Evacuation Logistics Research Articles

Logistics of patient evacuation in response to disease Outbreaks: Critical considerations for transportation planning

The recent outbreaks of diseases have emphasized the importance of having robust decision-making models in place to aid in the evacuation of patients, particularly from overwhelmed hospitals to alternative facilities. The sudden surge of patients during an outbreak can quickly deplete a hospital's resources, leading to compromised healthcare delivery and an increase in mortality rates. Evacuating patients to other hospitals can alleviate the burden on a single facility, but numerous factors need to be considered when making evacuation decisions, including patient acuity, transportation logistics, and bed availability at other facilities. Despite the critical role of patient evacuation in disease outbreaks, there has been a lack of systematic and comprehensive research on developing decision-making models that identify the critical factors. This paper aims to bridge this gap by providing the key factors that should be considered when creating decision models for patient evacuation in response to contagious disease outbreaks. The findings reveal that decision-making processes are influenced by a multitude of factors, including patient numbers and classifications, staff scheduling and assignments, resource availability for transportation, road traffic conditions, capacities and numbers of evacuation and receiving hospitals, as well as the behaviour of disease outbreaks. These findings provide practical insights for relevant authorities to optimize emergency strategies during disease outbreaks and enhance the overall resilience of the healthcare system against external disruptions.

Impacts of household vulnerability on hurricane logistics evacuation under COVID-19: The case of U.S. Hampton Roads

Historical data suggest that when a severe tropical storm or hurricane impacts a community, the vulnerable segment of the population suffers the most severe consequences. With an increased aging population, it is crucial to understand how vulnerability alters evacuation behavior. Emergent variables such as fear of COVID-19 require additional exploration. People afraid of COVID-19 exposure may refuse to evacuate, exposing themselves unnecessarily. Differentiation is critical to evacuation logistics since it is needed to determine what proportion would stay in a local shelter, public or other, rather than evacuating or staying in their home and guide the logistics resource allocation process. This research uses data from a web and phone survey conducted in the Hampton Roads area of U.S. Virginia, with 2,200 valid responses to analyze the influence of social and demographic vulnerability factors and risk perception on evacuation decisions. This research contributes to the existing literature by developing a multinomial order logit model based on vulnerability factors and intended evacuation decisions, including staying at home, looking for a shelter, or leaving the Hampton Roads area. Findings show that race and risk perception are the variables that influence the decision-making process the most. Fear of COVID-19 transmission is also associated with an increased likelihood of leaving homes during evacuation. The variations in findings from previous studies are discussed regarding their implications for logistics emergency managers.

Risk perception and travel behavior under short-lead evacuation: Post disaster analysis of 2020 Beirut Port Explosion

Human-made disasters continue to be the most dangerous of all types of disasters due to their suddenness and unpredictability. This calls for a thorough examination of people’s evacuation behavior due to its impact on the evacuation procedure and its significance for evacuation planning. This study aims to provide a comprehensive understanding of the decision-making process of residents in case a human-made disaster occurs with an application to Beirut, Lebanon. This study is essential for pre-disaster planning, which mitigates potential damage from such disasters. Using structural equation modeling (SEM), the current study uses the Protective Action Decision Model (PADM) framework to explain intention toward evacuation behavior before a human-made disaster in three situations: being at home with all family members, having absent family members, and being at work or university when the event occurs. The findings of this study show that the PADM framework is relevant to explaining evacuation behavior intentions prior to a human-made disaster incident. Results indicate that knowledge perception does not trigger the intended behavior of evacuating immediately in the studied situations. Besides, the results indicate low confidence in the government’s emergency plans and the unreliability of the official government warnings about human-made hazards. Overall, the findings of this study may contribute to a better understanding of evacuation behavior from disasters with less lead warning time. Besides, they may aid the Disaster Risk Management unit of Lebanon in developing emergency evacuation strategies that: understand the public’s evacuation behavior; customize city-specific evacuation logistics; optimize the dissemination of evacuation information.

