title: External factors impacting hospital evacuations caused by Hurricane Rita: the role of situational awareness.
abstract: BACKGROUND
  The 2005 Gulf Coast hurricane season was one of the most costly and deadly in US history. Hurricane Rita stressed hospitals and led to multiple, simultaneous evacuations. This study systematically identified community factors associated with patient movement out of seven hospitals evacuated during Hurricane Rita.
  
  
  METHODS
  This study represents the second of two systematic, observational, and retrospective investigations of seven acute care hospitals that reported off-site evacuations due to Hurricane Rita. Participants from each hospital included decision makers that comprised the Incident Management Team (IMT). Investigators applied a standardized interview process designed to assess evacuation factors related to external situational awareness of community activities during facility evacuation due to hurricanes. The measured outcomes were responses to 95 questions within six sections of the survey instrument.
  
  
  RESULTS
  Investigators identified two factors that significantly impacted hospital IMT decision making: (1) incident characteristics affecting a facility's internal resources and challenges; and (2) incident characteristics affecting a facility's external evacuation activities. This article summarizes the latter and reports the following critical decision making points: (1) Emergency Operations Plans (EOP) were activated an average of 85 hours (3 days, 13 hours) prior to Hurricane Rita's landfall; (2) the decision to evacuate the hospital was made an average of 30 hours (1 day, 6 hours) from activation of the EOP; and (3) the implementation of the evacuation process took an average of 22 hours. Coordination of patient evacuations was most complicated by transportation deficits (the most significant of the 11 identified problem areas) and a lack of situational awareness of community response activities. All evacuation activities and subsequent evacuation times were negatively impacted by an overall lack of understanding on the part of hospital staff and the IMT regarding how to identify and coordinate with community resources.
  
  
  CONCLUSIONS
  Hospital evacuation requires coordinated processes and resources, including situational awareness that reflects the condition of the community as a result of the incident. Successful hospital evacuation decision making is influenced by community-wide situational awareness and transportation deficits. Planning with the community to create realistic EOPs that accurately reflect available resources and protocols is critical to informing hospital decision making during a crisis. Knowledge of these factors could improve decision making and evacuation practices, potentially reducing evacuation times in future hurricanes.
authors.affiliation: US Department of State, Office of the Geographer and Global Issues, Washington, DC, USA. edowney@tulanealumni.net
authors.forename: Erin L
authors.initials: EL
authors.lastname: Downey
authors.forename: Knox
authors.initials: K
authors.lastname: Andress
authors.forename: Carl H
authors.initials: CH
authors.lastname: Schultz
mesh_terms: D000328:Adult; D001364:Awareness; D055867:Cyclonic Storms / Q000266:history; D003657:Decision Making; D004189:Disaster Planning / Q000458:organization & administration; D006271:Health Facility Closure / Q000266:history; D049674:History, 21st Century; D006801:Humans; D010360:Patient Transfer / Q000266:history / Q000458:organization & administration*; D012189:Retrospective Studies