McGinty Meghan D, Burke Thomas A, Resnick Beth, Barnett Daniel J, Smith Katherine C, Rutkow Lainie
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).
J Public Health Manag Pract. 2017 Jan/Feb;23(1):29-36. doi: 10.1097/PHH.0000000000000404.
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.
To describe decision-making processes and identify determinants of acute care hospital evacuation and shelter-in-place during Hurricane Sandy.
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.
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.
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.
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.
医院的疏散和就地避难决策十分复杂，现有文献中关于这些决策在实际中如何做出的信息很少。
描述决策过程，并确定在桑迪飓风期间急症医院疏散和就地避难的决定因素。
2014年3月至2015年2月，对在2012年桑迪飓风期间对医院疏散和就地避难决策拥有权力和责任的关键信息提供者进行了半结构化访谈。访谈进行了录音、转录和主题分析。
受访者包括来自特拉华州、马里兰州、新泽西州和纽约州的医院管理人员以及州和地方公共卫生、应急管理和紧急医疗服务官员。
受访者确定了桑迪飓风期间急症医院疏散和就地避难的决策过程和决定因素。
我们采访了来自32个组织的42个人。决策者报告称，在桑迪飓风期间，他们依靠直觉而非使用指南或工具来做出疏散和就地避难的决策。疏散对患者健康的风险、以往经验、成本以及维持运营连续性的能力是决策中最具影响力的因素。预计会或实际影响运营连续性的洪水和公用事业中断是疏散的主要决定因素。
通过确保医院应急预案应对洪水并包括明确的阈值（一旦超过该阈值将触发疏散），可以改进医院的疏散和就地避难决策。通过改进与医院疏散与就地避难相关的发病率和死亡率数据的收集、分析和沟通，将增强为决策提供依据的比较风险评估。此外，管理人员和政府官员可以通过在培训和演习中练习使用决策工具来提高他们做出疏散和就地避难决策的准备程度。
