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Hospital evacuation
April 2022
Definition
Emptying entire hospital or a part of it
which is insecure for the patients and their relatives
due to internal and external factors
transferring people to safer zones
Hospital Evacuation
History
275 hospital evacuations in the United States within 1971 to 1997
Italy, Pakistan, China, Indonesia, South American countries, and the United Kingdom,
where some hospitals have been evacuated because of earthquake, flood, fire, and
other disasters
More than 9hospital evacuations in IRAN within 2019 to 2020 because of earthquake,
flood and corona.
Hospital Evacuation
Hospital Evacuation
Arezoo dehghani
Dehghani.am64@gmailc.om Health in Emergencies and Disaster
complex
process
psychologic
al, financial,
and social
problems
Hospital
Evacuation
Save health
and lives
Hospital evacuation factors
Fire and smoke
Damage to infrastructure
Lack of basic welfare services
Exposure to hazardous substances
Terrorist or violent operations
Threat of bombing
Hospital Evacuation
Evacuate the hospital
Determination
precise criteria
rapid decision-making process
enormous logistical undertaking
Cooperation
involvement of other organizations,
such as police, fire and EMS
provide transportation, facilities,
supplies, equipment and staffs
Basic needs
Types of evacuation
Immediate or delayed
Vertical or horizontal
Partial or total
Hospital Evacuation
Types of evacuation
Immediate
Emergency move-
evacuate immediately or
patients and staffs may
die, not time to prepare
Rapid
Evacuate as quickly and
safely as possible: limited
time to prepare ( 1-2 Hrs)
Gradual
No immediate danger,
sufficient time for
systematic evacuation
procedures ( many hrs to
several days)
Prepare only
Do not move patient, but
begin to prepare for
evacuation
Types of evacuation
Horizontal
Moving patients from the
one wing to another
adjacent area on the
same floor
Vertical
Moving patients from one
floor to another or even
from upper floors to
outside the facility
Partial
The relocation of patients
to unaffected areas or
removal from the building
of only those occupants in
affected areas
Total
Removal of all occupants
from the building, with the
possible exception of
emergency team members
1:Hospital evacuation plan
Integrated with other pertinent protocols EOP, including activation of
hospital ICS
Assigned responsibilities and formal process for review and update of
Evacuation Plan (Plan), including incorporation of after-action report results
Staff training:
Plan overview
Specific roles and responsibilities
Utilization of evacuation equipment
Techniques for lifting and carrying patients
Hospital Evacuation
2Hospital evacuation plan activation
Define criteria and authority for decision to activate the Plan
Define how the Plan is activated
Identify alert and notifications
Define the type/level of evacuation that could occur
Describe the phases of implementation
Define routes and exits
Describe the protocols for accepting and orienting staff and volunteers from other facilities to
assist with evacuation
Steps of hospital evacuation in severe damage
Perform A
Pre-event
Assessment
Estimate Time
Needed To
Evacuate The
Hospital
estimate
resources needed
to evacuate the
hospital
infrastructure, layout,
demographic situation
Evacuate The Hospital
Estimate Time Needed To Evacuate
The Hospital
Number of patients
Available exit routes
Available resources and staff
Staging area
Distance to the evacuation sites
Traffic conditions
Transport to alternate care sites
both to the staging area and to
transport to alternate care sites
Staff
Equipment
Vehicles
For both transportation and continuing
the medical services in the appropriate
environment, considering temperature,
air condition, security, and safety.
