PURPOSE: After Hurricane Katrina, for the first time in history, hospitals and Critical Care Units (ICU) in a major US city (New Orleans) faced the need to evacuate patients. We examined the experiences of these hospitals and ICU's. Using interviews and reviews of published accounts, we examined five general areas which include the following: Hospitals' decision to evacuate, The evacuation process, Hospitals disaster plans, Patients' status during the evacuation, and Lessons learned. Potential Health Policy implications were sought.
METHODS: Using a standard survey, interviews with senior officials at 10 New Orleans hospitals (IRB approved from Urban Institute) were conducted in November 2005. Also, local published accounts of the experience of hospitals and ICU's during and after Katrina were reviewed.
RESULTS: The most commonly cited reasons for lack of evacuation before the storm included the following: Hospitals historically considered a refuge, Ambulances confiscated by mayor's office, and Transfer hospitals' refusal to accept patients. Reasons for evacuation after the storm differed among hospitals due to the following: Flooding, Loss of electricity, water, sanitation, and Loss of police protection. The most unexpected complexities during evacuation included the following: Lack of access to methods to evacuate patients, Transfer of both morbidly obese and mechanically ventilated patients up dark stairwells (lack of electricity) to rooftop helipads.
CONCLUSION: Multiple complex issues including poor hospital and ICU infrastructure, lack of planning for an overwhelming disaster at both the hospital and municipal level, fear of litigation, political posturing, complete lack of communication and thus coordiation were associated with the poor evacuation response both pre/post Katrina.
CLINICAL IMPLICATIONS: Implications for both clinical and health policy include the following: Calls for mandatory evacuation should include hospitals and ICU's, Prioritize vulnerable for evacuation, Understand that circumstances determine whether hospitals and ICU's can self-evacuate or need external assistance, Liability concerns affect decisions to evacuate and needs addresseing, Reliable communication needed that can withstand hurricanes, flooding and loss of electricity, Hospital infrastructure should withstand flooding, including generators and electrical panels above ground level.
DISCLOSURE: Lee Arcement, None.