Readiness of iberian healthcare centers for electricity-dependent respiratory patients: a cross-sectional survey

Background: Long term oxygen therapy (LTOT) and home mechanical ventilation (HMV) depend on uninterrupted electricity supply. In April 2025, an unprecedented large-scale blackout affected Spain and Portugal for several hours, impacting millions of residents. Aims: To assess healthcare centers´ preparedness for managing electricity-dependent patients, evaluate consequences, and identify priorities for improvement. Methods: Cross-sectional online survey was conducted among pulmonologists from 60 centers (39 Spain, 21 Portugal). The questionnaire addressed protocols, patient registries and strategies implemented. Results: 35 centers (58%) reported systematic identification of LTOT-dependent patients, while only 18% consistently notified electricity providers. Emergency room admissions related to LTOT were reported in 36 centers (56%), with a median of 9 patients/center. Regarding HMV, back-up equipment was available for patients requiring >16 h/daily in 81.7% of centers. Permanent notification to electricity providers occurred in 25.9% of centers. During the blackout, 50% of centers reported emergency visits by HMV patients, mostly without hospitalization. Preparedness elements classified by LTOT and HMV are displayed in Figure 1. Conclusions: This outage exposed substantial preparedness gaps. Robust protocols, real-time patient registries, and coordination are key to enhancing health system resilience in future power crises.