Hostname: page-component-669899f699-tzmfd Total loading time: 0 Render date: 2025-05-01T01:49:10.588Z Has data issue: false hasContentIssue false
  • English
  • Français

Initial Management of Hospital Evacuations Caused by Hurricane Rita: A Systematic Investigation

Published online by Cambridge University Press:  21 February 2013

Erin L. Downey ,
Knox Andress  and
Carl H. Schultz
Erin L. Downey*
Affiliation:
US Department of State, Office of the Geographer and Global Issues, Washington, DC USA and Tulane University School of Public Health and Tropical Medicine (Adjunct Faculty), New Orleans, Louisiana USA
Knox Andress
Affiliation:
Louisiana State University Health Shreveport, Shreveport, Louisiana USA and Louisiana Poison Center, Shreveport, Louisiana USA
Carl H. Schultz
Affiliation:
Center for Disaster Medical Sciences, Department of Emergency Medicine, UC Irvine School of Medicine, Irvine, California USA
*
Correspondence: Erin L. Downey, MPH, ScD Tulane University School of Public Health and Tropical Medicine Department of Health Systems Management 1440 Canal Street New Orleans, LA 70112 USA E-mail [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Hurricanes remain a major threat to hospitals throughout the world. The authors attempted to identify the planning areas that impact hospital management of evacuations and the challenges faced when sheltering-in-place.

Methods

This observational, retrospective cohort study examined acute care institutions from one hospital system impacted by Hurricane Rita in 2005. Investigators used a standardized survey instrument and interview process, previously used in the hospital evacuation context, to examine hospitals’ initial internal situational awareness and subsequent decision making that resulted in evacuation due to Hurricane Rita. Participants from each hospital included representatives from senior leadership and clinical and nonclinical staff that comprised the Incident Management Team (IMT). The main measured outcomes were responses to 95 questions contained in the survey.

Results

Seven of ten eligible hospitals participated in the study. All facilities evacuated the sickest patients first. The most significant factors prompting evacuation were the issuing of mandatory evacuation orders, storm dynamics (category, projected path, storm surge), and loss of regional communications. Hospitals that sheltered-in-place experienced staff shortages, interruptions to electrical power, and loss of water supplies. Three fully-evacuated institutions experienced understaffing of 40%-60%, and four hospitals sustained depressed staffing levels for over four weeks. Five hospitals lost electricity for a mean of 4.8 days (range .5-11 days). All facilities continued to receive patients to their Emergency Departments (EDs) while conducting their own evacuation.

Conclusion

Hospital EDs should plan for continuous patient arrival during evacuation. Emergency Operation Plans (EOPs) that anticipate challenges associated with evacuation will help to maximize initial decision making and management during a crisis situation. Hospitals that shelter-in-place face critical shortages and must provide independent patient care for prolonged periods.

DowneyEL, AndressK, SchultzCH. Initial Management of Hospital Evacuations Caused by Hurricane Rita: A Systematic Investigation. Prehosp Disaster Med. 2013;28(3):1-7.

