Summary

During disasters, administrators of health care facilities are faced with decisions about how to operate and care for patients, including when and how to evacuate patients if the facility becomes unable to support adequate care, treatment, or services. Hospitals and nursing homes are required to have plans in place that describe how they will operate during emergencies. Hurricanes Katrina and Rita were incidents of national significance that highlighted the challenges involved in evacuating vulnerable populations, including those in hospitals and nursing homes. Federal officials used the National Disaster Medical System (NDMS) to help evacuate patients due to Hurricane Katrina--the first time the system has been used to evacuate such a large number of patients. Formed in 1984, NDMS is a partnership among the Department of Defense (DOD), the Department of Health and Human Services (HHS), the Department of Homeland Security (DHS), and the Department of Veterans Affairs (VA). We have begun work to assess the evacuation of hospital and nursing home patients due to disasters. We are performing this work under the Comptroller General's authority to conduct evaluations on his own initiative. To conduct our review, we obtained information on (1) who is responsible for deciding to evacuate hospitals and nursing homes, (2) what issues administrators consider when deciding to evacuate hospitals and nursing homes, and (3) what federal response capabilities support the evacuation of hospitals and nursing homes. The Senate Committee on Health, Education, Labor, and Pensions requested a briefing on the preliminary observations of our review. We briefed the committee with other committees of jurisdiction on February 16, 2006. This report documents our preliminary views as presented in those briefings.

We found that hospital and nursing home administrators are often responsible for deciding whether to evacuate patients from their facilities due to disasters, including hurricanes or other natural disasters. State and local governments can order evacuations of the population or segments of the population during emergencies, but health care facilities may be exempt from these orders. Hospitals and nursing home administrators told us that they evacuate only as a last resort and that facilities' emergency plans are designed primarily to shelter in place. Administrators consider several issues when deciding to evacuate or to shelter in place, including the availability of adequate resources to shelter in place, the risks to patients in deciding when to evacuate, the availability of transportation to move patients and of receiving facilities to accept patients, and the destruction of the facility's or community's infrastructure. Nursing home administrators must also consider additional factors, including that their residents generally have no other home and cannot care for themselves, and the necessity to locate receiving facilities that can accommodate residents for a long time. Finally, NDMS, a federal system, can provide assistance with evacuation of hospital patients, such as providing transportation from one location to another. Federal officials told us, however, that NDMS was not set up nor is it currently configured to provide assistance evacuating nursing homes. In our ongoing review, we are continuing to examine the vulnerabilities of nursing homes in future disasters, particularly hurricanes.