Successful Hospital Evacuations

Educational Objectives

The goal of this program is to improve response to events requiring hospital evacuation. After hearing and assimilating this program, the clinician will be better able to:

1. Compare hospital evacuations in events with no notice vs events with advance warning.

Summary

Reasons for hospital evacuation: include weather, infrastructure, violence, fire within the building or approaching the building; in speaker’s evacuations, one was fire set in psychiatric hospital and almost immediately extinguished and hospital was quickly repopulated; natural hazards (eg, tornadoes), involve hazards with water, steam, natural gas, electricity, boilers, chillers, security, health information technology, and telecommunications that may lead to evacuation; evacuation is considered when patient care cannot be provided safely within the hospital

Methodology: the Federal Emergency Management Agency (FEMA) recommends conducting a hazard vulnerability analysis for hospital evacuation; risks are assessed using an “all-hazard approach,” followed by a focus on key factors; consideration is given to relative onset, availability of resources, staffing, and community health care approach; this involves collaboration with neighbors, government, and other agencies to clearly define roles and responsibilities; the best approach involves risk mitigation; methods to make physical structures less vulnerable are carried out; key nonstructural pieces include policies, procedures, tactics, and techniques, like working with neighbors, establishing memorandum of understanding (MoU) and preparation or appropriate training

System-level planning: key to a successful hospital evacuation; a key decision maker is involved in the process of evacuation; a significant amount of expense and human cost is incurred in the event of evacuation; it is also difficult to provide safe care during an evacuation

Trigger points: not associated with financial pressures; provide a concise set of rules that govern actions; a clear, definable decision is taken regarding timing of evacuation; specific protective steps are then taken

Alternative sites of care: obtaining alternative sites of care is complex; the level of care provided at alternative centers has to be determined; transportation of equipment and materials to the alternative site is another issue; another question involves whether the location of the alternative site is in the same health system or a different one; partner facilities or less than optimal locations; speaker’s institution uses location for mass casualty events (sports facilities with water and electricity may be engaged); transfer agreements have to be made between partners in the system; patients can be tracked through brief clinical documentation with, eg, family and responsible party; patients' belongings, and equipment are to be labelled for easy recovery after the event; system-level planning may involve shelter in place, or local and regional organizations

Types of evacuation and practice sessions: include horizontal evacuation (evacuation of a single unit away from a threat), vertical evacuation (evacuation of a single floor), and complete hospital evacuation; practice involves familiarization with evacuation equipment; it is set up by the incident command; anyone with clinical respect for the organization, and an understanding how to effectively lead people in a crisis can run practice sessions or get involved in evacuation processes

Medical-asset tracking: involves keeping track of equipment, so that business can resume once the problem is resolved; this includes repatriation of patients, and recovery of assets; communication is the key to tracking; when internal communications are effective, the same is transferred to the outside world; effective communication is required with partnering agencies, families, and in the community to reassure everyone

Decision tree: for evacuation is based on the type of threat, timeline, and whether the threat is a planned or no-notice event; constant reassessment of threat is critical; evacuation plans are executed based on the type of threat (internal or external threat); it is easier to manage events that have an advance warning (eg, hurricane), than no-notice events (eg, explosions); evacuation priorities change in the case of a no-notice event; the ambulatory and lowest-acuity patients are moved first; when there is more time to execute plans (advance warning), the most critical patients are moved first; assistance for evacuation may be sought from ambulatory patients; hospital evacuation requires the best use of resources within a tight timeline that one is forced to work under

Recovery: dependent on planning, documentation, and tracking of patients and equipment, especially when using alternative sites, and transportation; MoU for shared care within or outside the system is crucial; once care can be resumed within the facility in terms of infrastructure and staff, patients and equipment are to be brought back; this is linked to communication and documentation that is brief and easy to perform

Readings

Khorram-Manesh A, Phattharapornjaroen P, Mortelmans LJ, et al. Current perspectives and concerns facing hospital evacuation: The results of a pilot study and literature review. Disaster Med Public Health Prep. 2022; 16(2):650-658. doi:10.1017/dmp.2020.391; Mace SE, Doyle CJ, Askew K, et al. Planning considerations for persons with access and functional needs in a disaster-Part 1: Overview and legal. Am J Disaster Med. 2018; 13(2):69-83. doi:10.5055/ajdm.2018.0289; Sahebi A, Jahangiri K, Alibabaei A, et al. Factors influencing hospital emergency evacuation during fire: A systematic literature review. Int J Prev Med. 2021; 12:147. Published 2021 Oct 26. doi:10.4103/ijpvm.IJPVM_653_20; Tekin E, Bayramoglu A, Uzkeser M, et al. Evacuation of hospitals during disaster, establishment of a field hospital, and communication. Eurasian J Med. 2017 Jun; 49(2):137-141. doi: 10.5152/eurasianjmed.2017.16102. Epub 2017 Apr 28.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Barnes was recorded at Medical Disaster Response, held in Las Vegas, NV, on March 27, 2022, and presented by the Trauma and Critical Care Foundation. For information about upcoming CME activities from these presenters please visit trauma-criticalcare.com. Audio Digest thanks the speakers and the presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

Lecture ID:

EM392303

Qualifies for:

Trauma

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.