Keywords

decision makinghospital evacuationhospital evacuation planhurricane
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 3 , June 2013 , pp. 257 - 263
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1. Hurricane Rita is the fourth-most intense Atlantic hurricane ever recorded and the most intense tropical cyclone observed in the Gulf of Mexico. Science Daily Web site. http://www.sciencedaily.com/articles/h/hurricane_rita.htm. Accessed June 21, 2011.Google Scholar
2. National Oceanic Atmospheric Administration. Tropical Cyclone Report: Hurricane Rita. http://www.nhc.noaa.gov/pdf/TCR-AL182005_Rita.pdf. Published 2006. Accessed July 20, 2011.Google Scholar
3. National Oceanic Atmospheric Administration. Tropical Cyclone Report: Hurricane Katrina. http://www.nhc.noaa.gov/pdf/TCR-AL122005_Katrina.pdf. Published 2005. Accessed July 20, 2011.Google Scholar
4. Latitude/Longitude: Buris, LA: 29.351667, - 89.513889; Johnson's Bayou, LA: 29.761964, -93.656564; Sabine Pass, LA: 29.733089, -93.894417. Assuming midpoint between Johnson's Bayou and Sabine Pass (29.747527, -93.775491) is Hurricane Rita landfall, the distance between the two landfalls is approximately 257 statute miles.Google Scholar
5.Chavez, CS, Binder, B. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge Earthquake. J Emerg Med. 1996;14(4):445-454.CrossRefGoogle Scholar
6.Schultz, CH, Koenig, KL, Noji, EK. A medical disaster response to reduce immediate mortality following an earthquake. N Engl J Med. 1996;334(7):438-444.CrossRefGoogle Scholar
7.Sternberg, E, Lee, GC, Huard, D. Counting crises: US hospital evacuations, 1971-1999. Prehosp Disast Med. 2004;19(2):150-157.CrossRefGoogle ScholarPubMed
8.McGlown, K., Determinants of the Evacuation of Health Care Facilities, PhD Dissertation, University of Alabama at Birmingham, 1999.Google Scholar
9.Government Accountability Office. Disaster Preparedness: Preliminary Observations on the Evacuation of Vulnerable Populations due to Hurricanes and Other Disasters. http://www.gao.gov/new.items/d06790t.pdf. Published 2006. Accessed October 19, 2010.Google Scholar
10.US Department of Transportation in cooperation with the US Department of Homeland Security. Catastrophic Hurricane Evacuation Plan: A Report to Congress. http://www.fhwa.dot.gov/reports/hurricanevacuation/. Published 2006. Accessed November 15, 2012.Google Scholar
11.Government Accountability Office. Disaster Preparedness: Limitations in Federal Evacuation Assistance for Health Facilities Should be Addressed. http://www.gao.gov/htext/d06826.html. Published 2006. Accessed November 15, 2012.Google Scholar
12.US House of Representatives. A Failure of Initiative: Final Report of the Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina. http://www.katrina.house.gov/full_katrina_report.htm. Published 2006. Accessed November 15, 2012.Google Scholar
13.Hurricanes: Science and Society. .2008-Hurricane Gustav. http://www.hurricanescience.org/history/storms/2000s/gustav/. Accessed January 24, 2013.Google Scholar
14.Minnesota Department of Health. Healthcare Facility Training Matrix for Sheltering, Relocation, and Evacuation. http://www.health.state.mn.us/oep/healthcare/flood.html/. Accessed November 17, 2012.Google Scholar
15.Bagaria, J, Heggie, C, Abrahams, J, Murray, V. Evacuation and sheltering of hospitals in emergencies: a review of international experience. Prehosp Disaster Med. 2009;24(5):461-467.CrossRefGoogle ScholarPubMed
16.Kader, S.Development of Design Strategies to Support Evacuation Processes of Hospital Buildings in Unites States [Masters Thesis]. Texas A&M University. December 2008.Google Scholar
17.Schultz, CH, Koenig, KL, Auf der Heide, E. Benchmarking for hospital evacuation: a critical data collection tool. Prehosp Disast Med. 2005;20(5):331-342.CrossRefGoogle ScholarPubMed
18.Hospital Incident Command Systems - Learning Modules. California Emergency Medical Services Authority. http://www.emsa.ca.gov/HICS/modules.asp. Accessed June 21, 2011.Google Scholar
19.The Joint Commission. Comprehensive Accreditation Manual for Hospitals: Standards EM.02.01.01 and EC.4.12. Published 2009.Google Scholar
20. Pendelton Memorial Methodist Hospital generator concerns weren't passed along. The Times-Picayune New Orleans Web site. http://www.nola.com/hurricane/index.ssf/2010/01/pendleton_memorial_methodist_h_2.html. Published 2010. Accessed June 17, 2011.Google Scholar
21.Barbera, JA, Macintyre, AG, DeAtley, CA. Ambulances to nowhere: America's critical shortfall in medical preparedness for catastrophic terrorism. Paper presented at the executive session on domestic preparedness as John F. Kennedy School of Government, Harvard University, October 2001. Boston, Massachusetts USA.Google Scholar
22.American Hospital Association. Emergency department overload: A growing crisis. http://www.aha.org/content/00-10/EdoCrisisSlides.pdf. Published 2002. Accessed November 17, 2012.Google Scholar
23.American Hospital Association. Trend Watch. Emergency Departments: An Essential Access Point to Care. http://www.aha.org/research/reports/tw/twmarch2001.pdf. Published 2001. Accessed November 15, 2012.Google Scholar
24.US Department of Homeland Security. Secretary Tom Ridge Approves National Incident Management System (NIMS): Notification letter to all State Governors. http://www.fws.gov/contaminants/FWS_OSCP_05/fwscontingencyappendices/A-NCP-NRP/NIMSpressrelease3-1-04.pdf. Posted 2004. Accessed November 15, 2012.Google Scholar
25.National Incident Management Systems (NIMS). Summary of NIMS Implementation Schedule Requirements and Certification Process. http://www.fema.gov/pdf/emergency/nims/summary_of_nims_implementation_schedule.pdf. Accessed June 21, 2011.Google Scholar