Hospital Evacuation Research Articles

The evacuation of two rural hospitals following a tsunami warning: What happened next

This paper describes the lessons gained and actions taken following the evacuation of two small rural hospitals following a tsunami warning. These evacuations were unique in that the normal protocol to transfer within the health system was not feasible due to their geographical isolation. The after action review process provided valuable insight to all stakeholders, who entered into discussions to ensure procedures, supplies, equipment and arrangements would be put in place to support the safe and effective evacuation of patients in the event of a future emergency. A key component of this process was the after action report, which captured key lessons learned and actionable items pertaining to five areas: evacuation locations, equipment and supplies, hospital unit/department evacuation plans, site evacuation plans, and exercising and validating plans. Following this format, each lesson is broken down into steps taken to achieve these goals, outlining best practices and lived experiences or highlighting gaps where further research is required and step-by-step guidance that can be adapted by emergency managers within the field of healthcare. Through this, pertinent strategies and considerations involved in the planning and execution in the evacuation of rural hospitals are also offered.

Issues of Which Organization is Responsible for Hospital Evacuation in Nuclear Disasters

Introduction:At the time of a nuclear disaster, residents should evacuate from areas with high air dose rate. In the Great East Japan Earthquake, about 10% of patients died in a hospital evacuation in which medical teams were not involved in transportation.Aim:To determine if hospital evacuation improved after the Fukushima nuclear accident.Methods:This research investigates how the medical system of a nuclear disaster in Japan changed.Results:There are 41 hospitals designated as Nuclear Emergency Core Hospitals, and they have 53 Nuclear Emergency Medical Assistance Teams (NEMAT; disaster medical dispatching team specialized in nuclear disasters consisting of medical doctors, nurses, and radiological technologists) that can support hospitals and information in the acute phase.Discussion:At the time of a nuclear disaster, NEMAT is supposed to evacuate residents from the Urgent Protective Action Planning Zone (UPZ; within about 30 km radius). Tens of thousands to one million people live in this area. Hospital evacuation of more than several thousand patients is necessary. The entry of workers for transportation vehicles and lifeline restoration is limited within UPZ, so staying in a hospital is virtually impossible. There are over 2000 Disaster Medical Assistance Teams (DMAT), and many Red Cross Relief Teams; both of which are stipulated not to conduct clinical treatment in high dose areas and are not educated on nuclear disasters. Although there are Radiation Emergency Medical Assistance Teams (REMAT) consisting of doctors and technicians specializing in radiation medicine, they are few in number. They can perform dose assessment, but general medical care cannot be performed because an emergency physician is not included. Therefore, although NEMATs will conduct emergency and hospital evacuation in the affected area, the number of teams is too small to respond. The issue of which organization is responsible for massive hospital evacuation remains unsolved.

Reviewing Disasters: Hospital Evacuations in the United States from 2000 to 2017

Introduction:Between 2000 to 2017, there were over 150 hospital evacuations in the United States. Data received from approximately 35 states were primarily concentrated in California, Florida, and Texas. This analysis will provide disaster planners and administrators statistics on hazards that cause disruptions to hospital facilities.Aim:The aim of this study is to investigate US hospital evacuations by compiling the data into external, internal, and man-made disasters thus creating a risk assessment for disaster planning.Methods:Hospital reports were retrieved from LexisNexis, Google, and PubMed databases and categorized according to evacuees, duration, location, and type. These incidents were grouped into three classifications: external, internal, and man-made. Both partial and full evacuations were included in the study design.Results:There were a total of 154 reported evacuations in the United States. 110 (71%) were due to external threats, followed by 24 (16%) man-made threats, and 20 (13%) internal threats. Assessing the external causes, 60 (55%) were attributed to hurricanes, 21 (19%) to wildfires, and 8 (7%) to storms. From the internal threats, 8 (40%) were attributed to hospital fires and 4 (20%) chemical fumes. From the man-made threats, 6 (40%) were attributed to bomb threats and 4 (27%) gunmen. From the 20 total reported durations of evacuations, 9 (45%) lasted between 2 to 11:59 hours, 6 (30%) lasted over 24 hours, and 5 (25%) lasted up to 1:59 hours.Discussion:Over 70% of hospital evacuations in the US were due to natural disasters. Compared to 1971-1999, there was an increase in internal and man-made threats. Exact statistics on evacuees, durations, injuries, and mortality rates were unascertainable due to a lack of reporting. It is critical to implement a national registry to report specifics on incidences of evacuations to further assist with disaster and infrastructure planning.

