title: Initial management of hospital evacuations caused by Hurricane Rita: a systematic investigation.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors: US Department of State, Office of the Geographer and Global Issues, Washington, DC, USA. edowney@tulanealumni.net
authors: Erin L
authors: EL
authors: Downey
authors: Knox
authors: K
authors: Andress
authors: Carl H
authors: CH
authors: Schultz
mesh_terms: D000328:Adult; D055867:Cyclonic Storms / Q000266:history; D004189:Disaster Planning; D060447:Emergency Shelter; D006271:Health Facility Closure / Q000266:history; D049674:History, 21st Century; D006801:Humans; D008145:Louisiana; D010360:Patient Transfer / Q000458:organization & administration*; D010564:Personnel, Hospital / Q000266:history / Q000600:supply & distribution; D013781:Texas