Hospital plans for full or partial evacuation should incorporate
pre-planning and address the incident command and management
structure established for its operational area (community). In
advance of an event, Hospitals should understand and incorporate
local plans and protocols that are in place to support evacuation
and should establish Memoranda of Understanding (MOUs) with other
hospitals, as necessary, for transfer and mutual aid during an
emergency.(See CHA Hospital Evacuation Plan Checklist)
When potential or actual evacuation is first contemplated, the
hospital should alert the local emergency medical services agency
(LEMSA), Emergency Operations Center (EOC), and/or Medical Health
Operational Area Coordinator (MHOAC) in accordance with the
protocols established for emergency notification in the area.
The LEMSA or EOC may assist the hospital with identifying and
coordinating placement and transport of patients and other
support while the hospital is preparing and staging for
evacuation of patients in accordance with local plans and
protocols. If the LEMSA or EOC are unable to provide assistance,
the hospital is responsible for identification of receiving
facilities and securing the consent of those facilities for
transfer. The hospital should have established protocols for
evacuation, including medications, supplies, equipment, medical
records summaries and patient tracking.
Because attending physicians may not be available for all
patients involved in an immediate evacuation, it is anticipated
that hospital-based physicians (for example, emergency,
hospitalists, medical director) will coordinate with the sending
and receiving hospitals. Medical record summaries should
accompany each patient and the patients attending physician
should be notified of the location of the patient.
The California Patient
Movement Plan provides statewide guidance for large-scale
patient movement and serves as framework for local planning
efforts. Emergency Medical Services Authority (EMSA) and
California Department of Public Health (CDPHi) will
conduct training and exercises based on the plan.
This Care and Shelter Planning Toolkit was developed with
guidance by the UASI Care and Shelter Subcommittee to the
Emergency Management Work Group. Included in the toolkit are
workshop summaries, shelter planning guidance, a resource gap
identification tool, best practices, and other resources.
This checklist provides guidance in the development or update of
a hospital evacuation plan containing detailed information,
instructions, and procedures that can be engaged in any emergency
situation necessitating either full or partial hospital
evacuation, as well as sheltering in place.
The expectation will be that staff may need to accompany patients
and work in staging areas, in local government Alternative Care
Sites (ACS) and/or at receiving facilities, subject to receiving
proper emergency credentials. Drills, training and reviews must
be conducted to ensure that staff have a working knowledge of the
plan and to ensure that the plan is workable.
The hospital evacuation plan should be consistent with federal
NIMS and The Joint Commission requirements.
Attached are a CHA Shelter-In-Place (SIP) Planning Checklist tool
and a decision-making algorithm for SIP and evacuation
activation. The Checklist and decision tree are to assist
hospitals with developing and/or reviewing and updating their
plans. Updated hospital evacuation plans and shelter in place
protocols documenting a hospital’s critical decision making
processes are a Hospital Preparedness Program (HPP) Year 7
The document is not intended to suggest that your plans be
reorganized to conform to the Checklist, but is provided as a
tool to help you ensure that the elements listed have been
addressed in your plans, policies and procedures.
The “Reference” column is to allow each hospital to note where in
their documentation each item is addressed. The decision tree is
to allow you to consider the critical decision making factors.
This is a Tool for the hospital, and is not for submission to the
It is important to note that there are a number of situations or
events that may require or lead a hospital to decide to shelter
in place and, therefore, to plan in advance for those situations.
Please also note that your plan should include what happens to
those “locked out” when you are “locked down” (identify a
sheltering site(s) outside of locked-down facilities). Also note
that SIP differs depending on the type of event.
Attached is a new tool for hospitals entitled Hospital
Repopulation after Evacuation Guidelines and Checklist
(Repopulation Guidelines). The purpose of the document is to
identify hospital operational and safety best practices, as well
as regulatory agency requirements, which must be considered when
repopulating after full or partial evacuation of general acute
care hospital inpatient building(s) (GACHB). The association
sought consultation from a number of State agencies prior to
publishing this document.
Evacuation of a healthcare facility may be necessary following an
emergency such as a facility fire or damage from a natural
disaster such as an earthquake or flooding. The decision to
evacuate a healthcare facility will be based on the ability of
the facility to meet the medical needs of the patients. Immediate
threats to life, such as internal fires or unstable structures,
will require emergent evacuation, while other situations may
allow for a planned and phased evacuation.
The Evacuation and Shelter in Place Guidance for Healthcare
Facilities is composed of three parts:
Part I provides general guidance on the differences between
evacuation and shelter in place including the roles and
responsibilities of healthcare facilities and the healthcare
system. Download Part
Part II is an Evacuation and Shelter in Place Plan Template
that healthcare facilities may use to create their own plan, or
to review when updating their plan. Download
Part III is a set of two Tabletop Exercises (shelter in place
and evacuation) that facilities may use in the planning phase as
they develop their plans to brainstorm about needs, gaps, or
solutions, and/or may use to educate personnel on the components
of their existing plan. Download
This guide was prepared through a collaborative effort to assist
healthcare providers assess pre-event vulnerabilities and plan
for the evacuation of medically fragile Level III NICU patients
while addressing core components of incident management, in
conjunction with the promotion of patient safety and evacuation
procedures based on lessons learned from past disasters and
This Hospital Evacuation Decision Guide was developed by
AHRQ, the lead Federal agency charged with supporting
research designed to improve the quality of health care, reduce
its cost, address patient safety and medical errors, and broaden
access to essential services.
This guide is designed to provide hospital evacuation
decision teams with organized and systematic guidance on how to
consider the many factors that bear on the decision to order an
evacuation, and to assist decision teams in identifying some
of the special situations, often overlooked, that may exist in
their facility or geographic area that could affect the decision
This guide is intended to supplement hospital emergency
plans, which frequently lack specific guidance on how to make the
critical decision to evacuate (including what factors to consider
and for how long the decision may be safely deferred).
This guide is designed to help organize the initial assessment of
a hospital upon return after an evacuation/closure due to an
emergency event. The specific assessments are meant to be
conducted by hospital staff to assess the level and locations of
damage sustained by the hospital, and provide information that
will be needed to create the full recovery plan. This guide will
be particularly useful for assessing a hospital that has
sustained significant or widespread damage.
Each hospital—and every emergency event causing an
evacuation—will have unique circumstances. The purpose of this
guide is to help organize the initial assessment of the hospital;
it is not intended to be a complete “reoccupation” or recovery
AHRQ has released a model to help federal, state, and local
emergency planners estimate the vehicles, drivers, road capacity
and other resources they will need to evacuate patients and
others from health care facilities in disaster areas.