Understanding the Decision to Evacuate on the United States Gulf Coast: The Case of Hurricane Irma in Florida

This paper considers local knowledge and individual decisions concerning hurricane evacuation for Hurricane Irma in Tampa, Florida, to better understand why people fail to evacuate from storm-vulnerable regions on the Gulf Coast of the United States. Research on hurricane evacuation has yielded equivocal results in predicting who will evacuate when given a mandatory order to evacuate, but one consistent finding is that approximately 30–40 percent do not evacuate. In-depth interviews with eleven neighbor-pairs (one who evacuated and one who did not) residing in mandatory evacuation zones for Hurricane Irma explored reasons to evacuate or stay. Evacuation rationales were analyzed to distinguish households that evacuated from those who remained. Thirteen rationales distinguished the two groups and reflected three main themes: perceived risk (storm-worthiness of their house and its elevation), influence by friends and neighbors (principally, neighbors), and evacuation logistics (leaving early). Because hurricane response in Florida is limited by the geography of the state, many who evacuated did not go far and sought refuge in safer buildings relatively close to home. Although disaster planning stresses evacuation, understanding local knowledge and strategies can help to plan for disasters and protect vulnerable populations from hurricane risk.

Effects of risk perception and perceived certainty on evacuate/stay decisions

In hurricane evacuation studies, the extant literature has extensively explored the effect of risk perception on evacuate/stay decisions. However, less attention has been paid to how perceived certainty affects households' evacuate/stay decisions. The objectives of this paper are to explore the effects of (1) perceived certainty about location of impact on both risk perception and perceived certainty about evacuation logistics; (2) risk perception on perceived certainty about evacuation logistics; and (3) perceived certainty about evacuation logistics on evacuate/stay decisions. Survey data gathered from households in the Jacksonville, Florida metropolitan area after Hurricane Matthew (2016) were analyzed using structural equation modeling (SEM). In addition, SEM allowed us to identify the factors that could be used to predict risk perception, perceived certainty about location of impact, and perceived certainty about evacuation logistics. The results showed that perceived certainty about location of impact had a non-significant effect on risk perception. Perceived certainty about location of impact had a positive effect on perceived certainty about evacuation logistics. However, the effect of risk perception on perceived certainty about evacuation logistics was non-significant. Both risk perception and perceived certainty about evacuation logistics had positive effects on households' evacuation decision while perceived certainty about location of impact had a negative effect on households' likelihood of evacuating. Overall, the findings can be used to improve on the prediction of households’ evacuation behavior.

Tsunami preparedness and resilience: Evacuation logistics and time estimations

Extensive research has studied the near-field tsunami threat in the Cascadia Subduction Zone (CSZ), but little research has examined the ability to evacuate the inundation zone before the first tsunami wave arrives. To address this gap, this study provides empirical evidence about people’s expectations about hazard onset and evacuation logistics when a tsunami threatens. We surveyed households in five CSZ communities to assess residents’ expected first wave arrival time, as well as their expectations about evacuation destinations, route choices, preparation times, travel times, and clearance times. Heatmaps are used to summarize residents’ evacuation destinations and route choices, and probabilistic functions are used to model evacuation distances and time estimates. The results suggest that respondents have similar patterns of time estimates, but a few plan to evacuate within the inundation zone, and some plan to evacuate on routes that were congested in a previous event and end their evacuations at destinations within the inundation zone.

