On September 3rd the Royal Perth Hospital in Australia was evacuated after a suspicious package and two firearms were discovered on a treatment floor forcing evacuation of staff and patients from the upper floors of the facility. Also on that day, a chemical spill at Lucy Curci Cancer Center at Eisenhower Medical Center in California forced an hour-long evacuation of the second floor while hazardous materials experts responded. A few days prior, in Colville, Washington, the Chelan Hospital was evacuated due to wildfires that threatened the safety of the facility and local inhabitants.

The decision to partially or completely evacuate a hospital or healthcare facility is a complex issue that needs to balance the nature of the threat against the risk patients and staff would face. Successful evacuation requires management of multiple objectives: the multifaceted set of circumstances forcing the evacuation, the ever evolving logistical support needed to accomplish the mission, and the timely and coordinated movement and tracking of patients, staff and materiel.

Survey Says – Hospital Evacuation Training is the Key

One of the keys to a successful operation is staff familiarity with the evacuation process. A study recently published on the evacuation experience of four New York City hospitals during Hurricane Sandy showed that only 21% of staff participated in an ICU drill in the past two years, and a mere 28% had prior training or real-life experience. 

A survey of hospital staff directly involved in the Hurricane Sandy ICU evacuations reported that processes were inconsistent for patient prioritization, tracking, transport medications, and transport care. Respondents identified communication (43%) as the key barrier to effective evacuation. The equipment considered most helpful included flashlights (24%), transport sleds (21%), and oxygen tanks and respiratory therapy supplies (19%). An evacuation wish list included walkie-talkies/phones (26%), lighting/electricity (18%), flashlights (10%), and portable ventilators and suction (16%).

A Focus on Patients

Evacuating “real” patients is an experience unlike what is often rehearsed in training and drills where mannequins or cooperative, healthy volunteers are strapped into an evacuation device and leisurely dragged down a hall and stairwell by several staff members where the pressures of the event are merely characterized in an inject written on an index card. A “true” evacuation requires time, labor-intensive resources, and support at levels that most healthcare facilities don’t possess for routine emergencies. 

Sicker patients require more time, resources and materiel to safely accomplish an evacuation. Failure to take into account the health of a facility’s inpatients during evacuation decision-making is one of the single biggest multipliers that will impact the morbidity and mortality of patients during an evacuation.

ICU providers who evacuated critically ill patients during Hurricane Sandy had little prior knowledge of evacuation processes or vertical evacuation experience. Study respondents felt that the weakest links in the patient evacuation process were communication and the availability of practical tools. Incorporating ICU providers into hospital evacuation planning and training, developing standard evacuation communication processes and tools, and collecting a uniform dataset among all evacuating hospitals could better inform critical care evacuation in the future.

For assistance with your evacuation training, planning and exercises, give DQE a call at 800-355-4628 or visit us at dqeready.com. DQE also provides products to assist in hospital evacuation management – see the PACE Evacuation Toolbox here.

Reference: Disaster Med Public Health Preparedness. 2015;0:1–8). (http://dx.doi.org/10.1017/dmp.2015.94).