Development of Patient Evacuation Resource Classification System (PERC) Using Systems Engineering to Assist Hospital Evacuations in a Disaster

The aim of this study was the development of a decision-support tool capable of identifying the most appropriate transportation and local area coalition bed space (resources) for patient evacuations during a crisis. Introduction of the new concept of dichotomous tables and how they are incorporated into the Patient Evacuation Resource Classification (PERC) system. The methods used were Systems Engineering fundamentals to conduct a requirements analysis of the process, develop a new construct guided by functional analysis, design an evidence-based model that accurately identifies patient resource requirements translatable to resource capabilities, and create a prototype for a proof of concept. Research resulted in the PERC system prototype. The PERC system prototype created by this research allows for system testing under a Solomon four-group design simulation with the participation of leading medical, emergency response, academic, consulting industry, and logistics professionals from the Washington, DC, metropolitan area.

Modeling hospitals' adaptive capacity during a loss of infrastructure services

Resilience in hospitals - their ability to withstand, adapt to, and rapidly recover from disruptive events - is vital to their role as part of national critical infrastructure. This paper presents a model to provide planning guidance to decision makers about how to make hospitals more resilient against possible disruption scenarios. This model represents a hospital's adaptive capacities that are leveraged to care for patients during loss of infrastructure services (power, water, etc.). The model is an optimization that reallocates and substitutes resources to keep patients in a high care state or allocates resources to allow evacuation if necessary. An illustrative example demonstrates how the model might be used in practice.

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

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.

Prioritization strategies for patient evacuations

Evacuation from a health care facility is considered last resort, and in the event of a complete evacuation, a standard planning assumption is that all patients will be evacuated. A literature review of the suggested prioritization strategies for evacuation planning-as well as the transportation priorities used in actual facility evacuations-shows a lack of consensus about whether critical or non-critical care patients should be transferred first. In addition, it is implied that these policies are "greedy" in that one patient group is given priority, and patients from that group are chosen to be completely evacuated before any patients are evacuated from the other group. The purpose of this paper is to present a dynamic programming model for emergency patient evacuations and show that a greedy, "all-or-nothing" policy is not always optimal as well as discuss insights of the resulting optimal prioritization strategies for unit- or floor-level evacuations.

Decision to evacuate a hospital during an emergency: the safe way or the leader's way?

Hospitals have frequently been evacuated because of natural or man-made disasters. In this article, we identify elements to be considered when confronted with the possibility of hospital evacuation. Hospital evacuation may have a significant impact on the surrounding community and the overall population. When the patients in a hospital are placed at risk, hospital leadership often decides to evacuate the facility to safeguard the well-being of both patients and staff. Such a decision is not likely to be criticized. We present various considerations. The effect of evacuation on patients, hospital staff, family members, the community, and even the nation as a whole, as well as repercussions affecting potential patients should be integral to the decision-making process and parallel to the risk assessment.