Perceived Gratification, Difficulties and Suggestion among the Registered Farmers of Integrated Technology Enabled Agri Management System (iTEAMS), Meghalaya, India

The 1917 iTEAMS (Integrated Technology Enabled Agri Management System) is an initiative by the government of Meghalaya employing ICT to fulfil its objectives of providing organised evacuation logistics, access to markets and agro-advisories to the farmers upon registering with them. According to the recent data, a total of 84,246 farmers are registered with iTEAMS so far. The present study was conducted to understand the perceived gratification, difficulties and suggestions among the registered farmers of iTEAMS. Empirical data were collected from 120 registered farmers from Ri bhoi district of Meghalaya, India. Findings of the study reveal the majority of farmers were satisfied with the timing of the services offered by iTEAMS, followed by the services provided by the centre to them during the Covid-19 lockdown, in the sale of their produce. The farmers' biggest challenge, according to the findings, was a lack of understanding of how the centre worked. Farmers also expressed a lack of interest in availing of the services. It was observed that the farmers were not completely aware of iTEAMS and there was a lack of interest among the farmers to avail the services. There is a need to spread awareness not just about ICT among the farmers but also about the very many benefits that can be drawn from employing it.

Towards modelling of evacuation behavior and planning for emergency logistics due to the Philippine Taal Volcanic eruption in 2020

Emergency evacuation is the immediate escape of people away from a place of an imminent threat to a place of safety. The ability of the households to evacuate is a crucial component in reducing disaster risks. Logistical issues such as a lack of resources during and after the evacuation, as well as road congestion, might arise, especially in short and no-notice calamities such as a volcanic eruption. This study examines the relationship of variables of evacuation logistics of Barangay Banga, Talisay, Batangas, in the context of the 2020 Taal Volcanic eruption. A survey was conducted based on the evacuation experience of the households at the onset of the eruption. First, a descriptive statistical analysis was performed for all the variables on household evacuation logistics to understand the evacuation behavior of households. These variables include the type of evacuation, departure timing, evacuation mode, and destination type choice. Additionally, a pairwise correlaton analysis was employed to identify the influential factors related to household evacuation logistics such as socio-demographic and household characteristics, their experience with Taal Volcano’s recurring activities and relationship with other evacuation-related decisions. The results of this study aim to provide insights into a better understanding of the evacuation behavior of households in the context of a volcanic eruption and be useful in the evacuation logistics planning of the country.

Maternal stress and social support during Hurricane Florence

In theoretical research on disaster vulnerability, access to resources is critical for optimal outcomes. Studying the impact of a hurricane on maternal stress can expand theories of disaster vulnerability. This is a cross-sectional mixed-methods prospective study of maternal stress during Hurricane Florence in the United States. Results from chi-squares compared the proportion of respondents who reported having support for a financial emergency were significant, specifically that higher income respondents indicated the ability to rely on someone in case of an emergency. A regression analysis indicated that social support was significant and negatively related to stress as a dependent variable, while evacuation status and pregnancy status were not significant predictors of stress. Five themes emerged from the overall qualitative data: concerns about infant feeding, evacuation logistics, general stress, family roles, and ‘other’ issues.

Cascadia Subduction Zone Residents’ Tsunami Evacuation Expectations

The U.S. Pacific Northwest coast must be prepared to evacuate immediately after a Cascadia Subduction Zone earthquake. This requires coastal residents to understand the tsunami threat, have accurate expectations about warning sources, engage in preimpact evacuation preparedness actions, and plan (and practice) their evacuation logistics, including an appropriate transportation mode, evacuation route, and destination. A survey of 221 residents in three communities identified areas in which many coastal residents have reached adequate levels of preparedness. Moreover, residents who are not adequately prepared are willing to improve their performance in most of the areas in which they fall short. However, many respondents expect to engage in time-consuming evacuation preparations before evacuating. Additionally, their estimates of evacuation travel time might be inaccurate because only 28–52% had practiced their evacuation routes. These results indicate that more coastal residents should prepare grab-and-go kits to speed their departure, as well as practice evacuation preparation and evacuation travel to test the accuracy of these evacuation time estimates. Overall, these results, together with recommendations for overcoming them, can guide CSZ emergency managers in methods of improving hazard awareness and education programs. In addition, these data can guide transportation engineers’ evacuation analyses and evacuation plans.

