For the Case Study Analysis, use the following format:

Overview of Issues/Concepts

Case Study Analysis

Case Study Application

2 Critical Thinking Questions

In addition to being ill, hospital patients are frail, in pain, and bed bound. Thus, hospital evacuations are a last resort and occur only when the physical plant and its support systems fail or are likely to do so. The difficulties of moving hospitalized patients make it impossible to practice an evacuation.

An exercise was conducted in southwestern Pennsylvania to simulate evacuation of a hospital because of structural damage sustained during a natural disaster. In addition to an ED and adult intensive care unit, the hospital has one of the largest neonatal intensive care units (NICUs) in the eastern United States and a large labor and delivery program. The exercise required the simulated evacuation of 309 patients requiring various levels of care. The exercise scenario involved a powerful micro-burst windstorm that struck near the hospital. The storm propelled an SUV through the five-story glass atrium of the building and into load-bearing support columns. The damage made the facility unsafe for continued use. Hospital ED staff began treating the injured and communicated the need for additional assistance to local command officials.

The hospital implemented its emergency operations plan and activated the Incident Command System to assess building damage, continue provision of care, and evaluate next steps. In consultation with the local Emergency Management Authorities the decision was made to evacuate the facility.

The municipal emergency operations center (MEOC) was activated, and key command positions were assigned. Movement of patients from the stricken hospital to other healthcare facilities was coordinated by health and medical services (emergency support function 8) located in the MEOC.102

Several issues were identified:

Some hospitals that were to receive healthy mothers and babies lacked the appropriate staff (nurses, obstetricians, and pediatricians) and supplies (diapers and formula) to care for infants. Local hospitals that were expected to provide neonatology services did not have enough staff or beds to "surge" their NICUs. These hospitals requested that the evacuating hospital send its clinicians, beds, pharmaceuticals, and supplies with the infants. Due to the limited number of NICU beds in the region, 38 infants would have to be transported to hospitals in neighboring regions and states. Questions What types of preparedness activities would be needed to successfully evacuate a hospital? How is the decision to evacuate a hospital made? What internal and external communications are essential during a hospital evacuation?