Responder perspectives on preparedness for healthcare needs of vulnerable populations during floods and heatwaves: a qualitative study in Emilia-Romagna, Italy.

Introduction: Climate change poses significant challenges to public health, exacerbated by the increasing frequency and intensity of extreme weather events. Emilia-Romagna, Italy, has recently experienced severe extreme weather events, including heatwaves and floods, prompting a need to assess the healthcare system's capacity to respond to such events. Despite national initiatives, there is limited understanding of how vulnerable populations' healthcare needs are addressed during climate-induced crises. This study explored preparedness and response strategies adopted by healthcare responders and close civil protection system stakeholders in addressing the healthcare needs of vulnerable populations during extreme weather events, such as floods and heatwaves, in Emilia-Romagna. Methods: We conducted a qualitative study in Emilia-Romagna's Forlì-Cesena province, involving 10 key informants from the health district and related disaster management institutions within the civil protection system. We investigated preparedness, response and adaptation strategies for heatwaves and floods. Semistructured interviews were conducted, recorded and then transcribed. We employed reflexive thematic analysis, guided by the preparedness cycle framework. Results: An overarching theme was identified: 'Flexible collaboration: adapting together in crisis' comprising three subthemes: enhancing adaptability through teamwork, balancing flexibility and consistency in response and rethinking vulnerabilities and risk perceptions. Interviews indicated a lack of experience in activating heatwave early warning systems within civil protection plans. However, the frequent health emergencies, including COVID-19, floods and an earthquake, provided a form of 'real-life training' that enhanced response coordination and functionality during crises. Conclusion: The findings suggest the importance of flexibility and multilevel collaboration across the healthcare sector and its stakeholders in responding to climate-induced crises, such as heatwaves and floods. While coordination was strong during the response phase, the results suggest a lack of efforts in integrating community engagement in long-term recovery and adaptation planning.