Hospitals may not be ready for emergency evacuation

Aug 1, 2006 3:54 PM

Hurricane Katrina demonstrated the difficulties involved in evacuating communities and raised questions about how hospitals and nursing homes plan for evacuations and how the federal government assists.
Due to broad-based congressional interest, the Government Accountability Office (GAO) has assessed the evacuation of hospital patients and nursing home residents. GAO examined the challenges hospital and nursing home administrators faced; the extent to which limitations exist in the design of the National Disaster Medical System (NDMS) to assist with patient evacuations; and the federal requirements for hospital and nursing home disaster and evacuation planning.
In interviews with administrators in the hurricane-affected regions, the GAO found that the administrators faced several challenges related to evacuations during recent hurricanes, including deciding whether to evacuate or stay in their facilities and "shelter in place," obtaining transportation necessary for evacuations and maintaining communication outside of their facilities.
Administrators took steps to ensure that their facilities had needed resources -- including staff, supplies, food, water, and power -- to provide care during the hurricane and maintain self-sufficiency immediately after. However, when evacuations were needed, facility administrators said that they had problems with transportation, such as securing the vehicles needed to evacuate patients. Although facility administrators had contracts with transportation companies, competition for the same pool of vehicles created supply shortages when multiple facilities in a community had to be evacuated. To make matters worse, communication was impaired by hurricane damage.
NDM, a partnership of four federal agencies -- the Deptartments of Health and Human Services, Defense, Homeland Security and Veterans Affairs -- has two limitations in its design that constrain its assistance to state and local governments with patient evacuation.
The first limitation is that NDMS evacuation efforts begin at a mobilization center, such as an airport, and do not include short-distance transportation assets, such as ambulances or helicopters, to move patients out of health care facilities to mobilization centers. The second limitation is that NDMS supports the evacuation of patients needing hospital care; the program was not designed nor is it currently configured to move people who do not require hospitalization, such as nursing home residents.
At the federal level, Health and Human Services' Centers for Medicare and Medicaid Services (CMS) have requirements related to hospital and nursing home evacuation planning as a condition of participation in the Medicare and Medicaid programs.

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