Influence of social networks and opportunities for social support on evacuation destination decision-making

While evacuation decision-making has been extensively studied over the past decades, few studies examine the basis for these decisions: the locations of family and friends who can provide evacuees with social support at evacuation destinations. To address this gap, we conduct a multivariate regression analysis of social–spatial network data gathered from survey respondents in three U.S. areas to understand the relationship between evacuees’ social networks, opportunities for social support, and planned evacuation destinations. Our findings show that the locations of evacuees’ family and friends influence where they plan to go during an evacuation. Evacuees with closer family and friends plan to travel shorter distances than evacuees whose family and friends live farther away. Furthermore, we observe that unsupported evacuees–citizens traveling to destinations outside their social network–plan to travel twice as far as supported evacuees–citizens traveling to destinations where family and friends can offer instrumental, informational, or emotional assistance. These findings suggest new opportunities to predict and model evacuation logistics decisions based on the geographic distribution of evacuees’ social networks and the opportunities for social support they provide.

Changing Logistics of Evacuation Transportation in Hazardous Settings during COVID-19

The logistics of public-sponsored evacuation include transportation assets, personnel, and infrastructure. Effective orchestration leading up to a severe weather event is a complex undertaking requiring capacity that is matched to needs. However, under the compound hurricane-pandemic scenario, the demands for evacuation assistance and the capacity to meet demands change. Pre-event planning must be adjusted and transit modified to reduce risks posed to evacuees and essential workers. This study explores how visualizations of redistributed vulnerability and transportation resources influence planning. The research identifies how transportation, emergency management, and public health officials are adapting hurricane evacuation resources during the COVID-19 pandemic using original data from compound hazard workshops and participatory stakeholder focus groups. Findings show that by the peak of hurricane season, local evacuation recommendations were favored by officials, contracts were in place for noncongregate options, and public resources were adjusted to account for those requiring congregate sheltering. A need remained for coordinating interjurisdictional information about real-time weather, resources, staffing, and traffic as well as local knowledge of roadway flooding with ongoing hazard planning.

An application of media and network multiplexity theory to the structure and perceptions of information environments in hurricane evacuation

AbstractUnderstanding how information use contributes to uncertainties surrounding evacuation decisions is crucial during disasters. While literature increasingly establishes that people consult multiple information sources in disaster situations, little is known about the patterns in which multiple media and personal network sources are combined simultaneously and sequentially across decision‐making phases. We address this gap using survey data collected from households in Jacksonville, Florida affected by 2016's Hurricane Matthew. Results direct attention to perceived consistency of information as a key predictor of uncertainty regarding hurricane impact and evacuation logistics. Frequently utilizing National Weather Service, national and local TV channels, and personal network contacts contributed to higher perceived consistency of information, while the use of other local and online sources was associated with lower perceived consistency. Furthermore, combining a larger number of media and official sources predicted higher levels of perceived information consistency. One's perception of information amount did not significantly explain uncertainty. This study contributes to the theorizing of individuals' information environment from the perspective of media and network multiplexity and provides practical implications regarding the need of information coordination for improved evacuation decision‐making.

Self-assessment of tsunami evacuation logistics: Importance of time and earthquake experience

The available literature on tsunami evacuation has neglected to investigate the differences between day and night evacuation logistics, as well as the changes that apply to night-time evacuation before and after an actual earthquake. The current study collected three sets of data on tsunami evacuation logistics: the 2013 day-time data, the 2013 night-time data, and the 2014 night-time data. Using the 2013 night-time data as reference variables, comparative results showed that longer mobilization time and longer clearance time were required at night than during the day. People tended to spend less time on evacuation preparation after an earthquake experience. In the daytime evacuation scenario, a longer mobilization time was required for older people and those whose dwellings were constructed according to the 1981 Building Standards Act. In the night-time evacuation scenario, the need for vehicle evacuation was enhanced by an earthquake experience.

