Resilience in an era of systemic risk: An integrated analysis of critical local and national infrastructure, emergency medicine, and civil defence

The stability and functionality of modern, highly technological societies are profoundly dependent on the uninterrupted availability of critical infrastructure services. The health sector plays a unique role in protecting the highest-priority goal of preserving and saving human lives and health. This analysis uses a systematic investigation, moving from empirically grounded case studies of regional disasters in a winter storm in 2005 and a flood in 2021 in Germany, through operational management models and application-oriented research, to the strategic and legal frameworks at the local to national level. The resilience of health systems and public health cannot be considered in isolation. It is deeply embedded in the resilience of the entire critical infrastructure and, ultimately, in local and national strategies. The results are that institutionalised learning needs to take place following disruptive events, that “single points of failure" and „common-mode failures“ need to be identified. The findings point to a demand for engagement with the scenario of civil defence in the context of a collective security crisis, thereby postulating the necessity of an integral, multi-level resilience strategy for emergency medicine and society as a whole.