A mass medical evacuation is initiated when local demand overwhelms the local healthcare infrastructure and/or when the infrastructure itself is compromised – which might easily, and inconveniently, occur in a variety of disaster scenarios ranging from hurricanes, for example, to incidents involving hazardous materials. Hospitals, long-term care facilities, and the houses or apartments of persons receiving health care or hospice support may be in the path of an oncoming tornado or other danger and therefore suffer direct damage from such a threat.
Even persons living in their own homes, or in healthcare facilities that suffer little or no physical damage, may still need to evacuate because of a loss of utilities, damage to highways or communications infrastructure, or the lack of available staff. Although U.S. healthcare facilities are almost always required to have evacuation plans in place, most of those plans focus primarily if not exclusively on fire evacuations that do not extend beyond the parking lot – and also do not address the full range of potential hazards threatening the surrounding area. Moreover, when other plans fail, the evacuation of a healthcare facility still requires tightly coordinated efforts between and among the facility staff, first responders, emergency management personnel, and other officials.
In some ways, an even greater challenge than the evacuation of healthcare facilities is the ability to identify and evacuate homebound persons known to be suffering from various medical or functional needs. Anyone requiring dialysis, oxygen, insulin, personal care support, and/or basic transportation may in fact survive the initial stage of a disaster but soon require additional support. When a major disaster blocks transportation routes or impedes basic communications capabilities, for example, many such persons may soon become isolated and vulnerable to the dangerous effects associated with not meeting their medical or functional needs. To protect these persons in such situations it is essential that local planners be quickly able to: (a) identify the current whereabouts of such individuals; and (b) provide for the full range of necessities – including transportation, sheltering, and unique support requirements – immediately required.
Search Tools and Data Sources – Plus Common Sense
There is a vast array of search tools and data sources available to planners to characterize their areas’ at-risk populations. To develop an effective evacuation plan for such populations, many different data sources may be needed for a single jurisdiction. Public data sources provide a particularly helpful starting point for identifying populations at risk. Census data, for example: (a) identify some variables of interest –specifically including an individual’s socioeconomic status, age, and race; and (b) highlight congregate settings such as long-term care facilities. State and local government data sources are often both relevant and quickly available, but consideration of nongovernmental data – frequently provided by faith- or community-based organizations –is also important because such information can often identify specific individuals who may be less likely to share personal details with government agencies.
As data sources are being explored, it is helpful to also consider sources that may be less direct. For example, when planners are seeking to identify persons with mobility impairments, they should also – rather than relying primarily or exclusively on social- services organizations – consider other agencies and organizations that have a direct interest in supporting at-risk populations: local transportation and/or mass-transit organizations, to cite but one example, often possess detailed information on local residents who require transportation assistance. In addition, most if not all utility companies maintain power-restoration priority lists for persons who use and must rely on powered medical devices. For planners just starting to collect such data, it may be necessary to “start small” by focusing on a highly specific type of population – e.g., dialysis patients, or those suffering from a sensory impairment – and then expand from there.
Individual information also may be available through special-purpose registries of residents with specific medical conditions or functional needs. As at-risk residents are identified, their residences should be plotted on a map for response planning purposes and given higher priority in preparedness outreach campaigns. Other residents who fall into the categories associated with existing registries also should be encouraged to register – but at the same time reminded that registering as an individual with a medical or functional need does not guarantee that assistance will be immediately available during weather-related or other types of disasters.
For both short- and long-term reasons, there are two common-sense rules that also should be remembered at all times: (a) Personal planning and preparedness should always be the first priorities of the individual citizen; and (b) Planners should be aware of the limitations, as well as the advantages, of registries and plan beyond them.
Fortunately, there continues to be rapid growth in geographic information system (GIS) applications in the field of emergency management, which range from free Internet resources to the growth of robust systems possessing multiple layers of data that can be queried for detailed reports. For resource-poor jurisdictions, there also are ample free resources that can be used to at least map the locations of facilities housing at-risk groups of local residents. It also would be helpful to identify local and state agencies that collect and analyze GIS-compatible data – much of which, including a number of maps, is often readily available and can be used to enhance local planning and response capacity.
Future Capabilities & Additional Growth Predicted
When planning for community residents who have unique medical and functional needs, it is important to include them personally in the planning process. Advocacy organizations and/or key members of these groups can provide invaluable insights into various local challenges that might impede effective preparedness and response operations. They can also provide helpful advice not only on how to quickly identify residents at risk but also how to communicate with them most effectively.
Cultivating these relationships may also vastly improve the receptiveness of the at-risk group to key messages by coordinating the messages through trusted leaders within their respective groups. As trust is promoted, members of the group will almost always become more willing to be involved in planning, training, and exercises. Without such personal participation, the emergency necessities of various groups with medical or functional needs cannot be fully understood or adequately addressed. For that reason, as with other aspects of the planning process, it may be helpful to start with a small group and expand slowly, focusing primarily on priorities established through a local assessment of existing populations with unique needs.
In recent years, many public and private healthcare organizations throughout the United States have cobbled together enough funding to support the development and fielding of emergency health information technology tools – including Internet-based and data-exchange systems that can be used to manage critical data such as bed reports, healthcare worker credentials, and patient tracking. In fact – because security standards, common definitions, and minimum patient data elements are continually evolving – these reporting capabilities are often developing at so fast a pace that policymakers cannot always update and promulgate the guidelines and policies needed to keep up with them.
During a rapid evacuation of persons with specific medical needs, there is usually only limited time and less than adequate manpower available to gather health details beyond the basics needed to safely transport the patients at risk. However, as electronic health records (EHRs) become the new norm, more detailed data will be available to use in a broad spectrum of evacuation scenarios. Fortunately, the federal Medicare and Medicaid systems have established an EHR incentive program that, among other things, ensures that hospitals and other healthcare facilities will in the future receive paid incentives for demonstrating the meaningful use of approved EHR technology.
That change is intended, of course, to accelerate the availability and use of EHRs and thereby not only improve patient management during sudden times of disaster but also increase the effectiveness of the resource allocations provided. As technology expands and is used in the context of growing partnerships with community stakeholders, the future looks bright for even better management of the unique needs of at-risk populations during mass evacuations.
Bruce Clements
Bruce Clements is the Public Health Preparedness Director for the Texas Department of State Health Services in Austin, Texas, and in that post is responsible for health and medical preparedness and response programs ranging from pandemic influenza to the health impact of hurricanes. A well-known speaker and writer, he also serves as adjunct faculty at the Saint Louis University Institute for BioSecurity. His most recent book, Disasters and Public Health: Planning and Response, was released in 2009.
