Hospital Evacuation Planning

Disaster planning must include a community mutual aid plan in the event that the hospital (s), nursing home(s), or other residential health care facility needs to be evacuated. Plans for evacuation of health care facilities must be realistic and achievable, and contain sufficient specific detail as to where patients will be relocated to and who will be there to care for them. Patient evacuation was a major challenge to disaster response efforts following Hurricane Katrina, and was hampered by the destruction of all major transportation routes in and out of the city. Pre-planning for the possibility of the need to evacuate entire health care facilities must address alternative modes of transportation and include adequate security measures (see Figure 1.4). 

The application of simulation to a disaster event can be as simple as using the simulators to drill evacuation procedures at a long-term care (ETC) facility. With hurricane season on us, several ETC organizations will begin to work with their staff to do just that. By programming the simulators to be elderly with chronic conditions and adding a nasal O2 mask, staff will be able to evaluate the effectiveness of their evacuation plan. Or perhaps the placement of patient simulators within a hospital itself... 

Figure 6. Interaction of the red and white plans for the evacuation of casualties following a disaster. The fire service are responsible for rescue and primary evacuation of casualties as far as the advanced medical post. Here, casualties are triaged and receive primary treatment. The hospital white plan for the management of mass casualties is extended to this point using medically manned mobile intensive care units which can carry out extensive early care before transporting the patient to the most appropriate hospital facility. In the case of a toxic release, this will be to a special reference hospital, manned and equipped to deal with casualties from a chemical-biological release...

Facilities which treat, store or dispose of hazardous wastes must, under 40 CFR 264 and 265, develop emergency plans to minimize hazards to human health and the environment in the event of fire, explosion, or chemical release into the environment. A detailed plan of action is required, which considers such events and details arrangements with local police, fire, hospital, emergency response teams. The plan should list the name of the emergency coordinator(s), emergency equipment, and detail the evacuation plan. 

Figure 11.6 shows the STAMP-based analysis of the Oakbridge city emergency-response system. Planning was totally inadequate or out of date. The fire department did not have the proper equipment and training for a chemical emergency, the hospital also did not have adequate emergency resources or a backup plan, and the evacuation plan was ten years out of date and inadequate for the current level of population. 

The ambulance circuits and loading points should be upwind of the incident site and outside the outer cordon. The evacuation plan should also be coordinated at a higher level to ensure casualties are sent to appropriate hospitals and distributed so that no single hospital is overwhelmed if possible. In the event of a hospital receiving a significant number of contaminated casualties the evacuation plan may be changed to redirect clean casualties to alternative hospitals. 

All hospital plans should include provisions for a proportionate response to the arrival of contaminated casualties, with procedures for rapid lock-down and establishing entry and exit restrictions. Most ambulance service plans already provide for sending an immediate alert to all hospitals designated to receive casualties whenever a major incident is declared. Although patients may have already self-evacuated before the emergency services arrive, ambulance plans should also provide for warning all... 

Pre-hospital disaster care in France is controlled by two national response plans, called red (Plan Rouge http //en.wikipedia.org/wiki/ Plan rouge) and white (Plan Blanc http //www. sante.gouv. fr/htm/actu/3 l 030814b.htm http // en/wikipedia.org/wiki/Plan blanc). The red plan concerns the rescue and evacuation of victims from a disaster site by the fire and rescue service. The plan provides for an overall on-site commander (COS) who controls a fire and rescue and a... 

The classical concept of military medical care has been that a chain of surface or ground evacuation is available. Using helicopter evacuation, immediate casualty collection points may be bypassed so that wounded personnel can be taken directly to well-equipped hospital facilities located relatively far to the rear reducing the need for an extensive ground evacuation system. However, reorganization of the medical evacuation system in which the intermediate elements are deleted, based primarily upon the proposed use of helicopter evacuation, may not be possible or desirable. Helicopter evacuation may become severely limited if nuclear weapons are used extensively, and the success of helicopter evacuation is certainly affected by weather conditions and enemy air capabilities. Therefore, a ground based evacuation system must be planned for since it could easily become the primary means of evacuation. 

B. It may become necessary for all hospitals to be able to establish and operate a continuous minimal treatment facility as part of the regular operational plan. This minimal treatment facility would be used to house those patients who cannot return to duty and who do not require or warrant hospitalization in the regular or intensive treatment part of the hospital. This is necessary since, whether patients in an evacuation chain are hospitalized or not, they must be held somewhere and accounted for. They must be housed, fed, and given at least minimal care, and they must be near definitive medical care so that they can receive additional medical treatment in an efficient manner when time and resources permit. In such a minimal treatment facility, the emphasis would be on self-care since the staffing would have to be minimal. 

Echelon IV medical care, found at the Echelon Above Corps (EAC) and higher, is presently provided in a General Hospital (GH). The MRI plans to replace the GH with a hospital of similar capability at the EAC. The GH or its replacement consists of general and specialized medical and surgical capability, including treatment that may be required to stabilize the casualties who require evacuation to CONUS. 

The existing plant emergency plan went into effect immediately with the sounding of the automatic siren alarm. Plant evacuation, head count, and confirmation that a cHticality accident had occurred were accomplished within less than five minutes. Within the next few minutes, as provided in the emergency plan, an ambulance was summoned for the injured employee and notification was made to the Plant Superintendent, other Company officials, and the USAEC. Within the first hour, the Plant Superintendent had arrived on site. The ambulance had been redirected by radio to Rhode Island Hospital in Providence when the local hospital indicated it could not handle the case because of a lack of facilities for treating radiation injuries. 

---