Estimate
Resources Needed
Hospital evacuation
process
ICS commander:
Evacuation command
Ward preparedness
Internal evacuation
Unit of care and
treatment
Triage unit
External transport
Admit
unit
Hospital external evacuation steps
Creating a
staging
location
Patients
categorized transport
a crucial phase
Hospitals, clinics,
hotels, nursing
facilities
Green
Yellow
Red
Patient categorise
(1) ambulatory and self-sufficient patients
(2) non-ambulatory patients who require medical
care and support but are not in critical or unstable condition
(3) patients who need critical and continuous medical services
or are fully dependent on technology (patients in the ICU or
isolation rooms)
3Patient evacuation process
Specify the protocol to assure that the patient destination is compatible to patient acuity and
healthcare needs
Establish protocols for sharing special needs information, as appropriate, with personnel
participating in the evacuation including transport agencies, receiving facilities, alternate care
sites, shelters, and others involved in evacuee patient care
Identify the resources necessary to address patient needs during transport, how to access, and
responsibility for acquiring and sending with the patient
Provide evacuees with standardized visual identifiers, such as a color-coded wristband or
evacuation tag, to help personnel rapidly identify special needs for high-risk conditions
Document staff activities on the traffic flow and the movement of patients to a staging area
4Tracking destination / arrival of patients
A patient identification wristband (or equivalent identification) must be intact on all patients
Describe the process to be utilized to track the arrival of each patient at the destination
The tracking form should contain key patient information, including the following:
Medical Record Number
Time left the facility
Name of transporting agency
Original chart sent with patient (yes/no)
Critical medical record information (orders, medications list, face sheet) (yes/no)
Meds sent with patient (list)
Equipment sent with patient (list)
Family notified of transfer (yes/no)
Private MD notified of transfer (yes/no)
5Transport of records, supplies and equipment
Describe the procedure for transport of Medication Administration Records (MARs) patient
care/medical records
Describe measures taken to protect patient confidentiality
Describe the process to transport essential patient equipment and supplies
Define protocol for transfer of patient-specific
medications and records to receiving facility
Protocol for the transfer of patient-specific controlled substances sent with patients and
procedure to record
Hospital Evacuation Rules
Maintaining continuous medical services to non-ambulatory patients
Triage in evacuation is necessary if it is not possible to evacuate some patients
Areas and floors in highest danger should be evacuated first
A top-to-bottom evacuation should be considered if there is no immediate threat to
the hospital
Hospital Incident Command System Structure(0-2 Hours)
23
Incident
Commander
Operations
Section Chief
Staging
Manager Medical Care
Branch
Director
Infrastructure
Branch
Director
Planning
Section Chief
Situation Unit
Leader
Logistics
Section Chief
Support
Branch
Director
Command
Staff
Incident Commander
Activate the facility emergency operations plan and the Incident Command structure
Appoint Command Staff and Section Chiefs
Determine type of evacuation neededimmediate vs. delayed; vertical, horizontal, or
complete
Order organized and timely evacuation of the facility
24
Liaison Office
Communicate with local emergency management agency, Fire, EMS and
law enforcement about facility status and evacuation order.
25
Safety Officer
Oversee immediate stabilization of facility
Recommend areas for immediate evacuation to protect life
Ensure safe evacuation of patients, staff and visitors
26
OperationsSection
Implement emergency life support procedures to sustain critical services (i.e.,
power, water, communications) until evacuation can be accomplished
Determine evacuation type needed, with Incident Commanderimmediate,
delayed; vertical, horizontal, complete
Implement planning for immediate evacuation of the facility
Prioritize patients and areas of the facility to be evacuated
Prepare patient records, medications and valuables for transfer
Confirm transfer and timeline with accepting hospitals, provide patient
information
27
Planning Section
Track patients and personnel including evacuation location and receiving facility
Establish operational periods, incident objectives and develop Incident Action
Plan with Incident Commander
Ensure documentation of all actions and activities
28
Hospital Incident Command System Structure (2-12 Hours)
29
Incident
Commander
Operations
Section Chief
Staging
Manager Medical Care
Branch
Director
Infrastructure
Branch
Director
Planning
Section Chief
Situation Unit
Leader
Logistics
Section Chief
Support
Branch
Director
Command
Staff
Evacuation: Intermediate (2-12 Hours)
Incident Commander
Notify hospital Board and other internal authorities of situation status
and evacuation
Liaison
Integrate with external agencies, including healthcare facilities
Safety Officer
Conduct ongoing analysis of existing response practices for health and
safety issues related to staff, patients and facility; implement corrective
actions to address
30
Evacuation: Intermediate (2-12 Hours)
Operations Section
Ensure appropriate patient care and management during evacuation
Continue facility security, traffic and crowd control
Ensure family notification of patient transfer
Continue facilitating discharges
Continue to communicate patient information and status to receiving
