Staged Guilford County EMS ResourcesWith the dire situation surrounding #Harvey, there are a lot of individuals conversing on social media around the evacuation of hospitals prior to events. Below are my thoughts on an evacuation decision framework, not a proclamation of what should have been done. My one universal piece of advice is let’s try not to arm chair quarterback individuals in an unprecedented event, the appropriate time is to analyze decisions and learn is via a formal after action review. After action reviews are conducted after the event.

A Brief Primer on Hospital Evacuation Decision Factors

  • In case you are not versed in healthcare emergency management or hospital operations: One thing to remember is evacuating a hospital is not like your elementary school fire drill, it is one of the most medically and logistically complex actions any organization could undertake. Planned hospital moves take months to plan, and require hundreds of resources.

The Incident Management Team has to consider hundreds if not thousands of variables and here are just a limited smattering:

  • Time- It can take a day or two to evacuate a hospital, can you get patients transferred safely in the available time window.
  • Hardened Facility- How hardened is your facility? What is your building built to with stand and what kind of utility redundancy do you have?
  • Resources- It takes people, medical equipment, ambulances, buses, trucks, carts, stretchers, and more people. Prior to predicted events resources become scarce as they are tasked to other operations or re-positioned for the event. Hospitals would have to rely on external partners for transportation needs and many other support items.
  • Availability at an Appropriate Receiving Facility- Most patients cannot be discharged home, they either need to go to another hospital or skilled facility to continue care that is outside of the predicted impacted area. So there must be available appropriate beds at an appropriate facility that is willing to accept the patient. The concept of what is appropriate is key, for example, a dialysis patient should not be transferred to a facility that cannot support a dialysis patient.
  • Transportation Logistics- The availability of ambulances and ambulance buses are just one consideration and lets not even go into having the right type of ambulance (BLS vs Critical Care). Another consideration how long of a transport will it be? What if the ambulance gets stuck in traffic? (See inset picture of Houston Evacuation prior to Hurricane Rita 2005) Do you have to fly patients to other facilities? NDMS is a great resource/system for patient evacuation and relocation but it requires a presidential declaration and days to stand up. (The lead time for most hurricanes is 3-5 days)
Gridlock during Hurricane Rita Evacuation 2005

A few other considerations:

  • External Environment (weather, etc)
  • Infection Risk
  • Medical Gas Availability
  • Financial
  • Community Evacuation Status
  • Patient Choice
  • Patient Conditions
  • Operating Room Status

The final consideration is that critically ill patients when moved can decompensate and have negative outcomes or in other words, they can die. I do not envy the individuals making these impossible life and death decisions, but I do give them grace.

If you are wondering what you can do, a colleague of mine had one of the best statements:

For most, it’s not our storm. Yet, all emergency workers CAN make a difference by building the best damn program they can at home. #Harvey – Keith Dowler, CEM (@keithdowler – Twitter)

We will be learning from Harvey for years just as we learned from Sandy and Katrina. As a result of those learnings, last year under President Obama, CMS published an Emergency Preparedness Rule dictating requirements for planning, training, and testing plans for events like hurricanes with a final implementation date of November 15, 2017. Those requirements affect 17 healthcare provider types and cover everything from evacuating to communicating.


Crisis Focus, LLC has focused expertise in healthcare emergency management, including CMS compliance. Please visit Crisis Focus’ CMS Emergency Preparedness resource page or contact us for more information.

An earlier version of this post originally appeared on Jody Moore’s LinkedIn Account and is cross-posted here as a resource.