title: Hospital evacuation: Exercise versus reality.
abstract: BACKGROUND
  The Dutch Major Incident Hospital (MIH) is a standby, highly prepared, 200-bed hospital strictly reserved to provide immediate, large-scale, and emergency care for victims of disasters and major incidents. It has long-standing experience training for various major incident scenarios, including functioning as a back-up facility for the Netherlands. In 1995, the MIH had experience with overtaking an evacuated hospital when that hospital was threatened by flooding. In November 2014, an exercise was performed to transfer an evacuating hospital to the MIH. The scenario again became reality when a neighbouring hospital had to evacuate in September 2015. This article evaluates the events and compares the exercise to the real events in order to further optimise future training.
  
  
  METHODS
  All three events were analysed using the Protocol for Reports from Major Accidents and Disasters, a standardised protocol to evaluate medical responses to a major incident.
  
  
  RESULTS
  During the 2014 exercise, 72 patients were received, compared with 143 and 70, respectively, in the real events in 1995 and 2015. Personnel from the evacuating hospitals accompanied the patients and continued working in the MIH. The patient surge differed on all three occasions. The information technology (IT) systems proved to be more prone to fail during the real event, and legal implications to have staff from another hospital work in the MIH had to be put in protocol during the deployment. The acute phase was comparable in all three events, and performance was good. However, the exercise did not last long enough to analyse the implications on multiday care, as experienced during a multiday deployment.
  
  
  CONCLUSIONS
  Large-scale major incident exercises are a great benchmark for the medical response in the acute phase of relief. The MIH was shown to be highly prepared to admit an entire evacuating hospital or large groups of patients in such a scenario. Experiences from the past, combined with regular training that closely resembles reality, guarantee the level of preparedness. Key differences between a true deployment and an exercise are the inability to train multiple days, and in our experience, a successful operation of IT systems in test environments does not guarantee their successful use during live events.
authors.affiliation: Major Incident Hospital, University Medical Center Utrecht, the Netherlands. Electronic address: jjm.haverkort@outlook.com.
authors.forename: J J Mark
authors.initials: JJ
authors.lastname: Haverkort
authors.affiliation: VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Tessa H
authors.initials: TH
authors.lastname: Biesheuvel
authors.affiliation: VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Bloemers
authors.affiliation: Major Incident Hospital, University Medical Center Utrecht, the Netherlands; Department of Surgery and Trauma Surgery, University Medical Center Utrecht, the Netherlands.
authors.forename: Mirjam B
authors.initials: MB
authors.lastname: de Jong
authors.affiliation: Department of Surgery and Trauma Surgery, University Medical Center Utrecht, the Netherlands.
authors.forename: Falco
authors.initials: F
authors.lastname: Hietbrink
authors.affiliation: Major Incident Hospital, University Medical Center Utrecht, the Netherlands.
authors.forename: Lukas L
authors.initials: LL
authors.lastname: van Spengler
authors.affiliation: Major Incident Hospital, University Medical Center Utrecht, the Netherlands; Department of Surgery and Trauma Surgery, University Medical Center Utrecht, the Netherlands.
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D003299:Cooperative Behavior; D004189:Disaster Planning / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D017598:Efficiency, Organizational / Q000592:standards*; D004636:Emergency Service, Hospital; D005260:Female; D006739:Hospital Administration; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010360:Patient Transfer / Q000458:organization & administration* / Q000592:standards; D015397:Program Evaluation; D018635:Rescue Work; D055872:Surge Capacity / Q000592:standards; D014187:Transportation of Patients / Q000458:organization & administration* / Q000592:standards; D014218:Triage
keywords: Evacuation; Major incident; Major incident hospital; Preparedness; Surge capacity