facilities
31
Evacuation: Intermediate (2-12 Hours)
Planning Section
Continue patient and personnel tracking and documentation
Update and revise the Incident Action Plan
Ensure complete documentation of activities, decisions and actions
32
Evacuation: Intermediate (2-12 Hours)
Logistics Section
Supply supplemental staffing to key areas to facilitate evacuation
Provide for staff food and water and rest periods
Monitor facility damage and initiate repairs, as appropriate, as long as it
does not hinder evacuation of the facility
Initiate salvage operations of damaged areas and relocate equipment
from evacuated areas to secure areas or to other facilities
33
Evacuation: Intermediate (2-12 Hours)
Finance/ Administration Section
Track costs and expenditures of response and evacuation
Track estimates of lost revenue due to evacuation of the facility
34
Hospital Incident Command System Structure (12+ Hours)
35
Incident
Commander
Operations
Section Chief
Staging
Manager Medical Care
Branch
Director
Infrastructure
Branch
Director
Planning
Section Chief
Situation Unit
Leader
Logistics
Section Chief
Support
Branch
Director
Command
Staff
Evacuation: Extended
Incident Commander
Meet with Command Staff and Section Chiefs to update evacuation progress and
situation status
Liaison Officer
Continue to update local emergency management, Fire, EMS and law enforcement
officials on situation status and evacuation progress
Safety Officer
Continue ongoing evaluation of evacuation practices for health and safety issues
related to staff, patients, and facility, and implement corrective actions
36
Evacuation: Extended
Operations Section
Ensure patient care and management for patients waiting evacuation
Secure all evacuated areas, equipment, supplies and medications
Continue business continuity and recovery actions
37
Evacuation: Extended
Planning Section
Continue to track patients and staff locations
Track materiel and equipment transferred to other hospitals
Prepare a demobilization plan and deactivate Hospital Command Center positions
and staff when they are no longer necessary
Discuss staff utilization and salary practices during evacuation and closure of the
facility with Human Resources; provide information to employees when determined
Continue to ensure documentation of actions, decisions and activities
Update and revise Incident Action Plan
38
Evacuation: Extended
Logistics Section
Maintain information technology security
Support evacuation of supplies (medical, food, water, other
equipment)
Assess and secure utility systems
Finance and Administration
-Continue to track and report response costs and expenditures and lost
revenue
39
Hospital Incident Command System Structure
40
Roles/Staff Assignments
Evacuation is an extremely labor-intensive process. Teams of staff members
assigned duties to support the evacuation should be activated immediately. Some
staff may need to be called in from home, but this is more likely a requirement if an
evacuation occurs during the evening shift, the night shift, or weekend hours.
Estimated needs with respect to staff resources depend on a facilitys patient
demographics.
41
Example Staff Assignment Chart
42
Patient Tracking
There should be designated patient trackingstaff who are responsible for tracking and reporting on the
location of patients throughout the evacuation process to provide continuous accountability.
An individual designated to perform head counts at the assembly points.
Staff assigned to check rooms and floors to ensure that they have been vacated.
Senior personnel in each department responsible for addressing special hazards or concerns
(e.g., turning off
medical gases, performing head counts in their areas of responsibility).
43
Medical Records
Medical records are usually located on the wards with the patients. Ensure that medical
records accompany patients when they evacuate the facility
Medications and critical equipment for patients should be taken as well.
A specific protocol for ensuring that records leave with patients should be established
as part of the evacua-tion procedures.
Consideration should be given to storing all of a health facilitys medical/essential
records in fireproof filingcabinets (although such equipment can be extremely
expensive).
44
Patient Status/Location
Patientscurrent locations and their destinations must be determined by
the hospitals incident commander.
45
Emergency Contacts/Family Notification
There should be an emergency contact for all patients. Information on this contact person
is usually kept with the patients medical records. In an evacuation, designated personnel
should:
Attempt to notify family members and other responsible parties about the patients
transfer destination.
Answer calls and respond to questions from family members about the patients welfare
and location.
46
Assembly Points and Discharge Site Locations
The hospital should identify several locations surrounding the building that
could be used as assembly points, holding areas, and/or discharge sites.
47
A place or set of places where patient care units gather (outside the
main clinical buildings of the hospital) to receive basic care and
await transfer or reentry back into the hospital. Assembly points are
not intended to be comprehensive field hospitals; rather, they
should be designed as holding areas where
only essential care
resources are available
.
Assembly Point/
Holding Are
The place where patients who are being discharged home wait for
family or friends to pick them up. Discharge sites should be located
some distance away from assembly points to
minimize traffic
congestion and competition for roadways.
