I have spent my entire two-decade career designing hospitals, and one lesson has become increasingly clear: Hospitals are no longer just buildings. During a major climate event like a hurricane they become lifelines for their communities.

We have all experienced major blackout events in recent years. And while for many people it may be a temporary inconvenience, in a hospital it is a matter of life or death for vulnerable patients. A newborn baby in a neonatal intensive care unit (NICU) relies on a steady flow of oxygen while an elderly patient in an ICU may depend on a ventilator to breathe.

As Jamaica embarks on its most ambitious health-care modernisation programme, with four to six new hospitals being planned, we face a defining choice. Will these multi-billion-dollar investments simply be new buildings, or will they be resilient enough to withstand major climate events and serve Jamaicans for generations to come?

We have already seen the consequences of getting things wrong. When Superstorm Sandy struck the eastern coast of the United States in 2012 it laid bare a catastrophic flaw in traditional hospital design. Major facilities had their basements completely flooded, leaving essential infrastructure like switchgear, electrical panels, air handling units, and emergency generators under feet of saltwater. Elevators failed, forcing nurses and doctors to carry fragile infants down dark stairwells by flashlight.

Some of these hospitals were also academic medical centres where years of scientific research were lost. More recently, during severe heatwaves in Florida, extended power outages at long-term-care facilities led to a tragic loss of lives as cooling systems, without emergency back-up power, failed to protect vulnerable residents from extreme heat.

For a tropical island nation like Jamaica — where intense heat, high humidity, and increasingly volatile hurricane seasons are the reality of living in the Caribbean basin — these events are not simply warnings from the past. They are a blueprint for what we must actively design against.

To ensure Jamaica’s new health-care facilities never falter when the public needs them most, our engineering standards must evolve. Resiliency must be woven into the very fabric of the mechanical, electrical and plumbing infrastructure. The traditional practise of placing critical infrastructure in basements or lower levels must change. Switchgear, generators, and automatic transfer switches must be elevated high above potential flood zones. Rooftops should incorporate enclosed mechanical penthouses to protect sensitive climate-control equipment from severe hurricane-force winds. Flood barriers should also be integrated into the design, with civil, geotechnical and mechanical engineers working hand in hand with the mechanical engineering team from the earliest stages of the project.

Emergency power cannot be an afterthought designed to support only a few hours of utility downtime; during Superstorm Sandy, power outages lasted for more than a week. Jamaican hospitals need a minimum 96 hours of continuous fuel capacity, paired with dual-fuel systems combining fuel oil with natural gas or propane to ensure operational independence during extended, islandwide grid failures.

It is equally important how power is prioritised during a blackout event. Downstream from the generators, power must flow through a three-tiered, automatic transfer, switch system. During a blackout, power should cascade instantly to life safety systems (fire suppression, medical gas, emergency lighting), then to critical systems (operating rooms, ICU systems), and finally to general equipment.

High humidity can result in bacteria and mould growth, posing serious risks to patients and compromising safe drug storage. High temperatures combined with high humidity can also prove fatal to critical and vulnerable patients. In Jamaica’s tropical climate, cooling is not a luxury but a medical necessity. Air conditioning and ventilation systems must therefore be linked directly to emergency backup power. Technology like desiccant wheels can be used to lower the humidity of outside air before it enters the cooling coils of air handling units. Given Jamaica’s coastal environment, those coils should also be fitted with marine-grade protective coatings due to the proximity of the equipment to sea.

Critical life-support mechanical systems such as medical air compressors, vacuum pumps, operating room chillers, and isolation room exhaust fans must automatically feature N+1 redundancy. This means every essential component has a dedicated back-up, allowing the system to continue operating without interruption if one component fails.

Resilience goes beyond surviving storms; it transforms how hospitals interact with the national energy grid day to day. Because hospitals operate 24/7 and simultaneously require heavy heating and cooling, implementing combined heat and power (co-generation) plants at major medical campuses allows facilities to generate their own electricity while recycling waste heat. This not only reduces operating costs but also lessens dependence on an unstable electricity grid. Furthermore, by leveraging demand/response programmes, hospitals can seamlessly switch to on-site generation during periods of peak national grid stress, easing pressure on the public utility to reduce regional energy costs.

It is equally important to recognise that the energy used within hospitals does not have to be wasted. Modern mechanical equipment — like chiller heater systems and air-source heat pumps — can capture excess heat and repurpose it to produce domestic hot water, significantly improving overall energy efficiency.

Building automation systems have also come a long way. In hurricane-prone regions like Jamaica, digital twins can simulate different operating conditions, identify points of potential failure before they occur, and help engineers develop resilience strategies well in advance.

As Jamaica invests in world-class health-care infrastructure we must ensure that these facilities are designed not only to serve today’s needs but to withstand tomorrow’s challenges. We need to learn from past disasters and make resilience our highest priority, thereby protecting generations of Jamaicans for decades to come.

Rahul Tikekar is the senior vice-president & health-care engineering expert at Loring Consulting Engineers.

Rahul Tikekar, senior vice-president and health-care engineering expert at Loring Consulting Engineers.