Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-06-10T16:38:37.401Z Has data issue: false hasContentIssue false
  • English
  • Français

Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making

Published online by Cambridge University Press:  18 March 2015

Karen A. Ricci ,
Anne R. Griffin ,
Kevin C. Heslin ,
Derrick Kranke  and
Aram Dobalian
Karen A. Ricci
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CaliforniaUSA Adjunct Staff, RAND Corporation, Santa Monica, CaliforniaUSA
Anne R. Griffin
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CaliforniaUSA
Kevin C. Heslin
Affiliation:
US Department of Health and Human Services, Center for Delivery, Organizations, and Markets (CDOM), Agency for Healthcare Research and Quality, Rockville, MarylandUSA
Derrick Kranke
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CaliforniaUSA
Aram Dobalian*
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CaliforniaUSA Department of Health Policy and, Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CaliforniaUSA School of Nursing, University of California, Los Angeles, Los Angeles, CaliforniaUSA
*
Correspondence: Aram Dobalian, PhD, JD Veterans Emergency Management Evaluation Center (VEMEC) 16111 Plummer St. MS-152, North Hills, California 91343 USA E-mail: Aram.Dobalian@va.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Problem

Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System’s (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012.

Methods

Semi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event.

Results

The most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City’s (NYC’s) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city’s order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit.

Conclusions

Results suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.

RicciKA, GriffinAR, HeslinKC, KrankeD, DobalianA. Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making. Prehosp Disaster Med2015;30(3):1-6

Keywords

disastershospital evacuationorganizational cultureorganizational decision making
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 3 , June 2015 , pp. 233 - 238
Copyright
© World Association for Disaster and Emergency Medicine 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. City of New York. A Stronger, More Resilient New York, 2013. http://www.nycedc.com/resource/stronger-more-resilient-new-york. Accessed October 31, 2013.Google Scholar
2. Powell, T, Hanfling, D, Gostin, LO. Emergency preparedness and public health: the lessons of Hurricane Sandy. JAMA. 2012;308(24):2569-2570.Google Scholar
3. Fink, S. Beyond hurricane heroics: what Sandy should teach us all about preparedness. Stanford Medicine. 2013;30(2):22-29.Google Scholar
4. Arendt, LA, Hess, DB. Hospital Decision Making in the Wake of Katrina: the Case of New Orleans. Buffalo, New York USA: University at Buffalo, State University of New York; 2006.Google Scholar
5. Evans, M, Carlson, J, Barr, P, et al. Left in the dark: seven years after Katrina, Sandy is teaching hospitals more lessons on how to survive nature's fury. Mod Healthc. 2012;42(45):6-7,11,12.Google Scholar
6. Redlener, I, Reilly, MJ. Lessons from Sandy--preparing health systems for future disasters. N Engl J Med. 2012;367(24):2269-2271.Google Scholar
7. Gray, BH, Hebert, K. Hospitals in Hurricane Katrina: challenges facing custodial institutions in a disaster. J Health Care Poor Underserved. 2007;18(2):283-298.CrossRefGoogle ScholarPubMed
8. Leaning, J, Guha-Sapir, D. Natural disasters, armed conflict, and public health. N Engl J Med. 2013;369(19):1836-1842.CrossRefGoogle ScholarPubMed
9. Bagaria, J, Heggie, C, Abrahams, J, et al. Evacuation and sheltering of hospitals in emergencies: a review of international experience. Prehosp Disaster Med. 2009;24(5):461-467.CrossRefGoogle ScholarPubMed
10. Schultz, CH, Koenig, KL, Auf der Heide, E, et al. Benchmarking for hospital evacuation: a critical data collection tool. Prehosp Disaster Med. 2005;20(5):331-342.CrossRefGoogle ScholarPubMed
11. Childers, A, Taaffe, K. Health care facility evacuations: lessons learned, research activity, and the need for engineering contributions. Journal of Healthcare Engineering. 2010;1(1):125-140.Google Scholar
12. Downey, EL, Andress, K, Schultz, CH. External factors impacting hospital evacuations caused by Hurricane Rita: the role of situational awareness. Prehosp Disaster Med. 2013;28(3):264-271.Google Scholar
13. McGlown, KJ. Evacuation of health care facilities: a new twist to a classic model. Natural Hazards Review. 2001;2(2):90-99.Google Scholar
14. Sternberg, E, Lee, GC, Huard, D. Counting crises: US hospital evacuations, 1971-1999. Prehosp Disaster Med. 2004;19(2):150-157.Google Scholar
15. Taaffe, KM, Kohl, R, Kimbler, D. Hospital evacuation: issues and complexities. Paper presented at the 2005 Winter Simulation Conference, Clemson, South Carolina USA; 2005.Google Scholar
16. Carlton, PK, Bringle, D. Business continuity after catastrophic medical events: the Joplin medical business continuity report. Am J Disaster Med. 2012;7(4):321-331.CrossRefGoogle ScholarPubMed
17. Chavez, CW, Binder, B. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge earthquake. J Emerg Med. 1996;14(4):445-454.Google Scholar
18. Zane, RD, Biddinger, P, Hassol, A, et al. Hospital Evacuation Decision Guide. US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2010.Google Scholar
19. Downey, EL, Andress, K, Schultz, CH. Initial management of hospital evacuations caused by Hurricane Rita: a systematic investigation. Prehosp Disaster Med. 2013;28(3):257-263.Google Scholar
20. Harvard School of Public Health Emergency Preparedness and Response Exercise Program (HSPH-EPREP). Massachusetts Department of Public Health Hospital Evacuation Toolkit; 2012. http://www.hsph.harvard.edu/policy-translation-leadership-development/files/2013/05/MDPH-Hospital-Evacuation-Toolkit2.pdf. Accessed May 29, 2013.Google Scholar
21. Florida Department of Health. Hospital Emergency Evacuation Toolkit; 2011. http://www.floridahealth.gov/preparedness-and-response/healthcare-system-preparedness/discharge-planning/_documents/%20evac-toolkit.pdf. Accessed April 9, 2012.Google Scholar
22. Minnesota Department of Health. Emergency Sheltering, Relocation, and Evacuation for Healthcare Facilities. [Planning template]; 2012. http://www.health.state.mn.us/oep/healthcare/siphealthcare.docx. Accessed December 23, 2013.Google Scholar
23. California Hospital Association. Hospital Evacuation Plan Checklist; 2010. http://www.calhospitalprepare.org/evacuation. Accessed May 31, 2013.Google Scholar
24. Parker, AM, Nelson, C, Shelton, SR, et al. Measuring Crisis Decision Making for Public Health Emergencies. Santa Monica, California USA: RAND Corporation; 2009.CrossRefGoogle Scholar
25. Claver, M, Dobalian, A, Fickel, JJ, et al. Comprehensive care for vulnerable elderly veterans during disasters. Arch Gerontol Geriatr. 2013;56(1):205-213.CrossRefGoogle ScholarPubMed
26. Centers for Medicare & Medicaid Services. Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Federal Register: Proposed Rule. Washington DC, USA: Centers for Medicare & Medicaid Services, US Department of Health and Human Services; 2013;78(249):79082-79200.Google Scholar