Discharge Site
Important considerations include
The proximity and size of assembly points and discharge sites: While an assembly point
in close proximity to the hospital can aid in the effort to relocate fragile patients during
an evacuation, it also can be of concern in any event involving an explosive device,
chemical hazard, or some other type of potentially expansive threat.
Economies of scale: The selection of assembly points and discharge sites should take
into account that it is difficult for clinical support services (e.g., the pharmacy service) to
support patient care in many separated locations.
Site identification: Several nearby sites should be identified, and their willingness to help
in the event of an emergency should be confirmed. If an emergency occurs, these sites
should be contacted immediately.
48
Patient Destination Team
If patients are to be relocated to alternative health facilities, a patient destination team should be
activated. This team should include a representative from the incident command group as well as
senior nurses, admitting office representatives, and case managers.
All physicians and nurse practitioners must be notified that the patient destination team has been
activated and is arranging appropriate destinations for all patients. It is vitally important to the
success of the evacuation that individual physicians not compete with the team and attempt to
arrange transfers on their own.
49
Process Overview
50
Questions to Consider
Who in your organization would fill the roles of Incident Commander, Planning
Chief, Logistics Chief, and Operations Chief?
Who are their backups in case they are away from the facility?
How would your Incident Management Team make transitions between
operational periods if the event extended several days?
51
Demobilization/ System Recovery
Incident Commander
Assess if criteria for partial or complete reopening of the facility are met
Orders reopening and repatriation of patients
Oversees restoration of normal hospital operations
The incident commander is the last one to stand down their position.
52
Demobilization/ System Recovery
Liaison Officer
Notify other response agencies involved with the incident (Office of
Emergency Management, Fire, EMS) of incident termination and reopening of
facility
Safety Officer
Oversee the safe return to normal operations and repatriation of patients
53
Demobilization/ System Recovery
Operations Section
Restore patient care and management activities
Repatriate evacuated patients
Re-establish visitation and non-essential services
54
Operations: Assessment Teams
Security and fire safety
Medical
Ancillary services
Materials management
Support services
Facilities
Biomedical engineering
IT & communications
55
Operations: Assessment Teams
Assessment teams are an effective way of evaluating a closed facility to determine its status, what needs to be
accomplished in the recovery process, and when it is fit to be reopened. They consist of experts that can
evaluate a specific function of the facility, report back on it status, and identify exactly what must be done to
make it safe and operational again.
The teams tour the entire facility (internal and external) inspecting any areas that fall under their assigned
function. The teams should note the condition of the item/ area, whether it is safe or not, any repairs that
should be made (if repairable), and what course of action should be taken to safely bring their area into a
functional status (develop a plan). This information should be reported back to the administration and incident
commander.
Sub teams can (and should) be developed to assist with specific functions/ inspections.
56
Demobilization/ System Recovery
Logistics
Implement and confirm facility cleaning and restoration, including:
Structure
Medical equipment certification
Provide debriefing and mental health support
Inventory supplies, equipment, food, and water needed to return to
normal levels
57
Demobilization/ System Recovery
Planning Section
Finalize the Incident Action Plan and demobilization plan
Compile a final report of the incident and hospital response and recovery operations
Ensure appropriate archiving of incident documentation
Write after-action report and corrective action plan to include the following:
Summary of actions taken
Summary of the incident
Actions that went well
Area for improvement
Recommendations for future response actions
58
Demobilization/ System Recovery
Finance/Administration
Compile final response, recovery cost and expenditure, estimated lost
revenues
Submit to Incident Commander for approval
Contact insurance carriers to assist documenting structural and
infrastructure damage and initiate claims
59
References
60
Hospital Incident Command System. Incident Planning Guide: Evacuation, Complete or Partial Facility. August 2006.
Available at http://www.hicscenter.org/docs/206.swf
Ciottone, Biddinger, Darling, Fares, Keim, Molloy & Suner, Ciottone's Disaster Medicine, 2nd Edition, 2016
Guideline of evacuation dril CTIF/ www.ctif.org
Damon P. Coppola,Introduction to International Disaster Management, Third Edition 2016
www.ncbi.nlm.nih.gov pmc articles PMC5469841
Koenig and Schultzs, Disaster Medicine Comprehensive Principles and Practice, Second Edition, 2016
Khankeh et all, National hospital disaster risk management program based on accreditation indicators, 2018
Thanks
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ResearchGate has not been able to resolve any references for this publication.