter storm response plan.
Cold Weather Clinical Equipment and Protocols
From the clinical standpoint, equipment required for treating cold-related injuries should be inspected and readied for possible cases. This should include, as example, rewarming equipment, low temperature reading thermometers, ECMO, if available, and supplies to manage cold weather injuries.
Clinician should review such clinical entities as hypothermia, cold injury, including frost bite, rewarming techniques, as well as other associated cold weather problems.
Healthcare Staffing During Winter Storm Emergencies
At the time a winter storm warning is issued, each healthcare facility should have a plan to augment and manage clinical and administrative support staffing before the storm hits.
Staff Stranded at the Hospital
Arrangements need to be made for billeting and support of stranded clinical staff at the hospital. Staff stranded in the facility may be required to work extended shifts of 24 to 48 hours before relief can arrive. Work-rest cycles must be used to reduce fatigue. Other plans to provide support to such staff need to be engaged.
Plans to accommodate stranded clinical and other critical facility staff members should be implemented. Sleeping quarters need to be available, in addition to nourishment, hot beverages, showers, and fresh scrubs. Hospitals typically provide these services free during winter storm emergencies.
Staff Stranded at Home
Using snow-capable vehicles to pick up and transport clinical and other critical staff stranded at home often done. However, access to these vehicles needs to be arranged and coordinated with local disaster agencies prior to the winter storm impact.
Extended Support for Staff
Clinical staff and others will be concerned about their families if they are unable to get home. Efforts should be made to help staff tend to personal matters in order to ease their fear and stress. This is not only the “right thing” to do but it enhances their clinical performance and attention to duties.
Facility Patient Volume During Winter Storms
Patient volume tends to increase slightly just prior to the storm impact, decrease substantially during the storm impact, and increase again to surge levels as soon as patients and the EMS can access the facility. Consideration needs to be given to the continued support for critical care patients and others who could not be discharged or transferred prior to the impact of the storm.
Post-Acute Care Impacts
Post-acute care facilities such as nursing homes and rehabilitation centers will of course also be impacted by the winter storm. Many of the clinical planning points for the general healthcare facility and emergency department also apply to post-acute care facilities. Numerous reports mention instances where power outages have forced some of these facilities to transfer residents to local emergency departments. This obviously puts significant stress those healthcare facilities by overcrowding and engaging the emergency healthcare staff in the care of nonemergency patients.
Collaborative plans must be made with nearby post-acute care facilities prior to the impact of the winter storm. Development of alternate care locations, augmentation of clinical staff, and other alternate care plans for these patients should be part of the overall winter storm disaster planning process.
Arrival of Individuals Needing Shelter
Winter storms often incapacitate the infrastructure of most communities, they also frequently create large cohorts of individuals who need shelter and general medical support. This is particularly true when electrical power is disrupted for periods greater than 24 hours.
Because healthcare facilities are seen as “safe” places during such events, local community residents often make their way to the closest healthcare facility for refuge. These individuals may have medical needs that include medications, cardiovascular support, respiratory support, such as nebulizer treatments, or other general care. In addition, these individuals will have nutritional needs as well.
The numbers and nature of people arriving to the healthcare facility will depend on the local community. This is particularly true of special needs populations within each community. It is critical that healthcare facilities coordinate with local disaster planning and response agencies to anticipate and provide appropriate care for this population. Coordination with nongovernmental agencies such as the American Red Cross and to read Crescent societies is paramount in this area.
Winter Storm Impacts on Emergency Medical Services and Air Medical Services
Winter storms significantly impact the personnel and operational abilities of EMS and air medical services. These problems also directly impact the transfer and arrival of patients to healthcare facilities. These issues are covered in a detailed video and activity elsewhere. Additional information is also linked in the references to this activity.
Closing Comments
Winter storms are a reasonably common and expansive event across the regions of the country disrupting community infrastructure, particularly the provision of healthcare. Most fatalities and injuries resulted from traveling or being trapped outside while being unprepared for winter conditions. Many winter storm injuries occur disproportionately to critical clinical and support staff who “must travel” during winter conditions.
Part of the responsibility for protecting these individuals falls on the healthcare facility. Each facility should have education and other support available to protect their staff as part of their routine winter storm planning.
Understanding the mechanisms of injury and countering these with education and support reduces the adverse impacts on healthcare staff. It can also improve the overall ability of the healthcare facility to continue to function and provide quality healthcare for the community during these events.
Clinicians should review cold weather injuries such as hypothermia and localized cold injuries such as frostbite. Any equipment protocols and procedures should be reviewed and made ready prior to the storm impact. Healthcare facilities should stand up their Hospital Incident Command (HIC) at least 24 hours prior to the storm impact. The HIC should be integrated with local disaster planning and management to best coordinate and access needed resources during the event.
Much of the healthcare facility impact during the winter storm can be from population segments that need ongoing support and sheltering. Not planning for these individuals and coordinating their management with local disaster planning and response is a recipe for failure.
Remember that support needs to be provided for both clinical as well as administrative staff. Winter storms and their impact on our clinicians, patients, and healthcare facilities is a complex topic. However, multiple reports exist in the literature to provide us with a good history of the challenges as well as solutions that have been used in the past. A robust disaster planning and management group within each healthcare facility that collaborates and coordinates with local agencies based on reasonable assumptions is the best plan for success.
More information is available in the links and documents provided in the references for this activity.