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Hospital Evacuation Decision Guide (Table 6)

Public Health Emergency Preparedness

Table 6. Factors to Consider in Deciding Whether to Begin a Pre-Event Evacuation

Factor	Issues to Consider	Implications
Event Characteristics
Arrival	When is the event expected to "hit" the hospital? The metropolitan area? How variable is the time the event is expected to "hit"?	The amount of time until the event "hits," combined with the anticipated time to evacuate patients, determines how long an evacuation decision can be deferred.
Magnitude	What is the expected strength of the event? How likely is the event to gain or lose strength before it reaches the hospital? The metropolitan area?	The magnitude of the event forewarns the potential damage to a facility and utilities, which could cut off the supply of key resources, or otherwise limit the ability to shelter-in-place and care for patients.
Area impacted	How large is the geographic area to be affected by the event? How many vulnerable health care facilities are in this geographic area?	Competition for resources needed to evacuate patients (especially vehicles) increases when more facilities evacuate simultaneously.
Duration	How long is the event expected to last? How variable is the expected duration of the event?	The duration of the event will affect how long hospitals have to shelter-in-place or operate on backup, alternative, or less predictable sources of key resources.
Anticipated Effect of the Event on Key Resources Needed to Care for Patients
Water source	Is the main city water supply in jeopardy? Already non-functional? Is there a backup water supply (well, nearby building with intact water mains)? If not, how soon will city water return?	Water loss of unknown duration (more than 1-2 days) is almost always cause for evacuation.
Heat source	Is the heat source in jeopardy (steam, water for boilers, etc.)? Already non-functional? Is there a backup (intact nearby building that still has power/heat)? If not, will the building be too cold for patient safety before adequate heat returns?	Loss of heat, especially during a northern winter, is almost always a cause for evacuation—often within 12 hours.
Electricity	Is power in jeopardy? Just for the hospital or a wider area? Are backup generators functional? How long can they run without refueling? Is refueling possible (e.g., intake not under water)? Can some sections/wings be shut down to reduce fuel consumption and stretch fuel supplies?	Loss of electricity endangers ventilated patients, among others, and may affect the sequence in which patients are evacuated.
Building structural integrity	Is the building obviously/visibly unsafe? All of it or only portions (e.g., can people be consolidated in safer sections)? Was there a water tower on the roof, and is it intact? Is a building engineer needed to determine structural integrity/safety?	Earthquakes or explosions may cause rooftop water towers to fail, flooding the building. Safety/integrity may not be obvious to untrained occupants.
Anticipated Effect of the Event on the Surrounding Environment and Community That Could Affect an Evacuation Decision
Road conditions	Are any major routes from the hospital to potential receiving care sites closed? Is traffic at gridlock on major routes from the hospital to potential receiving care sites? Are access routes to the hospital cut off?	There may be a limited window of opportunity to carry out a ground-based evacuation. Increased use of helicopters to evacuate patients may be required. Staff may not be able to get to the hospital to relieve existing staff or assist in the evacuation.
Community/building security	Have any nearby areas experienced increases in disorder or looting? Are local law enforcement agencies understaffed due to self-evacuations or significant additional responsibilities? Are additional private security officers available to secure the hospital?	If patient and staff safety cannot be assured, evacuation will be necessary.
Evacuation status of other nearby health care facilities	Are other hospitals or other health care facilities already evacuating or planning to evacuate, or have they decided to shelter-in-place?	If other hospitals or health care facilities are evacuating: the competition for ambulances, wheelchair vans, and buses may be substantially increased. the hospital may be asked to accept additional patients. patients may have to be relocated to facilities further away than anticipated.
State/county/local evacuation order	Have evacuation orders been issued in areas that are closer to the event? Have any public or private statements been issued regarding the possibility of an evacuation order? Have any other incidents occurred that increase the likelihood that an evacuation order will be issued?	You may have no choice but to evacuate.
Availability of local emergency response agencies	Are local emergency response agencies understaffed (or otherwise unavailable) due to self-evacuations or additional responsibilities?	Unavailability of local fire agencies increases the risk of sheltering-in-place.

Page last reviewed July 2018

Page originally created August 2017

Internet Citation: Hospital Evacuation Decision Guide (Table 6). Content last reviewed July 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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