title: Hospital Evacuation and Shelter-in-Place: Who Is Responsible for Decision-Making?
abstract: During natural disasters, hospital evacuation may be necessary to ensure patient safety and care. We aimed to examine perceptions of stakeholders involved in these decisions throughout the Mid-Atlantic region of the United States during Hurricane Sandy in October 2012.
  
  
  
  Semistructured interviews were conducted from March 2014 to February 2015 to characterize stakeholders' perceptions about authority and responsibility for acute care hospital evacuation/shelter-in-place decision-making in Delaware, Maryland, New Jersey, and New York during Hurricane Sandy. Interviews were recorded, transcribed, and thematically analyzed using a framework approach.
  
  
  
  We interviewed 42 individuals from 32 organizations. Hospital executives from all states reported having authority and responsibility for evacuation/shelter-in-place decision-making. In New York and Maryland, government officials stated that they could order hospital evacuation, whereas officials in Delaware and New Jersey said the government lacked enforcement capacity and therefore could not mandate evacuation.
  
  
  
  Among government officials, perceived authority for hospital evacuation/shelter-in-place decision-making was viewed as a prerequisite to ordering evacuation. When both hospital executives and government officials perceive themselves to possess decision-making authority, there is the potential for inaction. Future work should examine whether a single entity bearing ultimate responsibility or regional emergency response coalitions would improve decision-making. (Disaster Med Public Health Preparedness. 2016;10:320-324).
authors.affiliation: 1Department of Health Policy and Management,Johns Hopkins Bloomberg School of Public Health,Baltimore,MD.
authors.forename: Meghan D
authors.identifier: 0000-0002-6833-3763
authors.initials: MD
authors.lastname: McGinty
authors.affiliation: 4US Environmental Protection Agency,Washington,DC.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Burke
authors.affiliation: 2Department of Environmental Health Sciences,Johns Hopkins Bloomberg School of Public Health,Baltimore,MD.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Barnett
authors.affiliation: 3Department of Health,Behavior and Society,Johns Hopkins Bloomberg School of Public Health,Baltimore,MD.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Smith
authors.affiliation: 1Department of Health Policy and Management,Johns Hopkins Bloomberg School of Public Health,Baltimore,MD.
authors.forename: Beth
authors.initials: B
authors.lastname: Resnick
authors.affiliation: 1Department of Health Policy and Management,Johns Hopkins Bloomberg School of Public Health,Baltimore,MD.
authors.forename: Lainie
authors.initials: L
authors.lastname: Rutkow
mesh_terms: D002959:Civil Defense / Q000331:legislation & jurisprudence* / Q000379:methods / Q000592:standards; D055867:Cyclonic Storms / Q000706:statistics & numerical data; D003657:Decision Making; D003691:Delaware; D060447:Emergency Shelter / Q000331:legislation & jurisprudence / Q000379:methods*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008396:Maryland; D009515:New Jersey; D009518:New York; D010465:Perception; D011635:Public Health Administration / Q000331:legislation & jurisprudence / Q000379:methods*; D036301:Qualitative Research
keywords: disasters; emergency preparedness; hospital evacuation; hospital shelter-in-place; organizational decision-making