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External Factors Impacting Hospital Evacuations Caused by Hurricane Rita: The Role of Situational Awareness

Published online by Cambridge University Press:  14 March 2013

Erin L. Downey*
US Department of State, Office of the Geographer and Global Issues, Washington, DC USA and Tulane University School of Public Health and Tropical Medicine (Adjunct Faculty), New Orleans, Louisiana USA
Knox Andress
Louisiana State University Health Shreveport, Shreveport, Louisiana USA and Louisiana Poison Center, Shreveport, Louisiana USA
Carl H. Schultz
Center for Disaster Medical Sciences, Department of Emergency Medicine, UC Irvine School of Medicine, Irvine, California USA
Correspondence: Erin L. Downey, MPH, ScD Tulane University School of Public Health and Tropical Medicine Department of Health Systems Management 1440 Canal Street New Orleans, LA USA E-mail



The 2005 Gulf Coast hurricane season was one of the most costly and deadly in US history. Hurricane Rita stressed hospitals and led to multiple, simultaneous evacuations. This study systematically identified community factors associated with patient movement out of seven hospitals evacuated during Hurricane Rita.


This study represents the second of two systematic, observational, and retrospective investigations of seven acute care hospitals that reported off-site evacuations due to Hurricane Rita. Participants from each hospital included decision makers that comprised the Incident Management Team (IMT). Investigators applied a standardized interview process designed to assess evacuation factors related to external situational awareness of community activities during facility evacuation due to hurricanes. The measured outcomes were responses to 95 questions within six sections of the survey instrument.


Investigators identified two factors that significantly impacted hospital IMT decision making: (1) incident characteristics affecting a facility's internal resources and challenges; and (2) incident characteristics affecting a facility's external evacuation activities. This article summarizes the latter and reports the following critical decision making points: (1) Emergency Operations Plans (EOP) were activated an average of 85 hours (3 days, 13 hours) prior to Hurricane Rita's landfall; (2) the decision to evacuate the hospital was made an average of 30 hours (1 day, 6 hours) from activation of the EOP; and (3) the implementation of the evacuation process took an average of 22 hours. Coordination of patient evacuations was most complicated by transportation deficits (the most significant of the 11 identified problem areas) and a lack of situational awareness of community response activities. All evacuation activities and subsequent evacuation times were negatively impacted by an overall lack of understanding on the part of hospital staff and the IMT regarding how to identify and coordinate with community resources.


Hospital evacuation requires coordinated processes and resources, including situational awareness that reflects the condition of the community as a result of the incident. Successful hospital evacuation decision making is influenced by community-wide situational awareness and transportation deficits. Planning with the community to create realistic EOPs that accurately reflect available resources and protocols is critical to informing hospital decision making during a crisis. Knowledge of these factors could improve decision making and evacuation practices, potentially reducing evacuation times in future hurricanes.

DowneyEL, AndressK, SchultzCH. External Factors Impacting Hospital Evacuations Caused by Hurricane Rita: The Role of Situational Awareness. Prehosp Disaster Med. 2013;28(3):1-8.

Original Research
Copyright © World Association for Disaster and Emergency Medicine 2013 

