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Decision Processes and Determinants of Hospital Evacuation and Shelter-in-Place During Hurricane Sandy

McGinty, Meghan D. MPH, MBA; Burke, Thomas A. PhD, MPH; Resnick, Beth MPH; Barnett, Daniel J. MD, MPH; Smith, Katherine C. PhD, MA; Rutkow, Lainie JD, PhD, MPH

Journal of Public Health Management and Practice: January/February 2017 - Volume 23 - Issue 1 - p 29–36
doi: 10.1097/PHH.0000000000000404
Research Articles
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Context: Evacuation and shelter-in-place decision making for hospitals is complex, and existing literature contains little information about how these decisions are made in practice.

Objective: To describe decision-making processes and identify determinants of acute care hospital evacuation and shelter-in-place during Hurricane Sandy.

Design: Semistructured interviews were conducted from March 2014 to February 2015 with key informants who had authority and responsibility for evacuation and shelter-in-place decisions for hospitals during Hurricane Sandy in 2012. Interviews were recorded, transcribed, and thematically analyzed.

Setting and Participants: Interviewees included hospital executives and state and local public health, emergency management, and emergency medical service officials from Delaware, Maryland, New Jersey, and New York.

Main Outcome Measure(s): Interviewees identified decision processes and determinants of acute care hospital evacuation and shelter-in-place during Hurricane Sandy.

Results: We interviewed 42 individuals from 32 organizations. Decisions makers reported relying on their instincts rather than employing guides or tools to make evacuation and shelter-in-place decisions during Hurricane Sandy. Risk to patient health from evacuation, prior experience, cost, and ability to maintain continuity of operations were the most influential factors in decision making. Flooding and utility outages, which were predicted to or actually impacted continuity of operations, were the primary determinants of evacuation.

Conclusion: Evacuation and shelter-in-place decision making for hospitals can be improved by ensuring hospital emergency plans address flooding and include explicit thresholds that, if exceeded, would trigger evacuation. Comparative risk assessments that inform decision making would be enhanced by improved collection, analysis, and communication of data on morbidity and mortality associated with evacuation versus sheltering-in-place of hospitals. In addition, administrators and public officials can improve their preparedness to make evacuation and shelter-in-place decisions by practicing the use of decision-making tools during training and exercises.

Department of Health Policy and Management (Mss McGinty and Resnick and Dr Rutkow), Department of Environmental Health Sciences (Dr Barnett), and Department of Health, Behavior and Society (Dr Smith), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and US Environmental Protection Agency, Washington, District of Columbia (Dr Burke).

Correspondence: Meghan D. McGinty, MPH, MBA, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 429, Baltimore, MD 21205 (meghan.mcginty@gmail.com).

This research was supported by the 2013-2014 Johns Hopkins Environment, Energy, Sustainability, and Health Institute (E2SHI) Fellowship and the 2013-2014 Lipitz Public Health Policy Award. M.D.M. was supported in part by funding from the National Institute for Occupational Safety and Health (NIOSH) Education and Research Center (ERC) for Occupational Safety and Health at the Johns Hopkins Bloomberg School of Public Health (#T42-OH 008428); the 2015 Johns Hopkins Health Resources and Services Administration (HRSA) Trainee Fellowship Program Agreement (#A03HP2750); the 2013-2014 E2SHI Fellowship; the 2013-2014 John C. Hume Award; and the 2014-2015 Victor Raymond Memorial Scholarship.

The funders had no role in the design and conduct of the study, or collection, management, analysis, and interpretation of the data. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of any of the funders.

Thomas A. Burke contributed to this work prior to his tenure at the US Environmental Protection Agency (EPA). The views expressed are his own and do not necessarily reflect the policy positions of the EPA. While working on this research, Thomas A. Burke was affiliated with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.

The authors declare no conflicts of interest.

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