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Hospital Evacuation Decision Guide

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Table 4. Pre-Disaster Critical Infrastructure Self-Assessment

Evacuation-Relevant Resources Implication
City Water
  • Is water used for heating the hospital?
  • Is water used for cooling?
  • Does the hospital have a well?
  • Is there one water line going into the hospital, or also a backup line?
  • Is there a water storage tower/tank on the roof?
  • If the water tower/tank collapsed, would the hospital then be without water (or sufficient pressure)?
  • How long can the hospital maintain a safe temperature without city water in summer heat?
  • How long can the hospital maintain a safe temperature without city water in winter cold?

Y= more vulnerable
Y=more vulnerable
N=more vulnerable
Only 1=more vulnerable

Y=more vulnerable to earthquakes (but good backup water source)
Y=more vulnerable
Hours = time until evacuation

Hours = time until evacuation

Steam
  • Does the hospital receive steam for heat from a separate steam-generation plant?
  • Is that steam plant on the hospital premises?
  • Is there one steam line into the hospital, or also a backup conduit?
  • How long can the hospital maintain a safe temperature if the steam-generation plant is off line?
  • Is steam also used to generate electricity?
  • If so, what % of electricity would be lost if the steam-generation plant went offline?

Y=more vulnerable

N=more vulnerable
Only 1=more vulnerable
Hours = time until evacuation

Y=more vulnerable
>50%=vulnerable

Electricity
  • Does the hospital have a central backup generator?
  • More than 1?
  • Is there a fuel storage tank on site with a direct line to the backup generator?
  • Is the fuel storage tank underground?
  • In a flood, would the intake be underwater?
  • How long can essential power be maintained using the current fuel supply?
  • Does the hospital have smaller or portable generators for floors/sections of the hospital?
  • Can all essential areas of the hospital be powered with these smaller generators?
  • Is fuel stored on site for these smaller generators?
  • How long can essential power be maintained using the current fuel supply and these smaller generators?

N= more vulnerable
N= more vulnerable
N= more vulnerable

N= more vulnerable
Y= more vulnerable
Hours = time until evacuation

N=more vulnerable

N= more vulnerable

N= more vulnerable
Hours = time until evacuation

Natural Gas
  • Is the boiler or other heating equipment fired by natural gas?
  • Is there one gas line into the hospital, or also a backup pipe?
  • How long can the hospital maintain a safe temperature if the gas stops?


Only 1= more vulnerable
Hours = time until evacuation

Boilers/Chillers
  • Does the hospital have backup/redundant boilers?
  • Does the hospital have backup/redundant chillers?
  • How long can the hospital maintain a safe temperature without the chiller in summer heat?
  • How long can the hospital maintain a safe temperature without the boiler in winter cold?

N= more vulnerable
N= more vulnerable
Hours = time until evacuation

Hours = time until evacuation

Powered Life Support Equipment
  • On a typical weekday, how many patients are on ventilators or other powered life-support equipment (including neonatal incubators and ventilators)?

     

  • Does each of these ventilators or other pieces of equipment have a battery pack?
  • What is the average battery life per ventilator/equip?
  • How many patients are otherwise oxygen dependent?

     

     

  • Does the medical gas system rely on electricity?
  • If the medical gas system fails, how long can these patients be maintained using the current stock of portable/backup oxygen?

<10 ____
11-25 ____
26-50 ____
51-100 ____
100+ ____

N= more vulnerable

Hours = time until evacuation

<10 ____
11-25 ____
26-50 ____
51-100 ____
100+ ____

Y= more vulnerable

Hours = time until evacuation

Information Technology and Telecommunication
  • Are servers and other telecommunication systems on the hospital premises or offsite?
  • Are redundant hardware and software systems deployed offsite?
  • Are critical databases (e.g. EMRs) managed or backed up offsite?
  • Can the EMR quickly generate patient discharge summaries to accompany each evacuated patient?
  • Can manual, paper-based backup systems and procedures be rapidly reconstituted (e.g. manual order entry, manual medication dispensing), and have staff been trained to safely use these systems?
  • Does the hospital have VOIP capabilities or two-way radios that interoperate with local emergency responders?

On premises = more vulnerable
N = more vulnerable
N = more vulnerable
N = more vulnerable

N = more vulnerable

N = more vulnerable

Security
  • Does the hospital employ its own security staff or contract with an outside security firm?
  • Are sufficient security staff on site during every shift (including nights and weekends) so that two can be stationed at every entrance/exit?
  • Can sufficient additional security staff be brought in to escort/guard transport vehicles?
  • Does the hospital evacuation plan assume that municipal or State police will be available to assist?

Own staff____
Contracted____
N= more vulnerable

N= more vulnerable

Y= more vulnerable

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