Hospital Evacuations: Historical Precedence and Modern Preparedness

Objectives: The purpose of this research was to identify common problems encountered during hospital evacuations and how those problems are or should be addressed when creating a hospital evacuation plan. Methods: Articles relating to hospital evacuations were retrieved from PubMed and CINAHL in addition to government websites and the Joint Commission on Accreditation of Healthcare Organizations. The articles collected were limited to within the last 20 years, from 1990 to 2010. Hospital plans were collected from search engines including Google and Yahoo. Moreover, a plan was obtained from a Dayton area hospital. Results: Numerous instances of hospital evacuations that were attributed earthquakes, hurricanes, tornadoes and fires have been documented. Frequently cited problems in these evacuations were related to communication, transportation and staffing problems. The hospital evacuation plans that were reviewed included the San Joaquin County Hospital Evacuation Plan, New York Center for Terrorism Planning and Preparedness, Washington Hospital Center Emergency Evacuation Plan and a Dayton, Ohio Hospital Emergency Evacuation Plan. Discussion: Plans need to be able to incorporate communication needs including emergency radios and cellular telephones with backup power sources. Updated call-lists are also crucial components to the successful execution of a hospital evacuation by helping to alleviate potential staffing shortages during en event. Transportation needs, including mutual aid agreements, need to be frequently reviewed and innovative measures must be taken to ensure success. Conclusion: Hospitals today are not prepared to adequately handle an evacuation. Comprehensive plans that incorporate the lessons learned from previous evacuations are crucial components for community resiliency. Hospital Evacuations: Historical Precedence and Modern Preparedness Squillace 6 | P a g e Introduction In the 21 century, the potential hazards that hospitals face are ever-increasing. Hospitals must be prepared to respond to a growing number of threats in order to ensure patient safety and community resiliency. Potential problems facing health care facilities are natural disasters such as tornadoes, floods, hurricanes and earthquakes; man-made disasters such as bombings and chemical spills; and internal disasters such as severe power failures and fires (Sternberg, Lee and Huard, 2004). Hospitals need to have plans in place that address all potential hazards not only to ensure continued operations and patient safety, but to meet the accreditation requirements set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Furthermore, the staff of the hospital, in addition to the local emergency personnel, should be well-versed with these plans in order to ensure, should they need to be executed, that they can be performed without confusion or inappropriate improvisation. Methods Articles related to evacuations were retrieved from the journal database, PubMed and CINAHL. Additionally, the Joint Commission on Accreditation of Healthcare Organizations’ and the federal government’s National Incident Management System/Federal Emergency Management Agency websites were searched for reports related to hospital evacuation. The clinical sciences librarian at Wright State University assisted with the search through the databases. Articles relating to clinical practice were among the articles relating to evacuations and accordingly, these articles were excluded from the project. The keywords used in the searches included combinations of the following: hospital evacuation; ICU evacuation; evacuation, hurricane, tornado, fire, wildfire, flood, bomb, terrorist, chemical, Katrina, Loma Prieta, Northridge, Hospital Evacuations: Historical Precedence and Modern Preparedness Squillace 7 | P a g e earthquake, ice, power failure, power outage; evacuation drill; evacuation exercise; horizontal evacuation; vertical evacuation. Incidents were limited to those that have taken place in North America. This was due to the fact that other areas of the world may have different infrastructures in terms of the hospital’s operation, government obligations and geography and therefore, incidents that have occurred outside of North America were excluded to add strength to the reviews and suggestions. Furthermore, evacuation recommendations were retrieved from the Joint Commission on Accreditation of Healthcare Organizations. Google searches were done in order to retrieve documents relating to hospital protocols and procedures using the keywords: hospital emergency management, hospital evacuation plan, hospital emergency plan and hospital evacuation procedures. Additionally, through contacts in a Dayton, Ohio area hospital, a hospital evacuation plan was analyzed and compared against the actual evacuations and the evacuation plans that were available online. Articles used in the review process were limited to events that had taken place no longer than 20 years ago, 1990 to 2010. This limitation on the time period was set due to the evolving standards that regulate hospitals in addition to the workforce structure that has changed. Events that date beyond 20 years will have faced substantially different challenges that may not be relevant to events that occur today.