Evacuation Decision-Making Making for the Health Care Facility · EMT-P, CHEP, CHSP, CEM ... Incident Management Solutions, Inc. Planning Training Leadership Incident Management Solutions,

Should I Stay or Should I Go?Should I Stay or Should I Go? Evacuation DecisionEvacuation Decision--MakingMaking for the Health Care Facilityfor the Health Care Facility

Zachary Goldfarb, Zachary Goldfarb, EMTEMT--P, CHEP, CHSP, CEMP, CHEP, CHSP, CEM

Certified Emergency ManagerCertified Emergency Manager

Planning Training Leadership

Incident Management Solutions, Inc.



PurposePurpose•• Develop the capability to preDevelop the capability to pre--plan the plan the

evacuation decisionevacuation decision•• Discuss criteria for determining whether Discuss criteria for determining whether

occupants should shelteroccupants should shelter--inin--place or place or evacuate from a threatened HCFevacuate from a threatened HCF

•• Learn about a tool forLearn about a tool for evacuation decisionevacuation decision--makingmaking

2© 2010, Incident Management Solutions, Inc.

All rights reserved.



The ChallengeThe Challenge•• Absent an imminent threat, there isAbsent an imminent threat, there is

great resistance to HCF evacuationgreat resistance to HCF evacuation•• HCF leadership tendency isHCF leadership tendency is

to ensure certainty of needto ensure certainty of need before initiating evacuationbefore initiating evacuation

•• DecisionDecision--making is oftenmaking is often subjectivesubjective

•• Evacuation delayed mayEvacuation delayed may be evacuation deniedbe evacuation denied



He who does not learn from historyHe who does not learn from history is doomed to repeat it.is doomed to repeat it.

------ George SantayanaGeorge Santayana



The EvacuationThe Evacuation DecisionDecision--Making ProcessMaking Process

•• BackgroundBackground•• ConceptConcept•• ScalabilityScalability•• Evaluation process for shelteringEvaluation process for sheltering--inin--placeplace•• Development of a decision support toolDevelopment of a decision support tool





Evacuation Decision OverviewEvacuation Decision Overview•• Event occursEvent occurs•• Immediate response proceduresImmediate response procedures•• Is there an evacuation risk?Is there an evacuation risk?

–– No:No: ShelterShelter--inin--placeplace•• Follow Emergency Operations PlanFollow Emergency Operations Plan•• Conserve resourcesConserve resources•• Maintain contact with community EOCMaintain contact with community EOC

–– Yes:Yes: Assess critical issuesAssess critical issues•• Internal operations / conditionsInternal operations / conditions•• External operations / conditionsExternal operations / conditions•• Evacuation considerationsEvacuation considerations

•• Apply Decision Support ToolApply Decision Support Tool5

© 2010, Incident Management Solutions, Inc. All rights reserved.



Assessing InternalAssessing Internal Operations / ConditionsOperations / Conditions

•• Physical plantPhysical plant•• Patient clinical and support activitiesPatient clinical and support activities•• Resources and assetsResources and assets•• Security and safetySecurity and safety•• UtilitiesUtilities•• StaffingStaffing•• CommunicationsCommunications





Assessing ExternalAssessing External Operations / ConditionsOperations / Conditions

•• Evacuation urgencyEvacuation urgency•• DurationDuration•• External logisticsExternal logistics•• Evacuation difficultiesEvacuation difficulties





Assessing Evacuation Assessing Evacuation ConsiderationsConsiderations

•• Destination(s)Destination(s)•• Staff availabilityStaff availability•• Transportation logisticsTransportation logistics

–– Van, bus, ambuletteVan, bus, ambulette





Model EvacuationModel Evacuation Decision Support ToolDecision Support Tool

•• Based on proprietary HVA modelBased on proprietary HVA model•• ExcelExcel®® spreadsheet platformspreadsheet platform•• Probability not a factorProbability not a factor•• All values scored based onAll values scored based on

objective criteria statementsobjective criteria statements•• [[Threat scoreThreat score] * [] * [consequence scoreconsequence score]]

= [= [evacuation decision scoreevacuation decision score]] => evacuation decision recommendation=> evacuation decision recommendation





Evacuation DecisionEvacuation Decision Support Tool ApplicationSupport Tool Application

•• PrePre--incident planningincident planning•• Community planningCommunity planning•• IncidentIncident--specific prespecific pre--planningplanning•• IncidentIncident--inin--progress decisionprogress decision--makingmaking





Key ComponentsKey Components

•• Situations that may lead to evacuationSituations that may lead to evacuation–– DefinitionsDefinitions–– FacilityFacility--based worst case scenariosbased worst case scenarios

•• Objective scoring tables and valuesObjective scoring tables and values–– ThreatsThreats–– ConsequencesConsequences

