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Failure to set, train, and follow an evacuation sequence order can result in extended
evacuation times and loss of life. Whether your facility is large enough to have a dedicated
Emergency Management team or emergency planning falls under Operations, one of the top
action items is to develop a sound evacuation plan.
This begs the question, in case of emergency, who do you evacuate first from a hospital?
We evaluated publicly available evacuation documentation from several facilities and
Emergency Management University programs and have compiled these guidelines.
Immediate Danger
In almost all cases, the top priority for evacuation is moving those who are in immediate
danger. In case of fire, chemical spill, or other localized danger, identifying those at highest
risk is easy because it is based on proximity. Be sure to consider evacuating both ambulatory
and non-ambulatory patients from a given area, without the use of elevators.
If you are in a multi-floor facility, evacuate those on the compromised floor, and then those
above that area before evacuating below to the main floor to ensure no evacuation.
If the threat is not centralized and impacting the entire facility, the question becomes
evaluating your time and resource level.
If you are short on either of those, staff may be tempted to focus their efforts on critical or
non-ambulatory patients first, but best procedures recommend you plan for a swift evacuation
of your ambulatory population first to maximize the lives saved.
Identify a trained guide to keep the flow of evacuees moving along a designated path to
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either a safe location within the facility or outside and stop anyone from re-entering. Examples
may be structural concerns after an earthquake or a rapidly approaching wildfire.
If there is time and the resources to safely evacuate everyone, focus your efforts on critical
patients first and then follow up with ambulatory patients. Disclaimer on this strategy is if your
facility has a high concentration of non-ambulatory or critical patients (I.e., more than 30% on
ventilators), plans developed for standard patient makeups may not make sense.
Non-Ambulatory
No matter when your evacuation plan calls for the extrication of non-ambulatory patients, you
need to ensure you are fully prepared to move even the most critical care patients without the
use of elevators or requiring staff or first responders to repeatedly re-enter a dangerous
facility.
Major Takeaway
The best evacuation plan and the proper evacuation sequence at a hospital will be as unique
as the facility’s design and patient makeup and will have several if/then statements fully
planned. Be sure to consider both real-life past examples (Northridge Earthquake, Hurricane
Katrina, Texas Deep Freeze) as well as evaluate worst case scenarios to follow an outcome-
focused readiness mindset.
Great Resources
With these guidelines you can develop and train to a plan that makes sense for your facility.
No matter what, your plan should be consistent with federal NIMS and The Joint Commission
requirements.
Training
The best laid plan will still fail if proper training is not offered to your staff. Set regular drills
and training sessions to make sure that during an emergency your staff knows exactly what to
do or who to come to for further guidance.
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