2014

MDPH HOSPITAL EVACUATION TOOLKIT

IX. HOSPITAL EVACUATION PLAN CHECKLIST

 Hospital Evacuation Plan Checklist

INITIAL DECISION MAKING AND INCIDENT

MANAGEMENT
Assessment of Initial Priorities
Following notification of a threat and/or disaster event, does your plan specify:
 How a threat assessment is being performed?
 Who is assessing critical infrastructure and key resources?
 How to automatically conduct & submit unit-level situation and/or damage reports to hospital leadership?
 The trigger for units to submit damage reports?
 Who is compiling the damage reports and how long it will take?
 How long it will take to perform an assessment of the hospital’s operational capabilities?

Establishment of Incident Command Structure

Does your plan specify:
 How you will rapidly compile, verify, and share information/reports?
 When you will need your first Incident Action Plan (IAP) to be completed?

Determination of Evacuation Trigger Points and Type of Evacuation

Does your plan specify:
 Specific trigger points that you will use to decide whether to evacuate?
 Formalized “pre-evacuation” stages with defined actions?
 Any alternatives to evacuation that you can use?
 Distinct types of evacuation? (Pre-evacuation staging, single unit, multi-unit, single/multiple buildings,
entire campus)
 How each evacuation stage is triggered?

Authority to Make Evacuation Decisions

Does your plan specify:

 If the staff or any other designated personnel have the authority to completely vacate an adjacent
(unaffected) unit in case of a possible immediate life threat (e.g. fire) if they perceive an impending threat?
 A predefined location to evacuate to?
 If multiple units are competing for the same location, how to resolve this?
 Someone on-site 24/7 who has the authority to order a partial or full evacuation?
 If the CEO/Board of Directors reserve the right to overrule operational decisions?
 What input/influence outside agencies will have on hospital decisions (State or local health department,

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 State or local emergency management authority, EMS, local fire command)? Can external agencies overrule
a hospital’s decision to shelter in place?
 How a dispute between the local fire department and hospital administration would be resolved if the
hospital disagreed with a specific portion of the evacuation order/recommendation?

Contact with Local Public Safety Incident Command System(s), Surrounding

Communities, & Other Response Partners
Does your plan specify:
 Mechanisms to use in sending/receiving information from local public safety and local public health
representatives?
 Types of information you need from local public safety and local public health representatives?
 The type of information you are sending them, the format you are using and when you are sending it?
 Which other response partners with whom you will be communicating?
 How you will be communicating with other response partners?
 What specific information you need from other response partners?
 What information you need to share with other response partners?

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 EVACUATION OPERATIONS

Primary Operational Objectives in Conducting a Rapid Response Hospital Evacuation

Does your plan specify:
 Your primary operational objectives?
 How these objectives are communicated to staff?
 Which section of your IC structure is primarily responsible for each objective?

Hospital Departments Involved in the Operation

Does your plan specify:
 The respective roles of hospital departments involved in evacuation operations?
 Roles for departments not directly involved in evacuation?

Roles of Partner Agencies

Does your plan specify:
 The operational support your partner agencies can be expected to offer?
 The specific resources available to you from your partner agencies?
 How soon the external assets will be expected to be available?

Primary Methods of Communication

Does your plan specify:
 Your primary methods of internal and external communication?
 How you will communicate the evacuation decision to staff, patients, and families?
 How you will communicate changes to the plan as they occur?

Establishment of Appropriate Security

Does your plan specify:
 The priorities (in order) for hospital security at the outset of evacuation operations?
 If there are adequate resources to maintain security at all operational sites?
 Additional options for security and crowd control other than local law enforcement?
 How these resources be will accessed and who has authority over them?
 How this will be coordinated and supervised?
 How traffic will be managed?
 If discharge/egress routes will be segregated from transfer departures?
 Alternate routes for both?
 How you will maintain security for special patient populations?
 Infants  Children  Psychiatric patients  Prisoners

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 Triage and/or Prioritization for Evacuation
Does your plan specify:
 Uniform and specific standards for triage within the institution?
 If triage standards are known to providers?
 If the units should perform and report a manual patient census prior to evacuation?
 How and to whom the units report the result of census performed?
 How evacuation triage is prioritized: acuity, mobility status (stretcher-bound/wheelchair/ambulatory),
location of the unit within the hospital, availability of a known transfer destination or some combination?
 Who (specifically) will be tasked with making triage decisions?
 If the people making triage decisions received any formal training in the evacuation plan or evacuation
triage?
 A framework for ethical decision-making related to triage?
 Mechanisms for resolving disputes over triage within the facility?
 How triage information will be compiled and incorporated into IAPs?
 Mechanism to allow for re-triage and resuscitation if necessary if patients deteriorate during evacuation (or
while waiting)?
 How triage tactics will change if your elevators were not operational?
 How medical equipment is prioritized for evacuation?
 How you will compile a list of the number of available equipment assets (e.g. portable cardiac monitors,
portable ventilators, oxygen cylinders, suction machines, IV pumps with battery, etc.) and the location of
those assets?
 How you will ensure that the available equipment is matched to the evacuating patients?
 Situations where portable medical equipment is allowed to leave the institution?
 How patients are prepared for transfer?
 If patients receive a supply of needed medications for the next 8-12 hours to support them during transfer?
 If a copy of the patient’s medical and medication record, and radiography, physically accompanies the
patient?
 A mechanism to instruct EMS and receiving facilities on the important therapies the patient may need over
the next 8-12 hours?