One Hospital’s Timeline for In-Hospital Vertical Evacuation during a Flood Disaster

Introduction:Recently, the risk of flood disasters due to concentrated heavy rains has been increasing in Japan. While some cases of hospital evacuation have been reported, standards for hospital evacuation have not been established and regional administrative evacuation plans do not include medical facilities.Aim:To clarify the timeline for in-hospital vertical evacuation during a flood disaster.Methods:A timeline was set for vertical evacuation as criteria of the hospital’s emergency response based on the Arakawa River Downstream Timeline, which is an estimate of the time until river flooding based on the water level of the Arakawa River located near the facility. The timeline was calculated backward from 0 hours to when the river floods. A drill was held for verification.Results:The timeline was based on the water level of the Arakawa River and objective evidence of risky transfer of critical patients; therefore, the decision to evacuate was made when the water level reached a dangerous level (-3 hours). However, this did not provide enough time to evacuate patients in all hospital departments simultaneously, resulting in a shortage of human resources. There was a planned shutdown of the electronic clinical record system at 0 hours to avoid water damage and evacuation of its server, but three hours were not enough to prepare patient clinical summaries.Discussion:There is a need for greater and earlier preparation for evacuation to reduce or discharge patients who can leave the hospital when a flood disaster is predicted. Only in-hospital vertical evacuation was considered because it is very risky to transfer critical patients without an evacuation order from government or municipal officials. In fact, over 10,000 patients would need to be evacuated in the region if the Arakawa River floods. Therefore, a regional plan is indispensable for such large scale and simultaneous hospital evacuations.

Revised Hospital-MIMMS Course for Japan

Introduction:HMIMMS (Major Incident Medical Management and Support: The Practical Approach in the Hospital) has been introduced by ALSG (Advanced Life Support Group, Manchester, UK) and developed for many countries for preparing to accept huge numbers of casualties at a hospital during major incidents. The original HMIMMS course has been held in Japan since 2007, produced over 1,200 providers. Japan has a crucial history of natural disasters, earthquakes, tsunamis, and typhoons often resulting in extensive damages to infrastructure and communications.Aim:The MIMMS-JAPAN and the Japanese Association for Disaster Medicine have joined to plan to revise the original HMIMMS course from the point of view of the difference of the type of disaster.Method:By the permission of ALSG, two subjects were added “Hospital Evacuation” and “Business Continuity Plan” as lectures, workshops, and tabletops to the original HMIMMS course. Before attending the course, students were required to watch e-learning for deeper understanding and time-saving. Total program was organized into two days.Results:Main points of modification are to: 1.Replace a system peculiar to the UK with a Japanese system.2.Add unique contents of a Japanese disaster.3.Add the important subjects especially in Japan.4.Modify the presentation slides to understand easily for Japanese students. But the fundamental concept that hospital functions upon ‘CSCATTT’ is strictly preserved.Discussion:Newly revised HMIMMS course will start in 2019 for Japanese learners. Many reflections must be accumulated and further revisions will continue.

Medical Activity Training using SDF Ship at Wide Area Disaster

Introduction:We have repeatedly trained to use the SDF ship as a temporary medical facility during acute disasters. The Maritime Self Defense Force has various types of ships: supply ship (Oumei type), transport ship (Osumi type), and escort ship (hinge type, whip type) which has a large hangar and a treatable medical compartment.Methods:The points of training are collaboration between the SDF and the commander’s line of medical personnel, construction of a method of contact with the outside, construction of contact method inside the ship, kind of patient, medical contents, use of medical zone, method of transporting to the ship, method of transporting to the outside of the ship, positioning of the ship in the afflicted area, etc.Results:Assuming the Nankai Trough Earthquake, the activities of SDF vessels in coastal areas are affected by the extent to which the functions of medical institutions in inland areas are kept, how transportation methods can be secured, and how many injured people there are.Discussion:As a result of the examination thus far, the range of activities of SDF vessels is limited. The function of the ship is considered to be offshore SCU, hospital evacuation support, etc. Tight collaboration and training with the SDF are necessary in the future.

Practitioner Application: Supporting Staff Through a Complete Hospital Evacuation and Extended Displacement Period.

