To evacuate or not to evacuate?
To evacuate or not to evacuate?
Communication will help make decision easier
Whether to evacuate patients prior to the arrival of a storm such as the recent Gulf Coast hurricanes often is not a cut-and-dried decision, says Robert Wise, MD, Vice President, Division of Standards and Survey Methods for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
"There are two kinds of decisions that need to be made," he says. "The first is at the community level, where the municipality determines whether the population should evacuate. Then, the actual hospital has to decide essentially if it is going to evacuate patients. A lot has to do with the physical facility and the hospital’s ability to withstand being isolated."
In discussions with facilities in areas that get hit by hurricanes on a regular basis, says Wise, "Many have hardened their structures to handle the assault a hurricane can deliver." The most critical considerations, he says, include whether the generators can continue to operate, whether there is a water supply, and whether staff will remain available.
Of course, if your facility is about to be hit by a Category 5 storm, much depends on whether the facility itself can sustain the blow. "The vulnerability of a hospital is based on the actual structure itself and whether it can endure," Wise says. "The other part is whether it can maintain operations. The most important piece in that equation is the generators."
Water and staff
Some hospitals, he notes, have moved their generators to higher floors, to avoid flood waters. "This makes sense," he says, "But if you go back to [tropical storm] Allison in Houston, a lot of hospitals had their generators on the third or fourth floor, but they had the switching components in the basement. You can’t have any critical components on the lower floors."
Another consideration, says Wise, is how long you expect to depend on your generators for electrical power. "A typical generator is not meant to hold a hospital for several weeks at a time," he points out.
If you know your facility can withstand the storm, the other key questions involve water and staff. Having potable water and being able to maintain sanitary conditions are essential. It is also, of course, impossible to run a facility without staff. "They are devastated, too," says Wise, "Because they may have lost all their belongings. You can have a facility that is able to run, but [it can’t run] if you have a staff that feels it has to go home and take care of its own needs."
How do you overcome this problem? "Some hospitals put together crews to protect staff houses," says Wise.
The bottom line is that evacuation is never an easy decision, says Randy Pilgrim, MD, president and chief medical officer of The Schumacher Group, a Lafayette, LA-based practice management firm that provides emergency medicine, staffing, and practice management services to 104 facilities, including 30 in Louisiana, and which was heavily involved the Katrina response process. His says his experiences have taught him a valuable lesson.
"I think that the biggest opportunity for change lies in having a clear idea of not necessarily when you’ll make the decision but how the different ingredients of command and control will come together when the decision is imminent," says Pilgrim. "What I noticed is that there are incredible pressures on the leadership structure, given that health care is thought of in America as nearly an inalienable right and the last thing you want to take from people. That mindset leads to the fact that hospitals will stay open long past when other businesses would have closed, shut down, boarded up, and evacuated. As you do that, more chaos surrounds you. In that confusion, you must have great clarity of thought and input."
Need More Information?
For more information, contact:
- Robert Wise, MD, Vice President, Division of Standards and Survey Methods, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5000.
- Randy Pilgrim, MD, President and Chief Medical Officer, The Schumacher Group, 200 Corporate Blvd., Suite 201, Lafayette, LA 70508. Phone: (800) 893-9698.
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