United States Government Accountability Office

GAO Testimony 

Before the Special Committee on Aging, 

U.S. Senate

DISASTER 

PREPAREDNESS 

Preliminary Observations 

on the Evacuation of 

Vulnerable Populations due 

to Hurricanes and Other 

Disasters 

Statement of Cynthia Bascetta 

Director, Health Care 

For Release on Delivery

Expected at 10:00 a.m. EDT 

Thursday, May 18, 2006

 

GAO-06-790T 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

May 18, 2006

DISASTER PREPAREDNESS 

Preliminary Observations on the 

Evacuation of Vulnerable Populations 

due to Hurricanes and Other Disasters 

Highlights of GAO-06-790T, a testimony 

before the Special Committee on Aging, 

U.S. Senate 

Hurricane Katrina struck near the 

Louisiana-Mississippi border and 

became one of the worst natural 

disasters in U.S. history, affecting a 

large geographic area and 

necessitating the evacuation of

people from parts of the area,

including vulnerable populations, 

such as hospital patients, nursing 

home residents and transportationdisadvantaged populations who

were not in such facilities. The 

disaster highlighted the challenges 

involved in evacuating vulnerable 

populations due to hurricanes. 

GAO was asked to discuss efforts 

to plan and prepare for the needs 

of seniors in the event of a national 

emergency. GAO describes its 

ongoing work on evacuation in the 

event of emergencies, such as 

hurricanes, and provides

preliminary observations on 

(1) challenges faced by hospital

and nursing home administrators 

that are related to hurricane

evacuations; (2) the federal 

program that supports the 

evacuation of patients needing

hospital care and nursing home 

residents; and (3) challenges states

and localities face in preparing for 

and carrying out the evacuation of

transportation-disadvantaged 

populations and efforts to address 

evacuation needs.

This testimony is based in part on a

prior GAO report, Disaster

Preparedness: Preliminary 

Observations on the Evacuation of

Hospitals and Nursing Homes 

Due to Hurricanes, GAO-06-443R

(February 16, 2006). 

Hospital and nursing home administrators face challenges related to 

evacuations caused by hurricanes, including deciding whether to evacuate 

and obtaining transportation. Although state and local governments can 

order evacuations, health care facilities can be exempt from these orders.

Facility administrators are generally responsible for deciding whether to 

evacuate, and if they decide not to evacuate, they face the challenge of 

ensuring that their facilities have sufficient resources to provide care until 

assistance arrives. If they evacuate, contractors providing transportation for 

hospitals and nursing homes could be unlikely to provide facilities with 

enough vehicles during a major disaster such as a hurricane because local 

demand for transportation would likely exceed supply. Nursing home 

administrators told us they face unique challenges during evacuations. For 

example, they must locate receiving facilities that can accommodate 

residents who may need a place to live for a long period of time. 

The National Disaster Medical System (NDMS), a partnership of four federal 

departments, is the primary federal program that supports the evacuation of 

patients in need of hospital care during disasters such as hurricanes, but the 

program was not designed nor is currently configured to move nursing home 

residents. NDMS supplements state and local emergency response 

capabilities with federal resources and services and helped evacuate about 

2,900 people during recent hurricanes, including Hurricane Katrina. Although 

NDMS supported evacuation efforts during Hurricane Katrina that included 

nursing home residents, according to program officials it is not designed to 

evacuate this population. Officials explained that the program does not have 

agreements with nursing homes that could receive evacuated nursing home 

residents. 

In preparing for and carrying out the evacuation of transportationdisadvantaged populations, such as the elderly or persons with disabilities, 

during a disaster, states and localities face challenges in identifying these 

populations, determining their needs, and providing for and coordinating 

their transportation. The elderly are likely to be represented among the 

transportation disadvantaged because they are more likely, compared with 

the general population, to have a disability, have a low income, or choose 

not to drive. GAO has observed mixed efforts at the state and local levels to 

address the evacuation needs of the transportation disadvantaged. Some 

emergency management officials told GAO they did not yet have a good 

understanding of the size, location, and composition of the transportation 

disadvantaged in their community. However, GAO also observed efforts in 

some locations to address the evacuation needs of the transportation 

disadvantaged by encouraging citizens to voluntarily register with their local 

emergency management agency, integrating social service providers into 

emergency planning, and other measures. GAO will continue to examine the 

extent to which the transportation disadvantaged are addressed in state and 

local evacuation efforts as part of its ongoing work. 

