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.
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 requirement.
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 County.
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 I
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 II
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 Part III
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 experiences.
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 to evacuate.
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 plan.
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.