Journal of Healthcare Management: May-June 2018 - Volume 63 - Issue 3 - p 210-211 doi: 10.1097/JHM-D-18-00032

Supporting Staff Through a Complete Hospital Evacuation and Extended Displacement Period.

Complete hospital evacuations due to natural or man-made disasters can have repercussions on all levels of hospital operations. An extended displacement period following an evacuation exacerbates the situation. Retaining a healthy, employed workforce following a disaster is a crucial step in ensuring that a facility is effectively staffed when it returns to normal operations. In this article, the authors address the issue of staff support during evacuation and extended displacement by examining the actions taken by the leadership of the VA New York Harbor Health Care System, a Veterans Health Administration facility, in response to the evacuation and displacement caused by Superstorm Sandy in 2012. As staff began to realize that the displacement would be extensive, frustration, complaints, and a sense of disenfranchisement emerged. The authors' findings suggest that the most valuable tool to allay staffs' fears were monthly forums, whereby staff had the opportunity to meet face-to-face with leadership and ask questions. An important consideration when staff are displaced is the role that cultural differences between host and displaced facility staff plays, even when those facilities are part of the same system. Significant attention must be given to cultural differences, in both acknowledging and resolving them. The study suggests that direct communication with leadership, support from upper and middle management, and an understanding that sharing best practices across facilities strengthens the entire team are key approaches to addressing these challenges.

Long-term outcomes of patients evacuated from hospitals near the Fukushima Daiichi nuclear power plant after the Great East Japan Earthquake

IntroductionAfter the accident of the Fukushima Daiichi nuclear power plant due to the Great East Japan Earthquake in March 2011, the Japanese government issued a mandatory evacuation order for people living within a 20 km radius of the nuclear power plant. The aim of the current study was to investigate long-term outcomes of these patients and identify factors related to mortality.Materials and methodsPatients who were evacuated from hospitals near the Fukushima Daiichi nuclear power plant to the Aizu Chuo Hospital from 15 to 26 March, 2011 were included in this study. The following data were collected from medical records: age, sex, activities of daily life, hospital they were admitted in at the time of earthquake, distance between the facility and the nuclear power plant, reasons of evacuation and number of transfers. The patient outcomes were collected from medical records and/or investigated on the telephone in January 2012.ResultsA total of 97 patients (28 men and 69 women) were transferred from 10 hospitals via ambulances or buses. No patients died or experienced exacerbation during transfer. Median age of the patients was 86 years. Of the total, 36 patients were not able to obey commands, 44 were bed-ridden and 61 were unable to sustain themselves via oral intake of food. Among 86 patients who were followed-up, 41 (48%) died at the end of 2011. Multiple-regression analysis showed that non-oral intake [Hazard Ratio (HR): 6.07, 95% Confidence interval (CI): 1.94–19.0] and male sex [HR: 8.35, 95% CI: 2.14–32.5] had significant impact on mortality.ConclusionThis study found that 48% of the evacuated patients died 9 months after the earthquake and they had significantly higher mortality rate than the nursing home residents. Non-oral intake and male sex had significant impact on mortality. These patients should be considered as especially vulnerable in case of hospital evacuation.

Triage by Resource Allocation for INpatients: A Novel Disaster Triage Tool for Hospitalized Pediatric Patients.

To develop a disaster triage tool for the evacuation of hospitalized neonatal and pediatric populations. We expanded an existing neonatal disaster triage tool for the evacuation of a children's hospital. We assessed inpatients using bedside visual assessments and chart review to categorize patients transport level based on local emergency medical services protocols and expert opinion. The tool was refined by using multiple Plan Do Study Act cycles. Primary outcome was the number of each level of transport required for hospital evacuation. Secondary outcome was improved efficiency of obtaining information about specific transport needs for evacuation. We evaluated 1382 patients both visually and through electronic chart review over 10 random days. Accordance between visual assessment and electronic chart review reached 96.3%. During a 2 hour statewide disaster drill, no hospital units completed self-assessed transport needs for their patients; a single nurse used Triage by Resource Allocation in INpatients to determine transportation needs in less than 1 hour. (Disaster Med Public Health Preparedness. 2018;12:692-696).