www.gao.gov/cgi-bin/getrpt?GAO-06-790T.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Cynthia 

Bascetta at (202) 512-7101 or 

bascettac@gao.gov. 
Mr. Chairman and Members of the Committee: 

Thank you for inviting me here to discuss our preliminary observations on

ongoing work on the evacuation of vulnerable populations due to 

hurricanes and other disasters, including patients in hospitals; residents in 

nursing homes; and transportation-disadvantaged populations, such as the 

elderly, persons with disabilities, and people who, by choice or 

circumstances, do not own or have access to a personal vehicle. 

On August 29, 2005, Hurricane Katrina struck near the LouisianaMississippi border and became one of the worst natural disasters in U.S. 

history. The hurricane affected a large geographic area and necessitated 

the evacuation of people from parts of the area. Among those needing to

be evacuated were hospital patients, nursing home residents, and 

transportation-disadvantaged populations who were not in such facilities. 

The disaster highlighted the challenges involved in evacuating these 

vulnerable populations. For example, administrators of hospitals and 

nursing homes must make decisions about the best way to care for their 

patients or residents, including whether to evacuate if the facility becomes 

unable to support adequate care, treatment, or other services. Although 

both hospital patients and nursing home residents were evacuated during 

Hurricane Katrina, in the aftermath of the event, congressional reports 

have raised questions about how health care facility administrators plan 

for hurricanes, how they implemented their plans, and how the federal 

government assisted health care facilities and state and local governments 

with facility evacuations.1

 Hurricane Katrina also pointed out the 

challenges of evacuating transportation-disadvantaged populations who 

are not in such facilities during a disaster. State and local governments are 

primarily responsible for responding to disasters that may result in 

evacuations. When state and local governments are overwhelmed in their 

response to a disaster, the federal government can assume a greater role. 

You asked me to discuss issues related to efforts to plan and prepare for 

the needs of seniors in the event of a national emergency. My remarks 

today will describe our ongoing work on evacuation in the event of 

emergencies and will provide preliminary observations on (1) the 

challenges faced by hospital and nursing home administrators that are 

 1

See U.S. House of Representatives, A Failure of Initiative: Final Report of the Select

Bipartisan Committee to Investigate the Preparation for and Response to Hurricane

Katrina (Feb. 15, 2006). See also Committee on Homeland Security and Governmental 

Affairs, U.S. Senate, Hurricane Katrina: A Nation Still Unprepared (May 2006). 

Page 1 GAO-06-790T
related to hurricane evacuations, (2) the federal program that supports the 

evacuation of patients needing hospital care and nursing home residents, 

and (3) challenges states and localities face in preparing for and carrying 

out the evacuation of transportation-disadvantaged populations and 

efforts to address evacuation needs.

My testimony today is based on our February 2006 interim report2

 as well 

as our ongoing work on the evacuation of hospitals and nursing homes 

due to hurricanes, and the evacuation of transportation-disadvantaged 

populations due to hurricanes and other disasters. Our work in this area is

being conducted under the Comptroller General’s authority to conduct 

evaluations on his own initiative.3

 In conducting the work for our interim 

report, we interviewed officials in Florida in areas that experienced 

hurricanes in 2004, including officials from three hospitals and three 

nursing homes that experienced Hurricane Charley,4

 state officials, and 

local emergency management officials in two counties. In addition, we 

interviewed officials from national hospital and nursing home associations 

and Florida hospital and nursing home associations. For our ongoing work 

related to the evacuation of hospitals and nursing homes, we interviewed 

officials in Mississippi in areas that were hit by Hurricane Katrina, 

including officials from five hospitals, officials from three nursing homes 

or assisted living facilities, state officials, and local officials in two 

counties. For our ongoing work on evacuating transportationdisadvantaged populations, we have visited communities in California, 

Florida, and New York, and we plan to visit communities in Louisiana and 

Washington, D.C. We have interviewed or will interview state and local

emergency management agencies, state and local transportation 

departments, local and regional transit agencies, and local and regional 

planning organizations. In addition, we interviewed entities that represent 

transportation and emergency management officials, entities such as the 

Federal Interagency Coordinating Council on Access and Mobility, and 

others. We also interviewed officials from the Department of Defense 

(DOD), the Department of Health and Human Services (HHS), the 

Department of Homeland Security (DHS), the Department of Veterans 

 2

GAO, Disaster Preparedness: Preliminary Observations on the Evacuation of Hospitals 

and Nursing Homes Due to Hurricanes, GAO-06-443R (Washington, D.C.: Feb. 16, 2006). 

