TheHospital Evacuation Decision Guidewas developed by theAgency for Healthcare Research and Quality (AHRQ), a lead Federal agency within the Department of Health and Human Services.1This guide was created to address the significant challenges hospital leadership teams face when deciding whether to evacuate patients or "shelter-in-place" during an approaching threat, such as a hurricane, or an immediate incident, such as a major utility failure. The AHRQ developed this tool because historical events, particularly Hurricane Katrina, highlighted that many hospitals lacked a systematic, evidence-based process for making this critical, high-stakes decision.
The guide provides a structured framework that helps "Decision Teams" evaluate the risk-benefit ratio of moving fragile patients. It emphasizes that evacuation is often more dangerous than sheltering in place due to the "transfer trauma" and the risks associated with moving patients on life-support without the full resources of a medical facility. The AHRQ guide introduces the concept of theDecision Point, the "last safe moment" an evacuation can be ordered to ensure it is completed before environmental conditions (like high winds or flooding) make transport impossible.
WhileThe Joint Commission(Option A) andCMS(Option C) mandate that hospitals have evacuation plans for accreditation and reimbursement purposes, they do not provide the granular, analytical guidance found in the AHRQ document. The AHRQ guide is an "all-hazards" tool that integrates with theHospital Incident Command System (HICS). It includes specific tools like the "Evacuation Planning Checklist" and the "Shelter-in-Place Analysis." For aCertified Emergency and Disaster Professional (CEDP), the AHRQ guide is the definitive resource for healthcare continuity planning. It shifts the focus from an emotional, reactive decision to a data-driven process that considers facility integrity, resource availability, and the specific medical needs of the patient population, ultimately ensuring that the choice made is the one that maximizes the survival chances of every soul in the facility.
