Preparedness for blackouts in Iberian Peninsula patients using home respiratory therapies

Home respiratory therapies, including long-term oxygen therapy (LTOT) and home mechanical ventilation (HMV), are essential for patients with chronic respiratory diseases, yet their effectiveness depends on uninterrupted electricity. However, the preparedness of healthcare systems for large-scale blackouts remains largely unexplored. The aim of the study was to evaluate the preparedness of healthcare centres in the Iberian Peninsula to manage patients who are dependent on home respiratory therapies during blackouts, evaluate the clinical impact of the April 2025 power outage, and identify areas for improvement.

Cross-sectional online survey among pulmonologists in Spain and Portugal, assessing protocols, patient identification systems, emergency responses and the clinical impact of the blackout.

60 centres participated (Spain n=39; Portugal n=21), each covering a median population of 350 000 inhabitants. 35% of centres had all three preparedness components: formal protocols, systematic patient identification and active registries of home respiratory therapies patients at risk. During the blackout, 44.8% of centres did not contact patients; those that did mainly used respiratory homecare providers (43.1%) as intermediaries. Emergency services were the primary source of support (80.4%). Hospital visits were reported in 55.9% of centres for LTOT patients and 50% for HMV patients, although most cases did not require hospitalisation. Multivariate analysis showed that formal protocols were the only factor associated with higher preparedness (β=3.36; p<0.001).

The blackout exposed critical gaps in emergency preparedness for patients dependent on home respiratory therapies. Ensuring updated patient registries, strengthening formal protocols, and cross-sector coordination are essential to safeguard vulnerable populations during power disruptions.