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1.Institute of Medicine. Medical Surge Capacity: Workshop Summary 2010. Published 2010. Accessed June 24, 2012.Google Scholar
2.U.S. Coast Guard. Team Coordination Training Instructor's Guide: Situational Awareness. Published 1998. Accessed June 25, 2012.Google Scholar
3.U.S. Department of Health and Human Services. Implementation Plan for the National Health Security Strategy of the United States of America. Published 2012. Accessed July 23, 2012.Google Scholar
4.Downey, EL, Andress, WK, Schultz, CH. Initial management of hospital evacuations caused by Hurricane Rita. Prehosp Disast Med. In press.Google Scholar
5.National Oceanic Atmospheric Administration. Tropical Cyclone Report: Hurricane Rita. Published 2006. Accessed July 20, 2011.Google Scholar
6.Schultz, CH, Koenig, KL, Auf der Heide, E. Benchmarking for hospital evacuation: a critical data collection tool. Prehosp Disast Med. 2005;20(5):331-342.CrossRefGoogle ScholarPubMed
7. HHS Fact Sheet: FY10 Hospital Preparedness Program (HPP). U.S. Department of Health and Human Services: Hospital Preparedness Planning Program Web site. Published 2012. Accessed July 19, 2011.Google Scholar
8. Federal Emergency Management Agency. Developing and Maintaining Emergency Operations Plans - Comprehensive Planning Guide 101. Version 2.0. Published 2010. Accessed May 22, 2011.Google Scholar
9.Chaffee, MW. Hospital response to acute-onset disasters: the state of the science in 2005. Nurs Clin N Am. 2005;40(3):565-577.CrossRefGoogle ScholarPubMed
10. Emergency Medical Assistance Compact. Articles of Agreement. Public Law 104-321. Published 1996. Accessed November 13, 2012.Google Scholar
11. The Joint Commission. Comprehensive Accreditation Manual for Hospitals: Standards EM.02.01.01, EM.02.02.03, and EM.02.02.11. Published 2009.Google Scholar
12. Code of Federal Regulations Title 42: Public Health 483.75(m) F518(1). Disaster and Emergency Preparedness. Published 2010. Accessed November 13, 2011.Google Scholar
13. US Department of Health and Human Services. Hospital Preparedness Program. Cooperative Agreement: 93.889, 2008-2009. Published 2008. Accessed May 24, 2010.Google Scholar
14. Louisiana Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing. Nursing Facility Minimum Licensing Standards, Emergency Preparedness. Promulgated 1998. Most recent amendment 2009.Google Scholar
15.Saliba, D, Buchanan, J, Kington, RS. Function and response of nursing facilities during community disaster. Am J Public Health. 2004;94(8):1436-1440.CrossRefGoogle ScholarPubMed
16. Closed NYC hospitals raise surge capacity concerns after Hurricane Sandy. Beckers Hospital Review Web site. Accessed November 13, 2012.Google Scholar
17.Government Accountability Office. Preliminary Observations on the Evacuations of Hospitals and Nursing Homes due to Hurricanes. Published 2006. Accessed August 18, 2011.Google Scholar
18.Agency for Healthcare Quality and Research. Nursing Homes in Public Health Emergencies: Special Needs and Potential Roles. Published 2007. Accessed July 20, 2009.Google Scholar
19.Brown, LM, Hyer, K, Polivka-West, L. A comparative study of laws, rules, codes and other influences on nursing homes’ disaster preparedness in the gulf coast states. Behav Sci Law. 2007;25(5):655-675.CrossRefGoogle ScholarPubMed
20. Disaster Medical Services Division: Hospital Incident Command System (HICS). California Emergency Medical Services Authority Website. Accessed October 20, 2008.Google Scholar
21.Cocanour, CS, Allen, SJ, Mazabob, J, et al. Lessons learned from the evacuation of an urban teaching hospital. Arch Surg. 2002;137:1141-1145.CrossRefGoogle ScholarPubMed
22. Hospital Evacuation Checklist - Planning for Hospital Evacuation. California Hospital Association website. Accessed September 10, 2011.Google Scholar
23. Five Year Training Plan. Federal Emergency Management Agency website. Accessed August 30, 2008.Google Scholar
24. IS-700.a: National Incident Management System, An Introduction. Federal Emergency Management Agency website. Accessed November 14, 2012.Google Scholar
25. IS-800.b National Response Framework, An Introduction. Federal Emergency Management Agency website. Accessed November 14, 2012.Google Scholar
26. Disaster Preparedness - Limitations in Federal Evacuation Assistance for Health Facilities Should be Addressed. Government Accountability Office (GAO) 06-826. Published 2006. Accessed October 12, 2010.Google Scholar
27.Powers, R, Phipps, J. Utilization of Information Systems for ED Disaster Registration and Tracking. JEN. 2006;32(6):497-501.Google ScholarPubMed
28.The Joint Commission. 2012 Hospital Accreditation Standards. Elements of Performance for EM 02.02.09. Revised publication 2012.Google Scholar
29.U.S. Federal Emergency Management Agency. Disaster Assistance Policy 9523.15 - Eligible Costs Related to Evacuations and Sheltering. Accessed August 10, 2012.Google Scholar