See related GAO products later in this statement. 

3

31 U.S.C. § 717(b)(1) (2000). 

4

Hurricane Charley struck the Gulf Coast of Florida on August 13, 2004, and continued

across the state to exit on the Atlantic Coast on August 14, 2004. 

Page 2 GAO-06-790T
Affairs (VA), and the Department of Transportation (DOT) about federal 

efforts to support evacuation of hospitals and nursing homes and 

transportation-disadvantaged populations not in such facilities. In 

addition, we reviewed documents, including emergency management 

plans from the states of Florida, Mississippi and other states, local 

governments, hospitals, and nursing homes; and federal documents such 

as the National Response Plan.5

 Finally, we reviewed the 

recommendations on evacuations contained in several recently issued 

reports on the Hurricane Katrina response prepared by the U.S. House of 

Representatives, U.S. Senate, the White House, and DOT and DHS. We 

discussed the facts contained in this statement with officials from DOD, 

HHS, DHS, DOT, and VA, and incorporated changes as appropriate. Our 

work began in December 2005 and is being performed in accordance with 

generally accepted government auditing standards.6

In summary, hospital and nursing home administrators face challenges 

related to evacuations caused by hurricanes, including deciding whether 

to evacuate their facilities and obtaining transportation. Although state 

and local governments can order evacuations, health care facilities can be 

exempt from these orders. Facility administrators are generally 

responsible for deciding whether or not to evacuate, and if administrators 

decide not to evacuate, they face the challenge of ensuring that their 

facilities have sufficient resources to provide care or other services until 

assistance can arrive. If facilities evacuate, administrators face the 

challenge of securing transportation; according to hospital and nursing 

home officials, contractors providing transportation for hospitals and 

nursing homes would be unlikely to provide facilities with enough vehicles

during a major disaster, such as a hurricane, because local demand for 

transportation would likely exceed supply. According to nursing home 

administrators, they face unique challenges during evacuations. For 

example, when a nursing home evacuates, the administrator must locate 

receiving facilities that can accommodate residents who may need a place 

to live for a long period of time. 

 5

The National Response Plan describes how the federal government assists in managing

incidents of national significance. 

6

We anticipate completing our work and issuing reports on the evacuation of hospitals and 

nursing homes and on the evacuation of transportation-disadvantaged populations later 

this year. 

Page 3 GAO-06-790T
The National Disaster Medical System (NDMS) is the primary federal 

program that supports the evacuation of patients in need of hospital care 

during disasters such as hurricanes, but the program was not designed nor 

is currently configured to move nursing home residents. NDMS is a federal 

partnership of DOD, HHS, DHS, and VA that supplements state and local 

emergency response capabilities with federal resources and services. The 

program helped evacuate about 2,900 people during recent hurricanes, 

including Hurricane Katrina. NDMS supported evacuation efforts during 

Hurricane Katrina that included nursing home residents, although officials 

explained that NDMS does not have agreements with nursing homes that 

could receive evacuated nursing home residents. In contrast, NDMS has 

agreements with participating hospitals to receive patients needing 

hospital care. 

In preparing for and carrying out the evacuation of transportationdisadvantaged populations who are not in institutions during a disaster, 

states and localities face challenges in identifying these populations, 

determining their needs, and providing for and coordinating their 

transportation. Identifying these populations and determining their needs 

present challenges because their overall size, location, and composition 

can be difficult to determine in advance of an emergency. For example, 

while transportation-disadvantaged populations include the elderly, lowincome individuals, and persons with disabilities, during disasters these 

populations can also include people who do not own or have access to 

cars and people who do not permanently reside in the community, such as 

tourists. The elderly are particularly likely to be represented among the 

transportation disadvantaged because they are more likely, compared with 

the general population, to have a disability, have a low income, or choose 

not to drive. Providing for and coordinating the transportation of 

transportation-disadvantaged populations presents challenges because 

evacuating them requires additional planning, time, resources (for 

example, evacuating seniors with special medical needs from their 

homes), and communication efforts (such as communicating with the 

vision or hearing impaired). In the course of our review, we observed 

mixed efforts at the state and local level to address the evacuation needs 

of the transportation disadvantaged. For example, emergency

management officials in two locations we visited indicated they did not yet 

have a good understanding of the size, location, and composition of the 

transportation disadvantaged in their communities. However, we also 

observed efforts in some locations to address the evacuation needs of the

transportation disadvantaged by encouraging citizens to voluntarily 

register with their local emergency management agencies, integrating 

social service providers into emergency planning, and other measures. 

