Prehospital and Disaster Medicine

Original Research

Initial Management of Hospital Evacuations Caused by Hurricane Rita: A Systematic Investigation

Erin L. Downeya1 c1, Knox Andressa2 and Carl H. Schultza3

a1 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

a2 Louisiana State University Health Shreveport, Shreveport, Louisiana USA and Louisiana Poison Center, Shreveport, Louisiana USA

a3 Center for Disaster Medical Sciences, Department of Emergency Medicine, UC Irvine School of Medicine, Irvine, California USA


Introduction Hurricanes remain a major threat to hospitals throughout the world. The authors attempted to identify the planning areas that impact hospital management of evacuations and the challenges faced when sheltering-in-place.

Methods This observational, retrospective cohort study examined acute care institutions from one hospital system impacted by Hurricane Rita in 2005. Investigators used a standardized survey instrument and interview process, previously used in the hospital evacuation context, to examine hospitals’ initial internal situational awareness and subsequent decision making that resulted in evacuation due to Hurricane Rita. Participants from each hospital included representatives from senior leadership and clinical and nonclinical staff that comprised the Incident Management Team (IMT). The main measured outcomes were responses to 95 questions contained in the survey.

Results Seven of ten eligible hospitals participated in the study. All facilities evacuated the sickest patients first. The most significant factors prompting evacuation were the issuing of mandatory evacuation orders, storm dynamics (category, projected path, storm surge), and loss of regional communications. Hospitals that sheltered-in-place experienced staff shortages, interruptions to electrical power, and loss of water supplies. Three fully-evacuated institutions experienced understaffing of 40%-60%, and four hospitals sustained depressed staffing levels for over four weeks. Five hospitals lost electricity for a mean of 4.8 days (range .5-11 days). All facilities continued to receive patients to their Emergency Departments (EDs) while conducting their own evacuation.

Conclusion Hospital EDs should plan for continuous patient arrival during evacuation. Emergency Operation Plans (EOPs) that anticipate challenges associated with evacuation will help to maximize initial decision making and management during a crisis situation. Hospitals that shelter-in-place face critical shortages and must provide independent patient care for prolonged periods.

EL Downey, K Andress, CH Schultz. Initial management of hospital evacuations caused by Hurricane Rita: a systematic investigation. Prehosp Disaster Med. 2013;28(3):1-7 .

(Received October 11 2012)

(Accepted November 13 2012)

(Revised November 26 2012)

(Online publication February 21 2013)


  • decision making;
  • hospital evacuation;
  • hospital evacuation plan;
  • hurricane


  • CEO:Chief Executive Officer;
  • CNO:Chief Nurse Officer;
  • ED:emergency department;
  • EOC:Emergency Operations Center;
  • EOP:Emergency Operations Plan;
  • HICS:Hospital Incident Command System;
  • ICS:Incident Command Systems;
  • ICU:intensive care unit;
  • IMT:Incident Management Team;
  • NIMS:National Incident Management System


c1 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 70112 USA E-mail


  Conflicts of interest and funding: ELD and CHS report no conflict of interest in any area. KA was an employee of the hospital system that agreed to the research project during the data collection. However, he was not employed by that corporation at the time of manuscript preparation, nor has he been employed by the corporation since. No grant funding was received in support of this project.