The emergency evacuation of a geriatrics hospital in Toxteth

A meta-analysis of hospital evacuations: overcoming barriers to effective planning

A hospital evacuation is a significant disaster scenario facing today's Hospital Emergency Coordinators (HECs) and Risk Managers. In this work we explore the numerous barriers that prevent HECs from being able to effectively plan for and execute hospital evacuations based on a review of the pertinent literature of the last 30 years. We discuss the finding that the reasons for the success or failure generally fall into 1 or more of 8 broad categories: Predisaster Assessment, Logistics, Communications, Community Relationships, Manual Records and Tracking, Resource Management, Special Patient Populations, and Postevacuation Return.

Patient-Driven Resource Planning of a Health Care Facility Evacuation

Introduction

The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old.

Methods

Utilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period.

Results

Survey data were collected on 2,050 patients. Units with patients having low continuous medical care needs during an emergency evacuation were the postpartum, psychiatry, rehabilitation medicine, surgical, and preoperative anesthesia care units, the Emergency Department, and Labor and Delivery Department (with the exception of patients in Stage II labor). Units with patients having high continuous medical care needs during an evacuation included the neonatal and adult intensive care units, special procedures unit, and operating and post-anesthesia care units. With the exception of the neonate group, 908 (47%) of the patients would be able to walk out of the facility, 492 (25.5%) would require a wheelchair, and 530 (27.5%) would require a stretcher to exit the HCF. A total of 1,639 patients (84.9%) were deemed able to comprehend the need to evacuate and to follow directions; the remainder were sedated, blind, or deaf. The charge nurses also determined that 17 (6.9%) of the 248 adult intensive care unit patients were too ill to survive an evacuation, and that in 10 (16.4%) of the 61 ongoing surgery cases, stopping the case was not considered to be safe.

Conclusion

Heath care facilities can utilize the results of this study to model their anticipated resource requirements for an emergency evacuation. This will permit the Incident Management Team to mobilize the necessary resources both within the facility and the community to provide for the safest evacuation of patients.

PetinauxB, YadavK. Patient-driven resource planning of a health care facility evacuation. Prehosp Disaster Med. 2013;28(2):1-7.

Suicidal Ideation and Depression among Institutionalized Elderly: The Influence of Residency Duration

An exploratory study of eighty-three randomly selected elderly persons relocated to a nursing home was conducted in the north of Israel. The aim was to examine the relationship between duration of residency and suicidal ideation. Elderly people in four different periods of residency were compared on three scales: the Beck Depression Inventory, the Beck Hopelessness Scale, and the Scale for Suicide Ideation. Participants at all four stages of relocation expressed high levels of suicidality, particularly those in their first seven months of residency. In addition, residents at different stages of adaptation to relocation at the nursing home expressed different levels of depression, suicidality, and hopelessness. It is suggested that special attention be paid to residents' subjective mental and emotional states, especially during the first period of relocation.

Vulnerability of disabled and elderly in disasters: case-study of Israel during 'Desert Storm'

Populations at risk in a disaster situation include the disabled and elderly. This large and growing segment of the population is in many ways more vulnerable than other people to safety and health hazards of disasters and has specific needs in emergency situations. The 'Desert Storm Operation' (Persian Gulf, January-February 1991) as it affected the elderly and disabled in Israel is described. Although the circumstances were rather specific, the increased vulnerability and some particular needs of this population were disclosed, and could be considered in the plans for preparedness for other types of disaster situations.

The unexpected relocation of elderly in-patients in response to a threatened strike

A threatened strike by non-professional hospital employees caused a teaching hospital to halve its in-patient numbers. This paper describes this unexpected, involuntary intervention in patient care in the Department of Geriatric Medicine. Fifty-three patients were discharged, 46 patients were transferred for 12 days to another hospital and 29 remained in the department. There was no evidence of important disruption in patient-care nor exacerbation of patient-distress as seen in ratings of patients' social, emotional and physical functioning. It is suggested that important factors in achieving successful unexpected relocation are: selection of patients who are medically stable albeit with significant physical and mental disability; the preparation and participation of patients and staff; and the continuation of patient care by nursing staff familiar to the patients.

Rapid nighttime evacuation of a veterans hospital

Loss of essential utilities and danger of explosion forced a rapid nighttime winter evacuation of 229 patients from an acute-care Veterans Administration hospital. Although distribution of patients to recipient hospitals was not optimal, and the location of several patients could not be documented for more than 24 hours, the evacuation in subfreezing weather went smoothly. Continuity of care and careful planning permitted an orderly return to the hospital five days later. Although financial costs were high, no excess mortality or morbidity was associated with the evacuation. No changes in pharyngeal gram-negative bacterial flora of the patients were noted. Further, a critique is presented to aid in planning for similar emergencies elsewhere.