Page 4 GAO-06-790T
Administrators of hospitals and nursing homes face several challenges 

related to evacuations caused by hurricanes. Among these challenges, 

administrators must decide whether to evacuate their facilities or stay in 

facilities and “shelter in place.” Although state and local governments can 

order evacuations of the population or segments of the population during 

various emergencies, health care facilities can be exempt from these 

orders.7

 Facility administrators are generally responsible for deciding 

whether to shelter in place or evacuate, and administrators told us they 

generally see evacuation as a last resort. However, to shelter in place, 

facility administrators face the challenge of ensuring that their facilities 

have sufficient resources to provide care or other services during the 

disaster and then in its aftermath until assistance can arrive. For example, 

during hurricanes Katrina and Charley, facility administrators said they 

had to ensure that their facilities had staff who could stay for longer shifts 

until the storms passed and relief staff could arrive. One hospital in 

Mississippi had prepared staff to stay for approximately 3 days; however,

staff had to stay 2 weeks before replacement staff could arrive. The 

administrator also said they had to have 3 days of food and supplies 

stocked and enough fuel to run generators for 1 week. Destruction of 

communications capabilities due to hurricanes can complicate the 

decision to evacuate. For example, during Hurricane Katrina, the 

destruction of communications systems left hospital and nursing home 

administrators unable to receive information about how long it would take 

before assistance would arrive. 

Facility 

Administrators Face 

Several Challenges 

Related to 

Evacuations, 

Including Deciding 

Whether to Evacuate 

and Securing 

Transportation 

If hospital and nursing home administrators decide to evacuate, they face

the challenge of securing sufficient and appropriate transportation to 

move their patients or residents. Hospital and nursing home association 

representatives told us that facilities are likely to have local arrangements 

for transportation services, but the facilities are less likely to have 

arrangements in other localities or states, as was necessary for the 

evacuations during Hurricane Katrina. According to hospital and nursing 

home administrators, their contractors providing transportation would be 

unlikely to provide them with vehicles during a major disaster because 

local demand for transportation would exceed supply. For example, 

during Hurricane Katrina, two counties in Mississippi had to secure 

 7

For example, officials in two counties in Florida told us they can recommend that

hospitals and nursing homes evacuate their facilities, but the final decision is made by each 

facility’s administrator. 

Page 5 GAO-06-790T
vehicles that were located in other states.8

 Facility administrators also face 

the related challenge of obtaining appropriate vehicles. One nursing home 

administrator told us the facility had a transportation agreement with a 

bus company, but the company supplied only regular buses and most of 

the facility’s residents needed vehicles with power lifts to accommodate 

electric wheelchairs. 

While hospital and nursing home administrators face many of the same 

challenges during evacuations, there are some challenges nursing home 

administrators in particular must address. According to nursing home 

administrators, one challenge results from the fact that people in nursing 

homes may reside there for a long time. As a result, these administrators 

explained that nursing homes cannot reduce the number of residents in 

their facilities for whom they are responsible because nursing home 

residents may have no other home and cannot care for themselves. In 

contrast, hospital administrators told us that it is common to discharge as 

many patients as possible before a hurricane in order to reduce the 

number of patients who need to be sheltered or evacuated. In addition, 

when a nursing home evacuates, the administrator must locate receiving 

facilities that can accommodate residents for a potentially long period of 

time. For example, a nursing home administrator in Florida told us that 

the facility had to relocate its residents for over 10 months until the facility 

could be fixed. 

 8

The two counties contract with a national ambulance company, which is able to obtain 

vehicles from its fleet located in other states. 

