When natural emergencies disable a hospital, inhibiting its ability to provide care to its patients such as recently occurred when a tornado devastated the St. Johns Regional Medical Center in Joplin, Missouri, the emergency community rushes to its aid. Acting on years of training and planning, they quickly evacuate its patients and victims to safety. However, in large scale disasters affecting multiple hospitals within a region, the overwhelming emergency resources required to evacuate a single facility may not be available for days.
During regional emergencies, hospitals are much more dependent on their own emergency and evacuation plans and resources to save lives. Having reviewed several hundred hospital evacuation plans, I can attest that while the hospital industry has made major strides in emergency preparation during the past decade, a majority of hospitals in America are unprepared to evacuate in a large scale emergency. As a brief summary, I have listed ten reasons:
1. Insufficient transportation resources – During a large emergency, local, state and federal resources place hospitals at a lower priority of evacuation. Most hospitals do not have alternate sources of transportation nor have they considered the number and type of resources that would be required to adequately respond to their emergency.
2. Undeveloped receiving facility resources – While most hospitals have mutual aid agreements and MOUs with other hospitals in their region, many have not developed detailed procedures for emergency acceptance and admittance. Most do not have agreements that go beyond their region in the event that their MOU receiving facilities are affected by the emergency.
3. Limited tracking – A large scale evacuation of several hundred patients in the span of 24 hours entails the potential use of dozens of ambulances, helicopters, and aircraft as well as the coordination of hundreds of personnel. In addition, internal and external tracking of patients, medicines, charts and personal belongings must be managed and tracked to mitigate the effect on patients and their families. Most hospitals do not have systems to accomplish this feat.
4. Lack of Coordination with Emergency Community – A majority of hospitals have reviewed their emergency and evacuation plans with their emergency management, EMS, police and fire departments. However, many have not relayed the weaknesses of their facility, nor have they clearly delineated the expectations they have of their local emergency providers. In the event that local providers are unable to assist, most hospitals have not detailed what is required to bring in outside providers. In addition, most have not detailed the communication plans that must be in place between the facility, their providers, and the emergency community.
5. Unclear triggering strategy and methodology – JCAHO standards outline minimum rationale for evacuating a hospital, yet realistic criteria are more complicated. Because of conflicting management issues, most decision criteria are not well delineated, creating confusion amongst the implementers of evacuation policies.
6. Undefined communication system – While most hospitals have acquired adequate communication hardware, including multiple backup methods, most have not defined the detailed communication processes that must be in place to implement a realistic evacuation. Rapid mass coordination of admission to receiving hospitals is one example.
7. Limited triage plan – Most hospitals have basic triage methodology to fit specific vulnerability analyses. However, many hospitals’ triage procedures have not considered realistic timing limitations of known transport resources and receiving facilities as well as a realistic rate of patient and personnel evacuation.
8. Undeveloped patient preparation plan – While much work has been done by most hospitals to develop detailed vertical and horizontal evacuation plans that correspond to required fire safety protocols, many hospitals inadequately rely on this planning to fulfill emergency internal evacuation processes. As an example, in most cases, vertical evacuation should be coordinated with the arrival patterns of transportation vehicles.
9. Lack of cost tracking – To be reimbursed by the Federal Government after incurring emergency expenses during a federal emergency, the hospital must provide detailed time and cost records for all personnel, materials, and vehicles used in the emergency. Most hospitals do not have adequate procedures or capacity to account real time for costs, potentially forfeiting millions of recovery dollars as a result.
10. Inadequate funding – The United States has access to 70,000 ambulances, enough to overwhelm even most large disasters. However, many hospitals rely on the Stafford Act to fund their rescue, limiting access to available resources. Most have not planned for alternate funding mechanisms to draw upon during an ongoing emergency.