Beyond the Coastline: Addressing Inland Vulnerabilities During Hurricanes

Hurricanes are often perceived as coastal threats. But recent events have made one thing clear: the danger doesn’t stop at the shoreline. The 2024 Atlantic hurricane season, particularly Hurricane Helene, revealed just how devastating these storms can be for communities hundreds of miles inland.

6/9/20252 min read

The Growing Risk for Inland Areas

Hurricane Helene made landfall in Florida's Big Bend region as a Category 4 storm and charged inland, flooding western North Carolina, East Tennessee, and southwestern Virginia. In North Carolina alone, more than 200 lives were lost and over 125,000 homes were damaged or destroyed—making it the most devastating disaster in the state’s modern history (Federal Reserve Bank of Richmond).

In Erwin, Tennessee, 54 patients and staff were airlifted from a hospital roof as floodwaters surged through the town (WYFF News 4). Roads vanished, rivers jumped their banks, and critical health infrastructure buckled under the pressure.

These events exposed long-standing vulnerabilities in inland areas:

Aging Infrastructure – Water systems, bridges, and roads are not built to withstand hurricane-driven flooding far from the coast.
Limited Emergency Services – Rural counties lack the staff and equipment for large-scale search and rescue.
Communication Breakdowns – Power failures and disrupted telecoms isolate communities when they need help most.

What’s Being Done (and Where the Gaps Remain)

Some states are rethinking their inland response strategies—and fast.

Missouri – In April 2025, after record-breaking floods, Missouri deployed Task Force 1, a specialized water rescue team. Governor Mike Kehoe mobilized resources to support overwhelmed counties and urged caution amid rapidly changing flood conditions.

Tennessee – The Tennessee Department of Safety and Homeland Security sent mobile units into flood-stricken towns, helping residents replace IDs and access vital documentation.

Ohio – The Resilience Improvement Plan from the Ohio Department of Transportation is targeting the top 20 at-risk roadways—many in Appalachian counties—to protect lifelines during storms.

Yet, widespread gaps persist:

Evacuation Protocols – Many counties have no clear inland evacuation routes or transportation assets.
Outdated Flood Maps – Communities are flying blind with data that underestimates today’s flood risk.
Healthcare Access – Disrupted roadways cut off clinics and hospitals just when demand surges.

What Health Response Alliance Is Doing

At Health Response Alliance (HRA), we work with partners to close these gaps before the next storm hits:

Mapping Access Gaps – We identify inland healthcare deserts vulnerable to service disruptions.
Aligning Logistics – We help NGOs pre-position resources where inland impacts are likely.
Assessing Facilities – We evaluate the backup power, road access, and staffing capacity of rural clinics in high-risk areas.

A Call to Think Beyond the Shoreline

Hurricane Helene taught us that storm surge isn’t the only threat. Rainfall, river floods, and infrastructure failures can cripple inland communities long after the eye of the storm has passed. Preparedness must evolve.

Emergency planners, state leaders, and health systems must broaden their lens—and act decisively. Coastal readiness is no longer enough. True resilience means going beyond the coastline.