Significance

• A planned exit strategystairs image by drawos from Fotolia.com
  
  Rutgers Center for State Health Policy reported that emergency department visits in New Jersey alone was at 3.36 million in 2005. As a nation, this number more than tripled, which is why health professionals deemed it necessary to have an efficient policy for evacuating patients and staff if and when a crisis occurs.
  
  

Types

• A hospital will either evacuate from an internal or external emergency. For internal emergencies, the New York Center for Terrorism Preparedness and Planning (NYCTP) lists in its March 2006 policy that fire, smoke, hazardous materials released, or fumes are reasons for evacuation. Other reasons include loss of environmental support services, loss of medical gases, explosion, police actions or violently armed visitor(s). External emergencies the NYCTP named by are natural hazards, regional power outage, civil disturbance, terrorism, radiation and contaminated victims.
  
  

Procedure

• Assisting patientsKrankenhauszimmer image by M. Johannsen from Fotolia.com
  
  Complications during a hospital evacuation are expected; telecommunications may be nonexistent, and patient participation is variable. In order to maintain control, each hospital employee is expected to understand and be ready to execute either a horizontal or vertical evacuation. According to NYCTP, employees "[s]hould remove patients who are in immediate danger first. Waiting for instructions is not an option."
  
  Horizontal evacuations require the removal of patients to a safer area within that same floor, while vertical evacuation is performed when the entire building needs to be cleared. Vertical evacuation is performed when the entire hospital structure is threatened, requiring all floors of care to be emptied.
  
  

Priorities

• Because evacuation policies are updated according to facility changes and new information, In May of 2006 the Center for BioTerrorism Preparedness and Planning added new implementations to the NYCTP. But it reinforced the rule of thumb for patient movement as; first, second and last.
  
  The first group to be moved aside from those in immediate danger are those that have mobility resources and require the least amount of assistance.
  
  The second group to evacuate should be composed of those who limited mobility and need moderate assistance.
  
  Last are the patients who are completely incapable of being self reliant. These individuals more than likely are depending on some form of life support and require more than two members of the hospital staff to help relocate them.
  
  

Post Evacuation

• Each one U.S. county has neighboring health care facilities that are named as transfer sources for hospitals in the case of an emergency. In 2009 Wyandotte County located in Kansas City, Kansas reported 306 facilities that have medical assistance available, this number varies per state.
  
  Ideally, patients would be placed in temporary safe areas located on hospital grounds until re-entry is possible.