Prehospital and Disaster Medicine

Original Research

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

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 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.

EL Downey, K Andress, CH Schultz. External factors impacting hospital evacuations caused by Hurricane Rita: the role of situational awareness. Prehosp Disaster Med. 2013;28(3):1-8 .

(Received October 11 2012)

(Accepted November 07 2012)

(Revised November 20 2012)

(Online publication March 14 2013)


  • hospital evacuation;
  • Hospital Incident Command System;
  • National Incident Management System;
  • patient tracking;
  • situational awareness


  • CEO:Chief Executive Officer;
  • ED:emergency department;
  • EMAC:emergency medical assistance compact;
  • EOP:emergency operations plan;
  • HEICS:Hospital Emergency Incident Command System;
  • HICS:Hospital Incident Command System;
  • HPP:Hospital Preparedness Program;
  • IMT:Incident Management Team;
  • ICU:intensive care unit;
  • MAA:mutual aid agreements;
  • NICU:neonatal intensive care unit;
  • PICU:pediatric intensive care unit;
  • RMOC:Regional Medical Operation Center


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 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 this 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.