OPERATIONS THROUGHPUT AS A DETERMINANT OF GOLDEN-HOUR IN MASS-GATHERING MEDICINE

BACKGROUNDGolden-hour, a time-tested concept for trauma-care, involves a systems approach encompassing healthcare, logistics, geographical, environmental and temporal variables. Golden-hour paradigm in mass-gathering-medicine such as the Hajj-pilgrimage entwines along healthcare availability, accessibility, efficiency and interoperability; expanding from the patient-centric to public-health centric approach. The realm of mass-gathering-medicine invokes an opportunity for incorporating operations-throughput as a determinant of golden-hour for overall capacity-building and interoperability.METHODSGolden-hour was evaluated during the Indian-Medical-Mission operations for Hajj-2016; which established, operated and coordinated a strategic network of round-the-clock medical operations. Throughput was evaluated as deliverables/time, against established Standard-Operating-Procedures for various clinical, investigation, drug-dispensing and patient-transfer algorithms. Patient encounter-time, waiting-time, turnaround-time were assessed throughout echeloned healthcare under a patient-centric healthcare-delivery model. Dynamic evaluation was carried out to cater for variation and heterogeneity.RESULTSMassive surge of 3,94,013 patients comprising 2,25,103 males (57.1%) and 1,68,910 females (42.9%) overwhelmed the throughput capacities of outpatient attendance, pharmacy, laboratory, imaging, ambulance, referrals and documentation. There was delay in attendance, suspicion, diagnosis and isolation of patients with communicable infections. The situational-analysis of operations-throughput highlights wasted turnaround-time due to mobilization of medical-team, diverting critical healthcare resources away from emergency situations.CONCLUSIONTime being a crucial factor in the complexity of medical-care, operations-throughput remains an important determinant towards interoperability of bottlenecks, thereby being a determinant of golden-hour in mass-gathering-medicine. Early transportation of patient to definitive-care reduces treatment initiation-time, notwithstanding logistics of communication, evacuation, terrain and weather being deterministic in outcome. Golden-hour needs to be emphasized under a population-based approach targeting the clientele towards administering first-aid and reaching out to hospital within the golden-hour.

A New Proposal for Management of Severe Frostbite in the Austere Environment

Despite advances in outdoor clothing and medical management of frostbite, individuals still experience catastrophic amputations. This is a particular risk for those in austere environments, due to resource limitations and delayed definitive treatment. The emerging best therapies for severe frostbite are thrombolytics and iloprost. However, they must be started within 24 hours after rewarming for recombinant tissue plasminogen activator (rt-PA) and within 48 hours for iloprost. Evacuation of individuals experiencing frostbite from remote environments within 24 to 48 hours is often impossible. To date, use of these agents has been confined to hospitals, thus depriving most individuals in the austere environment of the best treatment. We propose that thrombolytics and iloprost be considered for field treatment to maximize chances for recovery and reduce amputations. Given the small but potentially serious risk of complications, rt-PA should only be used for grade 4 frostbite where amputation is inevitable, and within 24 hours of rewarming. Prostacyclin has less risk and can be used for grades 2 to 4 frostbite within 48 hours of rewarming. Until more field experience is reported with these agents, their use should probably be restricted to experienced physicians. Other modalities, such as local nerve blocks and improving oxygenation at high altitude may also be considered. We submit that it remains possible to improve frostbite outcomes despite delayed evacuation using resource-limited treatment strategies. We present 2 cases of frostbite treated with rt-PA at K2 basecamp to illustrate feasibility and important considerations.