The Effectiveness of Vertical Transportation (Emergency Stairs and Ramp) as a Means of Egress for Safety of the Intensive Care Unit Patients in the Emergency Condition

Construction of multi-storey building is an alternative answer to the limitations of the existing land. It is including the health facilities building of RSUD Dr. Saiful Anwar Malang. This has given a matter of emergency response due to the emergencies condition. Hospital evacuation is relatively difficult and slow, since the building is dominated by patients with health problems, and loss of consciousness that need help from the health officer, due to evacuation in an emergency condition.

The Fort McMurray, Alberta wildfires: Emergency and recovery management of healthcare services

One of the largest wildfires in Canadian history raged through northern Alberta in May to July 2016, and prompted the largest emergency air evacuation in Canadian history. Central to the challenges were the evacuation of a regional hospital, and the emergency and recovery management associated with healthcare services. This paper describes multiple phases of emergency and recovery management, which employed and adapted the Incident Command System to healthcare services. There were no injuries reported throughout the medical evacuation and recovery of medical services. The leadership and management of healthcare services achieved the goals of evacuating patients and staff effectively, supporting emergency first responders and the re-entry of the population to Fort McMurray.

Decision-making on Hospital Emergency Evacuation in Disasters and Emergencies: Findings From a Systematic Review

Context: Disasters are increasing worldwide, with more devastating effects than ever before. Hospitals must maintain their normal functions or have an evacuation plan due to the rate of damages at the time of a sudden disaster. The present study was conducted to determine the effective determinants and components in hospital evacuation decision- making. Evidence Acquisition: In this systematic review study, which was conducted in 2016, bibliographies, citation databases, and other available records such as international guidelines, documents and reports of organizations and academic dissertations were used to find an answer to the following question: What are the effective components in hospital evacuation decision- making? Finally, 34 articles were included in this systematic review. This systematic review article was checked with PRISMA checklist. Results: The common factors affecting hospital emergency evacuation decision-making were classified into 4 general categories and 40 subcategories, which have been explored during thematic analysis. These 4 categories included hospital infrastructure consequences, threat, internal factors, and external factors. Level of risk was the most important component of threat category and it was mentioned in most of the reviewed literature. Loss of electricity and water, communication and transportation, resources such as staff, and removing patient devices were the most mentioned factors in hospital infrastructure consequences, external factors, and internal factors, respectively. Conclusions: Different variables affect the process of hospital emergency evacuation decision-making. Thus, further studies are needed to develop a decision-making tool for hospital emergency evacuations in Iran.

Challenges and Resources for Nurses Participating in a Hurricane Sandy Hospital Evacuation.

Weather-related disasters have increased dramatically in recent years. In 2012, severe flooding as a result of Hurricane Sandy necessitated the mid-storm patient evacuation of New York University Langone Medical Center. The purpose of this study was to explore, from the nurses' perspective, what the challenges and resources were to carrying out their responsibilities, and what the implications are for nursing education and preparation for disaster. This mixed-methods study included qualitative interviews with a purposive sample of nurses and an online survey of nurses who participated in the evacuation. The interviews explored prior disaster experience and training, communication, personal experience during the evacuation, and lessons learned. The cross-sectional survey assessed social demographic factors, nursing education and experience, as well as potential challenges and resources in carrying out their disaster roles. Qualitative interviews provided important contextual information about the specific challenges nurses experienced and their ability to respond effectively. Survey data identified important resources that helped nurses to carry out their roles, including support from coworkers, providing support to others, personal resourcefulness, and leadership. Nurses experienced considerable challenges in responding to this disaster due to limited prior disaster experience, training, and education, but drew on their personal resourcefulness, support from colleagues, and leadership to adapt to those challenges. Disaster preparedness education in schools of nursing and practice settings should include more hands-on disaster preparation exercises, more "low-tech" options to address power loss, and specific policies on nurses' disaster roles. Nurses play a critical role in responding to disasters. Learning from their disaster experience can inform approaches to nursing education and preparation.

Superstorm Sandy: Emergency management staff perceptions of impact and recommendations for future preparedness, New York State.

