From Natural Disasters to Utility Failures: Planning for Full Building Evacuations in Health Care Facilities

Matthew Icenroad

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Feb 22, 2023

On February 7, 2023, a fire broke out at Signature Healthcare Brockton Hospital resulting in the forced evacuation of all 160 patients occupying the facility. Although the investigation is underway and more is to be learned about this incident, it is clear the fire was not the primary reason for the evacuation. Ultimately, the fire damaged critical infrastructure resulting in a loss of power to the entire hospital. The facility no longer could operate its life safety features, life-saving medical devices were operating on battery back-ups, primary medical gases were unavailable, and vital non-medical equipment and infrastructure were not functional.

HVAs and Emergency Preparedness in Hospitals

In 2017, the Centers for Medicare & Medicaid Services (CMS) published the final rule “Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers.” The rule and associated Conditions of Participation set out to “establish national emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers to plan adequately for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems.”

The rule requires health care organizations to conduct a Hazard Vulnerability Assessment (HVA) ) [see § 482.15(a)(1)-(3)]. A hazard vulnerability assessment is a systematic process used to identify and prioritize the potential threats or hazards that a community, organization or facility may face. HVAs provide information that can be used to develop and implement effective mitigation and response strategies that minimize the impact of these hazards. HVAs go beyond identifying the risks of specific events to understand the potential consequences events can have on facilities.

Signature Health Brockton Hospital is an example of when it would be beneficial to conduct a risk assessment to understand the consequences of an event better, rather than evaluate the likelihood of the event occurring. The key to planning and mitigation is utilizing a Consequence-Based Planning (CBP) risk management approach that focuses on identifying and analyzing the potential consequences of an emergency event.

Considerations for Full Building Evacuation Planning

CMS Conditions of Participation also focuses on the need for health care organizations to have full building evacuation plans that allow for safe evacuation. Plans should include consideration for care and treatment of evacuees, staff responsibilities, transportation, evacuation location(s), and primary and alternate means of communication with external sources of assistance.

With careful planning and coordination, a full building evacuation plan provides a “playbook” on actions the organization, leadership, and front-line staff can take to mitigate the consequences of an event and safely evacuate the building. However, this plan should be flexible and be able to be amended during the response as situations, the environment, and availability of resources change.

Organizations should take the following into consideration when developing evacuation plans:

  1. Care and Treatment Needs. During the planning process, organizations must take into consideration the unique characteristics and types of care provided in each unit and department across their facility. A full evacuation of the Intensive Care Unit, Neonatal Intensive Care Unit, Medical Surgical Unit and Labor Delivery may have similar but vastly unique planning considerations. These units should consider:
    • Developing a process to prepare and “package” patients for evacuation.
    • Pre-planning internal staging areas based on acuity levels to allow for patient evacuation from their units/departments to a ground level evacuation point.
    • Planning internal evacuation routes for each area.
  2. Staff Responsibilities. To maintain control of the evacuation, internal staff and external supporting agencies must be assigned specific tasks to ensure the smooth and efficient evacuation of patients, including patient assessment, transportation, and communication with leadership and responding agencies.
  3. Evacuation Methods and Equipment. Organizations should develop methods and have equipment available that will ensure an effective and efficient evacuation. This includes:
    • Establishing horizontal and vertical evacuation methods to keep patients safe while moving out of the building.
    • Acquiring and utilizing safe evacuation equipment available from various manufacturers, such as evacuation sleds, infant evacuation baskets and evacuation stair chairs.
    • Training staff and maintaining their competency on how to use the different types of evacuation equipment based on patient needs.
    • Considering different care and treatment needs so that patients continue to receive treatment during evacuation.
  4. External Transportation. Patients must be transported to safe locations using appropriate transportation based on their medical needs and the resources available. This includes performing a transportation evacuation survey across hospital units/departments to establish a baseline transportation needs assessment as well as a process for the rapid assessment of transportation needs during evacuations.
  5. Patient Distribution and Tracking. A record of patients and their locations must be kept during the evacuation process to ensure accountability, safety and notification to family members. Hospitals should identify where certain critical care patients (e.g., ECMO, IABP, VAD, NICU) should be evacuated, with specific focus on hospitals that provide the same level of care.
  6. Digital Situational Awareness Tools. New and innovative digital tools have been developed and used during hospital evacuations. As common operating platform technologies have been developed and deployed, it is important to recognize the unique considerations for the health care industry. For example, while the number open beds available is a piece of essential information, understanding the categories of care those beds provide ultimately supports the health care community’s coordination of patient movement.
  7. Primary and Alternate Means of Communication with External Sources of Assistance. Regular communication with local emergency management and responding agencies must be maintained to ensure coordination and provide updates on the evacuation status, patient distribution, and requested resources. It is also critical to ensure that health care coalition groups share information and have the proper Memorandum of Understandings (MOUs) in place to assist one another during times of crisis.

Overall, hospital evacuations are a testament to the importance of emergency preparation and coordination and the continued need for innovation and improvement in evacuation planning and procedures. Hospital evacuations have rippling impacts on the surrounding health care community and lean heavily on local and state emergency management agencies, health care coalitions, and partners.

Read more about health care building evacuation planning in our upcoming white paper, which will provide an in-depth look at its impact on hospitals, important planning and response considerations, and other topics. Learn more about Jensen Hughes Health Care Solutions.