Patient Tracking System (including patient records)

Does your plan specify:
 Multiple check-in/check-out data collection points throughout the evacuation process?
 How check-in/check-out data are collected and reported centrally?
 How tracking information will be available to the patient’s treating clinicians?
 How tracking information will be available to the patient’s family?
 If the patient tracking system is adaptable to adverse conditions (i.e. paper-only if there is no electricity)?
 Who is responsible for compiling/securing patient records?

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  How the tracking system used for evacuation integrates into existing EMS patient tracking tools (MCI
based)?

Patient Destination Planning

Does your plan specify:
 How transfer beds will be identified and secured for evacuated patients?
 Who will carry out the task of finding beds, apart and separate from patient tracking activities?
 How point-to-point communication will occur between hospitals?
 Who is expected to be the point of contact at the other hospitals?
 Redundancies in knowing the patient’s destination?
 If there is a preference for hospitals within your network (if applicable) when determining patient
destinations?
 Measures in place for the special patient populations in your hospital that need a special type of hospital
for transfer (i.e. Level II nursery, burn center, tertiary hospital, etc.)?
 The role of EMS in destination planning?
 The role of local public health in destination planning?
 The role of DPH in destination planning?
 How the hospital IC structure will coordinate/communicate with the relevant external agencies (DPH, EMS)
during the evacuation?

Patient Staging (Assembly Point)

Does your plan specify:
 Patient staging for all or a majority of the patients outside of the main hospital building(s)?
 If the patient staging site is usable year round?
 If the staging site has sufficient access to emergency electrical power for medical equipment?
 Supplying the staging area with extra medications (and possibly a pharmacist) if new medical needs arise?
 A resuscitation area within the staging location if patients destabilize during transfer?
 Ready access to medical supplies (i.e. IV fluids) and oxygen for resupply of critical patient care needs at the
staging site?
 How patients will receive ongoing care during evacuation (i.e. medications, fluids, etc.)?
 Special measures are in place for acute or critically ill patients?
 Special measures in place for pediatric (including neonatal) patients?

Patient Discharge
Does your plan specify:
 How staff oversee the process (centralized vs. decentralized) of discharge?
 Where patients will be assembled while awaiting family/transport after discharge?
 A main assembly point for processing evacuees once they have departed the care units?
 A mechanism to discharge patients who simply leave the hospital during an evacuation and how such
patients are noted?

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 Patient Movement and Support
Does your plan specify:
 Who will carry out the physical moving of patients from the units to the Assembly Point/egress?
 How routes will be established/marked and monitored for back-ups?
 If there are outdoor transit/exposure issues associated with routes?
 Mechanism in place for patient movement if the elevators are not operational?
 How will the mobility level of patients be assessed? Who can decide if an appropriate day to day
ambulatory level cannot be considered ambulatory in an emergency?
 If you own special equipment for stair transport of stretcher-bound patients?
 If your staff is trained to “package” a patient with all necessary medical equipment for stair transports?
 If those expected to manually transport the patients down the stairs have practiced this transport?
 How long full evacuations by stairs take?
 How you will communicate with the floors to let them know when to evacuate?
 If the floors leave when possible, or if they must wait for a central order?
 How long you expect most patients to be in transit from original bed to destination bed?
 If the oxygen, medication, etc. and other patient supplies will last for the longest anticipated transit time?
 If EMS is expected to meet the patient at the curb or a staging area, or they are to come to the floors to
pick up patients?
 How EMS knows the destination of the patient?
 If hospital medical staff (MD, RN, RT, etc.) are expected to accompany certain patients to their destinations
and how they will return to the main campus?
 If your hospital medical staff is able to practice at other hospitals (pay, liability, etc.)?

Resources Needed for Evacuation Operations

Does your plan specify:
 The additional equipment you require?
 How resources are being tracked and located as they are used?
 Who is managing the labor pool?
 The labor needs at this time?
 Staff capable of performing heavy physical labor?
 Methods for addressing staff mobility issues?
 Methods of patient transport that will be utilized to execute transfers?
 With whom you are coordinating regarding the transport of patients (CMED, local EMS/Fire)?
 Roles other agencies will play in the hospital evacuation?
 How other agencies will be coordinated?
 If the outside agencies have adequate resources available to assist?
 The support outside agencies can offer?

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  If your organization has enough resources?
 The Mutual Aid Agreements that are in place to support this kind of operation?
 Whom you would turn to for assistance and have you coordinated with them about this?
 How patient and staff safety will be monitored during operations?
 Who stays behind to secure the hospital?
 A checklist of items that need to be secured (i.e. pharmacy, utilities, etc.)?
 Source of the personnel and how long will they are available to be committed?
 The plan to handle shift changes?

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 RECOVERY
Recovery Objectives
Does your plan specify:
 Your recovery priorities?
 Who determines the recovery priorities?

Process of Reopening the Facility

Does your plan specify:
 Who has the authority to reopen the facility?
 Who is involved in the reopening process?

 The process to make this happen?

 Defined triggers for reopening?

 The process you will use to appraise the status of your hospital?

 The functions that must be in place before you can return?

 The resources that are needed for re-entry efforts?

 If it is possible to return to the hospital before the facility is fully operational?

 The security considerations that will be factored into the decision to reopen the hospital?

 If you have enough resources/personnel to assist in the recovery?

Communication During Recovery

Does your plan specify:
 Who you are communicating with at this point in time?
 How hospital staff will be notified about the reopening?
 How you will notify the public that the hospital is reopened for business?
 What role partner agencies will play in repopulating the hospital facility?
 What process will be followed to reconstitute the local response capability?

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