Hospitals are the backbone of any health system. They are expected to remain functional when everything else fails. Whether it is a fire, a mass casualty incident, a chemical spill, or a natural disaster, the public expects hospitals to save lives & not become victims of the emergency themselves.

This makes emergency preparedness not just an operational responsibility but a public health imperative, a moral obligation, and a national priority. India, with its diverse geographic and demographic challenges, has witnessed several large-scale tragedies where inadequate preparedness worsened the impact.

The High Cost of Unpreparedness: A Modern Crisis

History and recent headlines serve as grim teachers. While we often look to the past, the current decade has exposed colossal cracks in healthcare safety that prove readiness is never fixed but a moving target.

India’s Recent Tragedies (2024–2025)

The Jaipur Hospital Fire (October 2025): A suspected short circuit at the state-run Sawai Man Singh (SMS) Hospital killed 6 ICU patients. This tragedy highlighted the danger of toxic gas release in enclosed medical spaces and the difficulty of evacuating critically ill patients on life support.

Climate-Induced Infrastructure Collapse (2024–2025): During this period, massive flooding in Punjab damaged medical infrastructure worth Rs 780 crore, rendering over 100 community health centres inaccessible exactly when waterborne disease outbreaks peaked.

The Jhansi NICU Fire (November 2024): A devastating blaze in the Neonatal Intensive Care Unit of Maharani Laxmi Bai Medical College claimed the lives of at least 10 newborns. Investigations revealed functional gaps that mirror past failures: blocked emergency exits, non-functional fire extinguishers, and a slow response to an electrical short circuit.

The Delhi “Baby Care” Disaster (May 2024): Seven infants perished in a private neonatal centre in New Delhi. The fire was exacerbated by the explosion of oxygen cylinders, underscoring the lethal risk of improper hazardous material storage in small healthcare settings

Historic & Global Benchmarks

Hurricane Helene (USA, 2024): Even in a developed nation, the 2024 hurricane caused critical IV fluid shortages across the United States after a major manufacturing plant was flooded, proving that hospital preparedness is deeply tied to supply chain resilience.

The Nepal & Bhuj Earthquakes: Both the 2001 Bhuj (India) and 2015 Nepal disasters showed that when hospitals are not built with structural retrofitting, they crumble, leaving the injured with nowhere to turn.

Bhopal Gas Tragedy (1984): Remains the world’s worst industrial disaster, where a lack of chemical triage meant hospitals were overwhelmed by 500,000+ exposed victims within hours.

Lessons Learned or Learnings Lost?

These incidents reveal a reactive rather than preventive culture. Modern failures are rarely about a lack of equipment; they are about maintenance, accountability, and overcrowding.

Maintenance: Expired extinguishers and outdated wiring are silent killers.

Overcrowding: NICUs operating at 200% capacity make safe evacuation nearly impossible.

Accountability: Legal frameworks often fail to penalize negligence, leading to “safety audits” becoming mere paperwork.

The Immediate Benefits of Readiness

Emergencies strike without warning—fires, stampedes, earthquakes, terrors, outbreaks.

Effective preparedness enables hospitals to:

Save Lives & Reduce Morbidity: Swift action prevents preventable deaths.

Maintain Continuity of Care: Ensuring patients already in the hospital aren’t neglected during a crisis.

Manage Resources: Efficiently using limited beds, blood, and oxygen.

Reduce Chaos: Implementing a clear Chain of Command to replace panic with protocol.

Core Pillars of Response: Fire, Crowd, and Casualties

Modern healthcare institutions must adopt structured frameworks to handle specific threats:

1. Fire Safety: Beyond functional extinguishers, hospitals must conduct annual fire audits. Staff should be experts in RACE (Rescue, Alarm, Confine, Extinguish) and PASS (Pull, Aim, Squeeze, Sweep) protocols.

2. Crowd & Surge Management: High-density areas require access control and diversion protocols to prevent stampedes and maintain hospital security.

3. Mass Casualty Incident (MCI): Hospitals must be ready to double their capacity instantly. This relies on the START (Simple Triage and Rapid Treatment) system for adults and JumpSTART for children.

By categorizing patients into Red (Immediate), Yellow (Delayed), Green (Walking), and Black (Deceased), medical teams can do the greatest good for the greatest number of people.

The long-term survival of a healthcare institution depends on the Science of Preparedness. This involves benchmarking against global standards and building systems that can withstand the invisible threats of the 21st century.

The Hospital Incident Command System (HICS)

A crisis cannot be managed by a standard administrative hierarchy. Hospitals must adopt the Hospital Incident Command System (HICS), which breaks roles into specific functions:

Command Staff: Incident Head, Safety Officer, and Public Information Officer.

General Staff: Operations, Planning, Logistics, and Finance.

Benchmarking with the WHO Hospital Safety Index (HSI)

The World Health Organization (WHO) provides the Hospital Safety Index, a tool to evaluate a facility’s Functional Safety. It moves beyond just checking if the walls are strong (Structural Safety) to assessing if the hospital can actually provide care during a flood or power outage.

The Modern Frontier: Digital & Supply Chain Resilience

In today’s era of telemedicine and Electronic Health Records (EHRs), cybersecurity has become a frontline safety priority. A ransomware attack on a hospital is no less dangerous than a fire—it can paralyze critical systems, endanger lives, and erode trust.

The recent ransomware attack on AIIMS New Delhi illustrates this stark reality. Sensitive patient data was compromised, hospital operations were disrupted, and hackers demanded nearly Rs 200 crore in cryptocurrency ransom. The inability to access patient records crippled day-to-day functioning, raising urgent concerns about the adequacy of cybersecurity safeguards in healthcare. This incident underscores the existential threat posed by digital vulnerabilities in modern medicine.

Resilience, however, is not only digital—it is also logistical. Just as hospitals must defend against cyberattacks, they must also ensure supply chain continuity. Buffer stocks of essential medicines, diversified vendor networks, and contingency planning for life-saving drugs are vital. A break in the supply chain can be as catastrophic as a system breach, jeopardizing patient care and institutional credibility.

Together, digital resilience and supply chain continuity form the twin pillars of modern healthcare preparedness. Protecting data and ensuring uninterrupted access to critical resources are no longer optional, as they are the new frontier of safety and trust in healthcare

The Human Element: Training and Mental Health

Muscle Memory & Mental Resilience

Muscle memory means the brain and body working together. With repeated practice, actions become automatic—both neurologically (quick signals in the brain) and physiologically (the body’s ability to act fast and precise).

Mock drills build this memory. In a Code Blue (cardiac arrest) or Code Red (fire), drills expose gaps and prepare staff to respond without hesitation.

But resilience is not only physical. Mental health support is vital. Programs for staff well-being and post-trauma care prevent burnout and protect against long-term stress.

Together, muscle memory and mental resilience make healthcare teams strong, ready, and able to save lives.

Emerging Considerations: Climate and Accountability

As we look toward the future, three new challenges emerge:

Climate Change: Extreme heat, floods, and new disease outbreaks demand advance resilience building.

Legal & Ethical Frameworks: Systems must ensure fairness and equity in resource allocation during crises.

Integration: No hospital is an island. Institutions must align with the NDMA (National Disaster Management Authority) and global WHO frameworks to share data and resources.

Conclusion: A Cycle of Improvement

Emergency preparedness is not a destination but a continuous cycle of improvement. A prepared hospital saves more lives, protects its staff, and maintains public trust. As India strengthens its healthcare infrastructure, preparedness must remain the central pillar of patient safety.

( The writer is the former President, AIIMS, Bathinda, Dean (R), Medical Superintendent & Professor, PGIMER, Chandigarh. )