Page 6 GAO-06-790T
NDMS is the primary federal program that supports efforts to evacuate 

patients who need hospital care during disasters such as hurricanes by 

moving them from an area affected by the emergency to reception areas in 

other locations. Formed in 1984 to care for casualties that could result 

from a domestic disaster or an overseas conventional war, NDMS is a 

federal program that supplements state and local emergency response 

capabilities with federal resources and services. DOD, HHS, DHS, and VA 

are federal partners in NDMS, and DHS has the authority to activate NDMS 

in response to public health emergencies, including but not limited to 

presidentially declared major disasters or emergencies.9

 Among its various

functions,10 NDMS supports the evacuation of hospitals by assisting in 

efforts to move patients from a mobilization center, such as an airport 

near the incident, to reception areas in other locations where patients can 

be placed in a hospital participating in NDMS to continue receiving 

medical care. NDMS officials told us that Hurricane Katrina was the first 

time that the patient evacuation component of NDMS was used to 

evacuate a large number of patients. In response to state requests for 

assistance due to recent hurricanes, about 2,900 people were transported 

from NDMS mobilization centers to NDMS patient reception areas.11

NDMS Is the Primary 

Federal Program That 

Evacuates Patients 

Needing Hospital 

Care, but It Is Not 

Designed to Move 

Nursing Home

Residents 

While NDMS supports the evacuation of patients in need of hospital care,

the program was not designed nor is currently configured to move nursing 

home residents. As stated in the memorandum of agreement among the 

NDMS federal partners, the patient evacuation function of NDMS is 

intended to move patients from a mobilization center to a reception area 

so they can be admitted to NDMS-affiliated hospitals—typically nonfederal 

hospitals that have agreements with NDMS—to receive medical care. 

 9

A presidentially declared major disaster or emergency can be declared under the Robert T. 

Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. §§ 5121-5206, which 

establishes the programs and processes by which the federal government supplements

state and local resources in major disasters and emergencies. 

10NDMS consists of three functions. One is medical response, which includes medical 

equipment and supplies, patient triage, and other primary and emergency health care 

services provided to disaster victims at a disaster site. Another is patient evacuation, which 

includes communication and transportation to evacuate patients from a mobilization 

center near the disaster site, such as an airport, to reception areas in other locations. The

third is “definitive care,” which is additional medical care—beyond emergency care—that 

begins once disaster victims are placed into an NDMS inpatient treatment facility (typically

a nonfederal hospital that has an agreement with NDMS). NDMS functions are included in

the Public Health and Medical Services Annex of the National Response Plan. 

11This figure represents the approximate number of people moved during Hurricane Katrina

and Hurricane Rita, which struck the Gulf Coast several weeks after Hurricane Katrina. 

Page 7 GAO-06-790T
Although during Hurricane Katrina NDMS evacuated nursing home 

residents who were brought to mobilization centers, program officials told

us that NDMS was not designed to evacuate this population and the 

program did not have agreements with nursing homes that could receive

evacuated nursing home residents. NDMS officials noted the challenge of 

meeting the needs of nursing home residents in an NDMS report prepared 

after Hurricane Katrina.12

In preparing for and carrying out the evacuation of transportationdisadvantaged populations due to a disaster, states and localities face 

challenges in identifying these populations, determining their needs, and 

providing for and coordinating their transportation. Identifying these 

populations and determining their needs present challenges because their 

overall size, location, and composition can be difficult to determine in 

advance of an emergency. For example, while these populations include 

the elderly, low-income individuals, and persons with disabilities, during 

disasters transportation-disadvantaged populations can also include 

people who either by choice or circumstance do not own or have access to 

cars. They can also include people with limited English proficiency and 

people who do not permanently reside in the community, such as tourists, 

temporary workers, and the homeless. In addition, transportationdisadvantaged populations may have specialized medical needs; people 

may move within the community, and these populations may harbor 

beliefs about privacy and fears of discrimination that discourage 

participation in outreach efforts. The elderly are particularly likely to be

represented among the transportation disadvantaged because they are 

more likely, compared with the general population, to have a disability, 

have a low income, or choose not to drive. 

States and Localities 

Face Challenges in 

Addressing the 

Evacuation Needs of 

TransportationDisadvantaged 

Populations 

Providing for and coordinating the evacuation of transportationdisadvantaged populations also present challenges because evacuating 

these populations requires additional planning, time, and resources. For 

example, evacuating seniors with special medical needs who are residing 

in their own homes may require additional planning of pick up routes; 

extra time to load and unload evacuation vehicles; and special resources, 

such as buses equipped with wheelchair lifts. In addition, communicating 

 12See National Disaster Medical System, National Disaster Medical System (NDMS) After

Action Review (AAR) Report on Patient Movement and Definitive Care Operations in 

Support of Hurricanes Katrina and Rita (Jan. 12, 2006). 

