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External Factors Impacting Hospital Evacuations Caused by Hurricane Rita: The Role of Situational Awareness

Published online by Cambridge University Press:  14 March 2013

Erin L. Downey ,
Knox Andress  and
Carl H. Schultz
Erin L. Downey*
Affiliation:
US Department of State, Office of the Geographer and Global Issues, Washington, DC USA and Tulane University School of Public Health and Tropical Medicine (Adjunct Faculty), New Orleans, Louisiana USA
Knox Andress
Affiliation:
Louisiana State University Health Shreveport, Shreveport, Louisiana USA and Louisiana Poison Center, Shreveport, Louisiana USA
Carl H. Schultz
Affiliation:
Center for Disaster Medical Sciences, Department of Emergency Medicine, UC Irvine School of Medicine, Irvine, California USA
*
Correspondence: Erin L. Downey, MPH, ScD Tulane University School of Public Health and Tropical Medicine Department of Health Systems Management 1440 Canal Street New Orleans, LA USA E-mail edowney@tulanealumni.net
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Abstract

Introduction

The 2005 Gulf Coast hurricane season was one of the most costly and deadly in US history. Hurricane Rita stressed hospitals and led to multiple, simultaneous evacuations. This study systematically identified community factors associated with patient movement out of seven hospitals evacuated during Hurricane Rita.

Methods

This study represents the second of two systematic, observational, and retrospective investigations of seven acute care hospitals that reported off-site evacuations due to Hurricane Rita. Participants from each hospital included decision makers that comprised the Incident Management Team (IMT). Investigators applied a standardized interview process designed to assess evacuation factors related to external situational awareness of community activities during facility evacuation due to hurricanes. The measured outcomes were responses to 95 questions within six sections of the survey instrument.

Results

Investigators identified two factors that significantly impacted hospital IMT decision making: (1) incident characteristics affecting a facility's internal resources and challenges; and (2) incident characteristics affecting a facility's external evacuation activities. This article summarizes the latter and reports the following critical decision making points: (1) Emergency Operations Plans (EOP) were activated an average of 85 hours (3 days, 13 hours) prior to Hurricane Rita's landfall; (2) the decision to evacuate the hospital was made an average of 30 hours (1 day, 6 hours) from activation of the EOP; and (3) the implementation of the evacuation process took an average of 22 hours. Coordination of patient evacuations was most complicated by transportation deficits (the most significant of the 11 identified problem areas) and a lack of situational awareness of community response activities. All evacuation activities and subsequent evacuation times were negatively impacted by an overall lack of understanding on the part of hospital staff and the IMT regarding how to identify and coordinate with community resources.

Conclusion

Hospital evacuation requires coordinated processes and resources, including situational awareness that reflects the condition of the community as a result of the incident. Successful hospital evacuation decision making is influenced by community-wide situational awareness and transportation deficits. Planning with the community to create realistic EOPs that accurately reflect available resources and protocols is critical to informing hospital decision making during a crisis. Knowledge of these factors could improve decision making and evacuation practices, potentially reducing evacuation times in future hurricanes.

DowneyEL, AndressK, SchultzCH. External Factors Impacting Hospital Evacuations Caused by Hurricane Rita: The Role of Situational Awareness. Prehosp Disaster Med. 2013;28(3):1-8.

Keywords

hospital evacuationHospital Incident Command SystemNational Incident Management Systempatient trackingsituational awareness
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 3 , June 2013 , pp. 264 - 271
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

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