Preparing for More Frequent + More Complex Hospital Evacuations

Roger Glick

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Jul 10, 2023

Hospitals and other health care facilities across the United States must be prepared for total “full building” evacuations. Although rare, these events can affect any health care facility and have a significant impact on its operations and the surrounding community. Consider the following examples:

  • On December 30, 2021, the fast-moving Marshall Fire in Colorado forced staff members at Centennial Peaks Hospital to evacuate 68 behavioral health patients in less than two hours, while two nearby acute care hospitals were also evacuating.
  • In 2022, Hurricane Ian forced at least 16 hospitals in central and southwestern Florida to evacuate patients after it made landfall near the city of Fort Myers.
  • In February 2023, all 160 patients at Brockton Signature Hospital in Brockton, Massachusetts, were fully evacuated and transferred to safety by 70 ambulances after an electrical transformer fire caused the hospital to lose power.

Good and important work is being done around the United States to prepare for health care evacuations – and for good reason. Health care facilities are almost always at high or maximum capacity. They are also vulnerable to numerous threats, including aging local or community infrastructure, insults from natural or man-made emergencies, and increasing reliance on technology.

While more work still needs to be done in the field of evacuation preparedness for inpatient health care facilities (e.g., hospitals, nursing homes), the need for evacuation planning in specialty inpatient health care is gaining greater attention. Hospitals, including specialty hospitals, are learning that patients requiring specialized care present unique challenges for evacuations. This includes critical care, pediatric, and neonatal intensive care unit patients, among other inpatient populations.

For example, our team has identified six ways inpatient behavioral health evacuations are different and more complex than traditional inpatient evacuations.

  • Staffing and space for behavioral health inpatient facilities/units are extremely limited. The Virginia Department of Behavioral Health and Developmental Services, for example, reported that behavioral health hospitals routinely maintained a patient census of 103% to 105% pre-COVID and that many communities often have 20 patients holding/waiting for an inpatient behavioral health bed at any given time. This would obviously be worse if an entire unit/building evacuates. Patient census numbers have worsened post-COVID.
  • It is difficult to decompress behavioral health patients rapidly. Unlike traditional inpatients, behavioral health patients cannot be discharged quickly or transferred to a lower level of care to create capacity within the system during an emergency.
  • Patients may become easily agitated in a rapidly changing emergency. Agitated patients can quickly cause other patients to escalate, creating a challenge that worsens exponentially.
  • Outpatient community resources are lacking. Some outpatient community partners that care for behavioral health patients (e.g., Community Service Boards) may not be engaged with inpatient behavioral health for evacuation or surge planning.
  • Patients may be at increased risk to self-harm, making it necessary to monitor the environment closely to ensure safety. Transportation and space hazards must be carefully assessed and mitigated. Sharp objects and ligature potential – on staff, in all evacuation routes, and at staging areas outside the hospital facility – must be removed. Because of the lack of excess inpatient behavioral beds, alternate care sites may need to be used and would require rigorous safety evaluation.
  • There are even greater regulations on the care, transportation/movement, and sheltering of behavioral health patients than traditional health care inpatients. Laws vary state-to-state, are intricate, and are often poorly understood by hospital and emergency decision-makers.

As a leader in health care emergency preparedness, Jensen Hughes partners with you to help you navigate your toughest challenges. Using our deep knowledge and vast experience in computer optimization modeling, ADA compliance, and full-building evacuation planning and training, we work together as a team to develop innovative, practical solutions for some of the most complex emergency preparedness issues faced by health care organizations. Learn more about how we can help you prepare for any emergency event.

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About the author

Roger Glick
Roger is an emergency management expert with specific expertise in healthcare. Having more than 20 years in the industry, he has worked with rural Critical Access Hospitals, large academic medical centers, regional healthcare systems, healthcare coalitions, colleges and universities, and government organizations.