Page 8 GAO-06-790T
evacuation information to these populations during disasters may be 

challenging because they may be vision or hearing impaired or have 

limited English proficiency. 

In the course of our review, we observed mixed efforts at the state and

local level to address the evacuation needs of the transportation 

disadvantaged during a disaster. In some locations we visited, emergency

management officials indicated they did not yet have a good 

understanding of the overall size, location, and composition of the 

transportation disadvantaged in their community and acknowledged the 

need to better integrate transportation-disadvantaged populations into 

emergency response planning. For example, emergency management 

officials in one city stated that their participation in the February 2006 

National Plan Review alerted them to the fact that they should better 

provide for and coordinate the needs of transportation-disadvantaged 

populations in their evacuation planning.13 One state official described 

coordination challenges and evacuation delays that occurred for 

transportation-disadvantaged populations in one community during an

approaching wildfire and attributed these problems to coordination 

difficulties between emergency management and other agencies. 

However, we also observed efforts underway in some locations to address 

the evacuation needs of the transportation disadvantaged. In three 

locations, local governments and regional organizations have conducted or 

were conducting studies to identify the number and location of 

transportation-disadvantaged populations in their jurisdiction. This 

information has been or was to be used to facilitate evacuation planning 

on resource use and deployment during disasters. Also, in three locations, 

emergency management officials were using preexisting citizen networks 

and community outreach activities to help inform and prepare 

transportation-disadvantaged populations for disasters. For example, in 

one city, emergency management officials used an existing neighborhood

watch network to facilitate community outreach to transportationdisadvantaged populations, better preparing them for a disaster. In 

another city, emergency management officials worked with home health 

organizations, doctors, and the Red Cross to inform transportationdisadvantaged populations about evacuation preparedness. 

 13The National Plan Review is a DHS review of the emergency plans, including catastrophic 

planning and mass evacuation planning, of the 50 states and 75 largest urban areas. 

Page 9 GAO-06-790T
In one location that had a well-developed program for evacuating the 

transportation disadvantaged, we observed that emergency management 

officials did the following: 

• Had emergency plans that clearly articulated methods of providing for and

coordinating the evacuation of transportation-disadvantaged populations, 

including the roles and responsibilities of various agencies. This plan 

clearly articulated how local and state emergency management, school 

boards, and transit agencies would work together to evacuate 

transportation-disadvantaged populations. Emergency management 

officials stated that this level of coordination enabled them to successfully

conduct several evacuations. 

• Encouraged citizens who have special medical needs to voluntarily 

register with their local emergency management agency. This registry 

placed individuals into categories, including those who would need special 

transport, such as an ambulance. According to emergency management 

officials, in several recent evacuations, the voluntary registry assisted 

emergency personnel in efficiently evacuating transportationdisadvantaged populations. However, the same emergency management 

officials also pointed out challenges that exist for voluntary registries 

including the administrative costs of keeping the information up to date,

the limited number of participants, and a surge in the number registrations 

immediately prior to an approaching storm. 

• Involved social service providers in the emergency response planning 

process. Social service providers’ transportation resources were used to 

evacuate many of the clients on a voluntary registry administered by the 

city. These social service providers have expertise and ongoing contact 

with the transportation-disadvantaged populations, and are familiar with 

their day-to-day and nonemergency needs. 

• Established formal agreements that alleviate legal liability and 

reimbursement concerns when securing transportation resources to assist 

in evacuating transportation-disadvantaged populations during any type of

disaster. 

• Conducted regular exercises of emergency response plans in order to test 

coordination between agencies involved in evacuations and their 

resources, and the integration of social service providers. 

In addition to these efforts by state and local governments, recent reports 

released by the federal government have put forth recommendations that 

address evacuation preparedness and response generally and for 

transportation-disadvantaged populations in particular. The White House 

Page 10 GAO-06-790T
report14 recommends that DOT be the primary federal agency responsible 

for developing the federal government’s capability to conduct mass 

evacuations and that DHS require that state and local governments to 

conduct evacuation planning and exercises as a condition for receiving

Homeland Security grants. The Senate report15 recommends that DOT 

should, in coordination with DHS and the states, plan, train and exercise 

for evacuations, including provisions for those populations that do not 

have the means to evacuate. 