•• Evacuation ScoreEvacuation Score





Situations that MaySituations that May Lead to EvacuationLead to Evacuation

•• Loss of external supportLoss of external support•• Loss of community Loss of community

InfrastructureInfrastructure•• Facility travel or access Facility travel or access

impedanceimpedance•• Communications failureCommunications failure•• Critical supply shortageCritical supply shortage•• Electrical utility power Electrical utility power

failurefailure•• Fire, internalFire, internal•• Flood, externalFlood, external•• Flood, internalFlood, internal•• Fuel shortage (oil)Fuel shortage (oil)

•• Generator failureGenerator failure•• HazMat incident HazMat incident

affecting facilityaffecting facility•• HVAC failureHVAC failure•• Medical gas failureMedical gas failure•• Natural gas failureNatural gas failure•• Physical plant damagePhysical plant damage•• Sewer failureSewer failure•• Smoke or fumes, Smoke or fumes,

internalinternal•• Staffing insufficiencyStaffing insufficiency•• Steam failureSteam failure•• Water supply failureWater supply failure





ThreatsThreats•• SeveritySeverity•• DurationDuration•• Cascade PotentialCascade Potential•• Evacuation DifficultyEvacuation Difficulty•• SIP CapabilitySIP Capability•• Destination CapabilityDestination Capability•• Recovery TimeRecovery Time





ConsequencesConsequences•• Life SafetyLife Safety•• SecuritySecurity•• StaffingStaffing•• Physical plantPhysical plant•• UtilitiesUtilities•• CommunicationsCommunications•• Resources and assetsResources and assets•• Patient clinical and supportPatient clinical and support•• External logisticsExternal logistics





Scoring ProcessScoring Process•• Validate the risk listValidate the risk list•• Assess the applicable riskAssess the applicable risk

–– Reasonable worstReasonable worst--case scenario case scenario developmentdevelopment

•• Assess the threat based onAssess the threat based on the worstthe worst--case scenariocase scenario

•• Assess the consequencesAssess the consequences based on the worst case scenariobased on the worst case scenario

•• The tool calculates the scoreThe tool calculates the score15




Decision Support ScaleDecision Support Scale





00--200200 Shelter in PlaceShelter in Place•• Plan / consider worstPlan / consider worst--case scenariocase scenario•• Initiate hardening activities /Initiate hardening activities /

defensive measuresdefensive measures•• Initiate conservation measuresInitiate conservation measures•• Enhance staff, supplies, resourcesEnhance staff, supplies, resources•• Relocate patients, assetsRelocate patients, assets

to safer locationsto safer locations

17

0-200Shelter in

Place




201201--400400 Evacuation Evacuation PreparationsPreparations

•• Review evacuation planReview evacuation plan•• Assess and tag patients for transportation Assess and tag patients for transportation

assistance level (TAL)assistance level (TAL)•• Establish facility census by TALEstablish facility census by TAL•• Communicate with stakeholdersCommunicate with stakeholders•• Identify potential destinationsIdentify potential destinations•• Identify transportationIdentify transportation

resourcesresources18

201-400Evacuation

Preparations




401401--600600 EvacuateEvacuate•• Discontinue admissionsDiscontinue admissions•• Initiate dischargesInitiate discharges•• Prioritize patients for evacuationPrioritize patients for evacuation•• Mobilize transportation resourcesMobilize transportation resources•• Determine destinationsDetermine destinations•• Coordinate with stakeholdersCoordinate with stakeholders•• DepartDepart•• Initiate facility shutdown andInitiate facility shutdown and

Stay Team activitiesStay Team activities•• Consider recovery activitiesConsider recovery activities

19

401-600Evacuate




WrapWrap--upup•• What have we learned?What have we learned?•• Where are we going?Where are we going?•• Next steps Next steps ……





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Questions?



ConclusionConclusion

•• Your feedback is keyYour feedback is key•• Thank you for your supportThank you for your support

Excellence in Emergency ManagementExcellence in Emergency Management





For additional information...For additional information...Zachary Goldfarb, PresidentZachary Goldfarb, PresidentIncident Management Solutions, Inc.Incident Management Solutions, Inc.50 Charles Lindbergh Boulevard50 Charles Lindbergh Boulevard Suite 400Suite 400Uniondale, NY 11553Uniondale, NY 11553516.390.IMS0 (4670)516.390.IMS0 (4670)[email protected]@IMScommand.comwww.IMScommand.comwww.IMScommand.com





© 2010, Incident Management Solutions, Inc.All rights reserved.

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Evacuation Decision-Making Making for the Health Care Facility · EMT-P, CHEP, CHSP, CEM ... Incident Management Solutions, Inc. Planning Training Leadership Incident Management Solutions,