This article was originally posted Oct. 15, 2018. It has been updated with new information.
“Calif. nursing home patients had minutes to flee wildfire”
“‘Unprecedented’ evacuations set as Hurricane Irma aims at Fla.”
“Patients evacuated from NH hospital due to possible chemical leak”
From infrastructure failings, to natural disasters, to violent attacks, emergency events sometimes reach the one place many consider a safe haven: hospitals. A hurricane, gas leak, wildfire or other emergency may force hospitals, nursing homes or skilled nursing facilities to evacuate to protect current and prospective patients.
While hospitals’ need to prepare for such events is ever present from their point of view, it may not be as front and center in EMS planning.
Are you aware of your local hospital’s evacuation plan? Has your organization had a seat at the table when discussing it? If not, then don’t be surprised to learn that you’re likely a big part of an evacuation plan; and that its success is contingent on your role.
Evacuations of this scale and acuity require planning. Whether it’s “just” the emergency department, or “just” the nursing home down the road, evacuating patients that require stretcher transport, specialized medical equipment or even specialized physician care requires planning.
Have a plan to evacuate local hospitals
EMS should have a prominent seat at the table when hospital evacuations are discussed. Resource availability, provider specialty, contingency plans, mutual aid – all of this can change based on the status of your daily or hourly resources.
Part of the incident command system and structure should integrate EMS supervisors and battalion chiefs that are aware of their daily staffing situation and resource limitations, and have the authority to make decisions that affect those of us on the street.
Planning should be conducted to the extent that as soon as the “magic button” is pressed, and an evacuation is called for, all the pieces of the puzzle should fall into place. The hospital evacuation plan binder should be referenced along with the emergency call-in policy.
Referencing a “hospital evacuation toolkit” can help facilitate this process, as well as sharing plans with local facilities, working with preparedness consultants and conducting tabletop exercises (and learning from them, too!).
The logistics of patient evacuation
Physically moving patients, undoubtedly, will be the primary role of EMS.
We should preplan before the incident, coordinate when it happens and act based on what needs to get done.
Ambulances don’t need to be restricted to transporting one patient at a time. In fact, some ambulance services have designed and incorporated multi-stretcher ambulances into their fleet.
Large transport specialty vehicle can accommodate more patients, providers and equipment. While many larger metropolitan areas employ these resources, their benefits extend to rural geographies, special event functions and MCI responses, on top of their disaster response functions.
Once units arrive at the hospital, established paperwork (including transfer orders and patient medical records) and patient tracking boards should be referenced. EMS should have as clear of a picture of what’s happening with the patient they’re transporting as the nurse caring for the patient in the hospital. This takes a lot of work, effort and planning.
Remain calm during evacuations
Preplan, build an equipment stock and consider how the design of your future ambulances and specialty vehicles will allow them to serve an evacuation function. The more that we can remain calm, cool and collected in evacuation situations, the better we’ll be able to function if (or when) the time comes.
After all, you’ve prepared for this!
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