This study collected and summarized feedback from staff at the New York State (NYS) Office of Emergency Management (OEM) and three county OEMs within NYS to understand lessons learned from the 2012 Superstorm Sandy. Cross-sectional qualitative and quantitative analysis. One staff person from each identified critical role from the state and county OEMs who were still employed in the roles identified. In-person interviews in 2014 followed by an anonymous survey in 2015 examined the response strengths, challenges, and recommendations using federally and study-defined Public Health Preparedness Capabilities. Quantitative analysis of staff survey ratings was used to summarize perceptions of interagency collaboration, communication effectiveness, and differences by staff position. Response rates were 78 percent for interviews (n = 7) and 45 percent for surveys (n = 36). In interviews, "emergency operations coordination" was cited most frequently (48 percent), specifically for successful interagency coordination. "Emergency operations coordination" was also cited most among challenges (45 percent), with emphasis on problems with uniformity of software systems across agencies. Survey responses indicated that "volunteer management" (50 percent) and the "safety and health of responders" (40 percent) were frequently reported as challenges. Additionally, 38 percent of OEM staff reported that situation reports submitted by health departments need improvement. Recommendations from OEM staff included "emergency operations coordination" (36 percent) such as sharing of resources and "training" (16 percent) including hospital evacuation training. Analysis of OEM staff feedback identified specific challenges, and concrete recommendations were made to improve response going forward.

Evacuation of Hospitals during Disaster, Establishment of a Field Hospital, and Communication.

The buildings, working personnel, and patients and their relatives may directly or indirectly be affected by the disasters. Here we will discuss evacuation, establishing a field hospital, communication, the role of the media in disasters, and defending against sabotage. The affected individuals should be evacuated and transferred to secure zones safely and rapidly. How the decision for evacuation should be made and how the evacuation triage should be performed are important issues. Field hospitals should be established within the bounds of possibility for continuation of the treatments of evacuated people. The standards for the field hospitals and its sections that may be created according to the needs will be explained. Undoubtedly, since one of the most important subjects in disasters is communication, the types of communication in disasters and their significance will be mentioned. How the relationships with the media should be an aspect of communication and how they can be beneficially used will also be mentioned. As in all organizations and institutions, sabotage attempts may also be present concerning health facilities. For this reason, during the preparation of the hospital disaster plan, defending against sabotage will be discussed, and what should be done at that stage will be mentioned.

Modeling to Optimize Hospital Evacuation Planning in EMS Systems

Objective: To develop optimal hospital evacuation plans within a large urban EMS system using a novel evacuation planning model and a realistic hospital evacuation scenario, and to illustrate the ways in which a decision support model may be useful in evacuation planning. Methods: An optimization model was used to produce detailed evacuation plans given the number and type of patients in the evacuating hospital, resource levels (teams to move patients, vehicles, and beds at other hospitals), and evacuation rules. Results: Optimal evacuation plans under various resource levels and rules were developed and high-level metrics were calculated, including evacuation duration and the utilization of resources. Using this model we were able to determine the limiting resources and demonstrate how strategically augmenting the resource levels can improve the performance of the evacuation plan. The model allowed the planner to test various evacuation conditions and resource levels to demonstrate the effect on performance of the evacuation plan. Conclusion: We present a hospital evacuation planning analysis for a hospital in a large urban EMS system using an optimization model. This model can be used by EMS administrators and medical directors to guide planning decisions and provide a better understanding of various resource allocation decisions and rules that govern a hospital evacuation.

Report of Hospital Evacuations in the 2016 Kumamoto Earthquake

Report of Hospital Evacuations in the 2016 Kumamoto Earthquake

Successful Hospital Evacuation After the Kumamoto Earthquakes, Japan, 2016.

Two major earthquakes struck Kumamoto Prefecture in Japan in April 2016. Disaster response was immediately provided, including disaster medical services. Many hospitals were damaged and patients needed immediate evacuation to alternative facilities. The hospital bed capacity of Kumamoto Prefecture was overwhelmed, and transportation of more than 100 patients was needed. Hospital evacuation was carried out smoothly with the coordinated efforts of multiple agencies. The overall operation was deemed a success because patients were transported in a timely manner without any significant adverse events. Upon repair of facilities in Kumamoto Prefecture, patients were returned safely to their previous facilities. The management of inpatients after this natural disaster in Kumamoto Prefecture can serve as a model for hospital evacuation with multi-agency coordination in the future. Future efforts are needed to improve interfacility communications immediately following a natural disaster. (Disaster Med Public Health Preparedness. 2017;11:517-521).

Benchmarking for Hospital Evacuation: A Standardized Data Collection Tool

Benchmarking for Hospital Evacuation: A Standardized Data Collection Tool