Understanding Hurricane Evacuation Planning in the Northeastern and Mid-Atlantic United States

AbstractThis study investigates planned evacuation logistics, including primary destination and means of transportation, in the Northeastern and Mid-Atlantic United States. Using responses to an Internet-based survey from a random sample of over 1,000 individuals, the authors estimate a number of probit and multinomial probit models to identify factors associated with the likelihood of having a hurricane evacuation plan, potential usage of public transportation to evacuate, and the primary evacuation destination. Survey results indicate that less than 36% of the respondents have an evacuation plan. Findings also indicate that most respondents would evacuate in their own vehicle to the home of a friend or a relative. About 19% would evacuate to a hotel, and less than 11% would go to a public shelter. Less than 5% of the respondents would use public transportation to evacuate. Evacuation planning is found to be associated with prior evacuation experiences, economic conditions, location, and household compos...

Analysis of hurricane evacuee mode choice behavior

The purpose of this study is to explain the evacuee mode choice behavior of Miami Beach residents using survey data from a hypothetical category four hurricane to reveal different evacuees’ plans. Evacuation logistics should incorporate the needs of transit users and car-less populations with special attention and proper treatment. A nested logit model has been developed to explain the mode choice decisions for evacuees’ from Miami Beach who use non-household transportation modes, such as special evacuation bus, taxi, regular bus, riding with someone from another household and another type of mode denoted and aggregated as other. Specifically, the model explains that the mode choice decisions of evacuees’, who are likely to use different non-household transportation modes, are influenced by several determining factors related to evacuees’ socio-demographics, household characteristics, evacuation destination and previous experience. The findings of this study will help emergency planners and policy-makers to develop better evacuation plans and strategies for evacuees depending on others for their evacuation transportation.

Design of a Traumatic Injury Simulator for Assessing Lower Limb Response to High Loading Rates

Current military conflicts are characterized by the use of the improvised explosive device. Improvements in personal protection, medical care, and evacuation logistics have resulted in increasing numbers of casualties surviving with complex musculoskeletal injuries, often leading to life-long disability. Thus, there exists an urgent requirement to investigate the mechanism of extremity injury caused by these devices in order to develop mitigation strategies. In addition, the wounds of war are no longer restricted to the battlefield; similar injuries can be witnessed in civilian centers following a terrorist attack. Key to understanding such mechanisms of injury is the ability to deconstruct the complexities of an explosive event into a controlled, laboratory-based environment. In this article, a traumatic injury simulator, designed to recreate in the laboratory the impulse that is transferred to the lower extremity from an anti-vehicle explosion, is presented and characterized experimentally and numerically. Tests with instrumented cadaveric limbs were then conducted to assess the simulator's ability to interact with the human in two mounting conditions, simulating typical seated and standing vehicle passengers. This experimental device will now allow us to (a) gain comprehensive understanding of the load-transfer mechanisms through the lower limb, (b) characterize the dissipating capacity of mitigation technologies, and (c) assess the bio-fidelity of surrogates.

Role of Transit in Carless Evacuation Planning

During evacuations, the needs of transit-depended and carless populations require special attention and add to the complexity of evacuation logistics. The objective of this paper is to examine the role of transit in the evacuation of carless populations as part of a comprehensive evacuation plan. For this purpose, a case study is presented describing the development of a large-scale simulation/optimization model for the Birmingham, Alabama region that considers evacuation of carless populations with transit in the event of flooding. Flooding evacuation studies can be useful in evaluating various alternatives to evacuate people, identifying alternative routes based on historical experience of flooded areas and supporting optimal assignment of rescue personnel and optimization of their routes. The paper first provides a synthesis of the state of practice in carless evacuation using transit. Then the study methodology is presented, and details are offered on model selection, development, and testing; study site characteristics; study scenarios modeled; and related assumptions. Study scenarios consider vehicle evacuation with and without evacuation of carless populations from the affected area to nearby shelters using transit assets. Consideration is given to the fact that some network links would not be accessible because of the flooding, and thus lane closures are modeled in the study scenarios to increase the realism of the model. The paper demonstrates the opportunities and requirements related to the use of transit for local emergency evacuations while best serving the needs and interests of carless populations and the public at large.