Absent a compelling reason to evacuate, the decision should be deferred and reconsidered at a later point, at which time the situation could significantly improve (i.e., no threat to patient/staff safety), significantly worsen (i.e., immediate threat to patient/staff safety), or not change significantly and require further careful assessment. As shown in Figure 2, this decision has two possible outcomes: A careful assessment of the factors listed in Table 4-in particular the risks posed to the hospital's water, sewer, electricity, and heat supply, as well as the overall building integrity-is required in order to decide whether an evacuation should be ordered, or if the decision should be deferred and the situation reassessed.įaced with a potential/evolving threat to patient and staff safety, decision teams must consider whether to evacuate.
Hurricane Katrina illustrates this situation many decision teams chose to shelter-in-place, only to find that catastrophic damage from the subsequent flood necessitated evacuation. Between these two extremes are situations when it is not immediately obvious whether or not the hospital should be evacuated. Potential/evolving threat to patient/staff safety.Similarly, six of eight hospitals damaged in the Northridge, California, earthquake evacuated within hours of the earthquake. Sinai (New York) hospital during a building fire in 2009 illustrates this situation. At the other extreme are situations in which the event clearly causes an immediate life-threatening risk to patients and staff, and the hospital must be rapidly evacuated. Immediate threat to patient/staff safety.This is the usual outcome for hospitals that experience minor earthquakes or that shelter-in-place throughout a hurricane and suffer little or no significant damage. In this situation, it is immediately clear that the hospital did not suffer any significant damage that would cause decision teams to order an evacuation. As shown in Figure 2, the flowchart assumes that hospitals will be in one of three conditions following the event: Some of the possible paths are determining there is an immediate threat to patients and ordering an immediate post-event evacuation monitoring a potential/evolving threat to patient safety during a wait-and-reassess period, and then ultimately not evacuating the hospital and monitoring a potential/evolving threat to patient safety during a wait-and-reassess period, and then deciding to evacuate the hospital.Īs soon as possible after the event occurs, building integrity, critical infrastructure, and other environmental factors must be assessed to determine whether the hospital can continue to provide appropriate medical care to patients or should instead be evacuated. There are several possible paths through the Figure 2 flowchart, as illustrated in the examples of pre-event evacuation decisions listed in Table 6. The steps in the flowchart are identical to the bottom half of Figure 1, the decision process for an Advanced Warning Event in which the decision team decides to shelter-in-place.
No Advanced Warning Events include, most notably, earthquakes, building fires, tornadoes, and explosions (both accidental and terrorist acts).įigure 2 shows a flowchart that illustrates the post-event evacuation decision process. Post-event evacuations have occurred either following Advanced Warning Events (i.e., if the decision was made to shelter-in-place during the event, but subsequent damage was sufficient to necessitate evacuation) or during No Advanced Warning Events.
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