Background:
In Italy hydrogeological risk is one of the major environmental risks with significant impacts on human life and activities. The City of Senigallia (40.000 inhabitants) was recently hit by two floods (2014 and 2022). Before the last flood event, which occurred on 15 September 2022, the Local Public Health Department (LPHD), the Local Health District (LHD) and the Municipality of Senigallia worked jointly to improve the capacities for hydrogeological risk preparedness and response.

Methods:
During the month of April 2022, a simulation exercise was carried out which allowed the confrontation between LPHD-LHD and the Municipality of Senigallia and made it possible to agree on objectives, procedures and activities aimed at managing a flood.

Results:
According with the main outcomes of the simulation exercise LPHD-LHD agreed on an operating procedure to be activated in the event of a regional alert for hydrogeological risk and collaborated to have a list of non-ambulatory patients living on the ground floor, immediately available through appropriate home-care management software improvements. In response to the 15 September 2022 flood, the Municipality of Senigallia promptly organized reception centres, alerted the population and secured the non-ambulatory patients living in risk areas 2 hours before the flood arrived. None of these actions has been implemented in neighboring cities.

Conclusion:
In the flood of 15 September 2022, the territories of 7 municipalities were severely affected. The damage caused to the structures is enormous; 1 missing person and 12 victims were recorded, one of whom was resident in the municipality of Senigallia where no injuries and deaths were recorded among frail and non-ambulatory people. Given the increasingly frequent extreme weather events, preparation for hydrogeological events is pivotal and Local Health Authorities must be able to continously improve floods preparedness and response involving all the municipalities in a sistematic and timely way.