Hospital and nursing home administrators generally face multiple 

challenges in weighing the risks of sheltering in place or evacuating. 

Although evacuation is a last resort, Hurricanes Charley and Katrina 

resulted in both hospitals and nursing homes having to evacuate. When

evacuating, administrators faced problems specifically related to 

transportation, including securing vehicles. Hurricane Katrina, the first 

emergency in which NDMS was used to evacuate a large number of 

people, brought to light that NDMS was not set up nor is currently 

configured to provide assistance to nursing homes. As a result, it does not 

have agreements with nursing homes to accept evacuated patients. In 

addition, states and localities face multiple challenges in ensuring that 

transportation-disadvantaged populations who are not in such facilities 

are evacuated. We will be monitoring federal efforts to improve preparing 

for and carrying out evacuations of these populations. Our ongoing work 

will continue to examine the vulnerabilities posed by disasters for hospital 

patients, nursing home residents, and transportation-disadvantaged 

populations living in their communities. 

Mr. Chairman, this concludes my prepared remarks. I would be happy to 

respond to any questions you or other members of the committee have at

this time. 

Concluding 

Observations 

 14Assistant to the President for Homeland Security and Counterterrorism, The Federal

Response to Hurricane Katrina: Lessons Learned (February 2006). 

15Committee on Homeland Security and Governmental Affairs, U.S. Senate, Hurricane 

Katrina: A Nation Still Unprepared (May 2006). 

Page 11 GAO-06-790T
For further information regarding this statement, please contact Cynthia 

Bascetta at (202) 512-7101 or at bascettac@gao.gov regarding issues 

related to the evacuation of hospitals and nursing homes. For issues 

related to the evacuation of transportation-disadvantaged populations, 

please contact Katherine Siggerud at (202) 512-2834 or siggerudk@gao.gov. 

Contact points for our Offices of Congressional Relations and Public 

Affairs may be found on the last page of this statement. Key contributors 

to this statement were Steve Cohen, Assistant Director; Linda T. Kohn, 

Assistant Director; La Sherri Bush; Krister Friday; Christopher Lyons; 

Nkeruka Okonmah; Laina Poon; Tina Won Sherman; and William Simerl. 

Contacts and 

Acknowledgments 

Page 12 GAO-06-790T
Page 13 GAO-06-790T

Related GAO Products 

Hurricane Katrina: Status of the Health Care System in New Orleans 

and Difficult Decisions Related to Efforts to Rebuild It Approximately 

6 Months After Hurricane Katrina. GAO-06-576R. Washington, D.C.: 

March 28, 2006. 

Hurricane Katrina: GAO's Preliminary Observations Regarding 

Preparedness, Response, and Recovery. GAO-06-442T. Washington, D.C.: 

March 8, 2006. 

Disaster Preparedness: Preliminary Observations on the Evacuation of 

Hospitals and Nursing Homes Due to Hurricanes. GAO-06-443R. 

Washington, D.C.: February 16, 2006.

Transportation Services: Better Dissemination and Oversight of DOT’s 

Guidance Could Lead to Improved Access for Limited English-Proficient

Populations. GAO-06-52. Washington, D.C.: November 2, 2005. (This report 

is also available in Spanish, Chinese, Vietnamese, and Korean.)

Transportation-Disadvantaged Seniors: Efforts to Enhance Senior 

Mobility Could Benefit from Additional Guidance and Information. 

GAO-04-971. Washington, D.C.: August 30, 2004. 

Transportation-Disadvantaged Populations: Federal Agencies Are 

Taking Steps to Assist States and Local Agencies in Coordinating 

Transportation Services. GAO-04-420R. Washington, D.C.: February 24, 

2004. 

HHS Bioterrorism Preparedness Programs: States Reported Progress but 

Fell Short of Program Goals for 2002. GAO-04-360R. Washington, D.C.: 

February 10, 2004. 

Transportation-Disadvantaged Populations: Some Coordination Efforts 

Among Programs Providing Transportation Services, but Obstacles 

Persist. GAO-03-697. Washington, D.C.: June 30, 2003. 

Transportation-Disadvantaged Populations: Many Federal Programs 

Fund Transportation Services, but Obstacles to Coordination Persist. 

GAO-03-698T. Washington, D.C.: May 1, 2003. 

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