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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 6. Factors to Consider in Deciding Whether to Begin a Pre-Event Evacuation

Factor Issues to Consider Implications
Event Characteristics
  • Arrival
  • When is the event expected to "hit" the hospital? The metropolitan area?
  • How variable is the time the event is expected to "hit"?
  • The amount of time until the event "hits," combined with the anticipated time to evacuate patients, determines how long an evacuation decision can be deferred.
  • Magnitude
  • What is the expected strength of the event?
  • How likely is the event to gain or lose strength before it reaches the hospital? The metropolitan area?
  • The magnitude of the event forewarns the potential damage to a facility and utilities, which could cut off the supply of key resources, or otherwise limit the ability to shelter-in-place and care for patients.
  • Area impacted
  • How large is the geographic area to be affected by the event?
  • How many vulnerable health care facilities are in this geographic area?
  • Competition for resources needed to evacuate patients (especially vehicles) increases when more facilities evacuate simultaneously.
  • Duration
  • How long is the event expected to last?
  • How variable is the expected duration of the event?
  • The duration of the event will affect how long hospitals have to shelter-in-place or operate on backup, alternative, or less predictable sources of key resources.
Anticipated Effect of the Event on Key Resources Needed to Care for Patients
  • Water source
  • Is the main city water supply in jeopardy? Already non-functional?
  • Is there a backup water supply (well, nearby building with intact water mains)?
  • If not, how soon will city water return?
  • Water loss of unknown duration (more than 1-2 days) is almost always cause for evacuation.
  • Heat source
  • Is the heat source in jeopardy (steam, water for boilers, etc.)? Already non-functional?
  • Is there a backup (intact nearby building that still has power/heat)?
  • If not, will the building be too cold for patient safety before adequate heat returns?
  • Loss of heat, especially during a northern winter, is almost always a cause for evacuation—often within 12 hours.
  • Electricity
  • Is power in jeopardy? Just for the hospital or a wider area?
  • Are backup generators functional? How long can they run without refueling? Is refueling possible (e.g., intake not under water)?
  • Can some sections/wings be shut down to reduce fuel consumption and stretch fuel supplies?
  • Loss of electricity endangers ventilated patients, among others, and may affect the sequence in which patients are evacuated.
  • Building structural integrity
  • Is the building obviously/visibly unsafe? All of it or only portions (e.g., can people be consolidated in safer sections)?
  • Was there a water tower on the roof, and is it intact?
  • Is a building engineer needed to determine structural integrity/safety?
  • Earthquakes or explosions may cause rooftop water towers to fail, flooding the building.


  • Safety/integrity may not be obvious to untrained occupants.
Anticipated Effect of the Event on the Surrounding Environment and Community That Could Affect an Evacuation Decision
  • Road conditions
  • Are any major routes from the hospital to potential receiving care sites closed?
  • Is traffic at gridlock on major routes from the hospital to potential receiving care sites?
  • Are access routes to the hospital cut off?
  • There may be a limited window of opportunity to carry out a ground-based evacuation.
  • Increased use of helicopters to evacuate patients may be required.
  • Staff may not be able to get to the hospital to relieve existing staff or assist in the evacuation.
  • Community/building security
  • Have any nearby areas experienced increases in disorder or looting?
  • Are local law enforcement agencies understaffed due to self-evacuations or significant additional responsibilities?
  • Are additional private security officers available to secure the hospital?
  • If patient and staff safety cannot be assured, evacuation will be necessary.
  • Evacuation status of other nearby health care facilities
  • Are other hospitals or other health care facilities already evacuating or planning to evacuate, or have they decided to shelter-in-place?
  • If other hospitals or health care facilities are evacuating:
    • the competition for ambulances, wheelchair vans, and buses may be substantially increased.
    • the hospital may be asked to accept additional patients.
    • patients may have to be relocated to facilities further away than anticipated.
  • State/county/local evacuation order
  • Have evacuation orders been issued in areas that are closer to the event?
  • Have any public or private statements been issued regarding the possibility of an evacuation order?
  • Have any other incidents occurred that increase the likelihood that an evacuation order will be issued?
  • You may have no choice but to evacuate.
  • Availability of local emergency response agencies
  • Are local emergency response agencies understaffed (or otherwise unavailable) due to self-evacuations or additional responsibilities?
  • Unavailability of local fire agencies increases the risk of sheltering-in-place.

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