TU Disaster Management Paper
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Evacuation Emergency Operation Plan
Tariq Alharbi
Jefferson University
Dr. Jean B. Bail, Ed.D., RN, MSN, CEN, EMT-P (Program Director)
Abstract
Emergencies and disasters may take place at any time anywhere, including in healthcare facilities. In this case, the hazards may be either natural or human-made, while emergencies may include building collapse. An example of a natural disaster is the occurrence of floods in an area, while human-made incidents include terror attacks. King Abdulaziz Specialty Hospital has developed a program for responding to such events when they take place. An emergency operation plan for evacuating patients is necessary for the hospital to minimize the risk of patients injured in case of the occurrence of an incident. Since the current evacuation program involves moving the patients from one building to the other within the same setting, the plan needs to be improved since the entire environment may be affected in case of an emergency.
Evacuation of patients is among the critical practices conducted during an emergency period to ensure continuity of operations and; therefore, it needs to be considered in an emergency operation plan. The aim of developing this capstone project is to develop an emergency operation plan for evacuating patients within King Abdulaziz Specialty Hospital to improve the current evacuation program. The existing facility’s evacuation plan facility is somehow ineffective since the building where the patients are moved to in case of an emergency is within the hospital setting. This indicates that when a major disaster takes place, both the operation buildings and the evacuating structure can be affected. Therefore, an emergency operation plan for full evacuation needs to be developed.
Contents
Evacuation Emergency Operation Plan. 3
Examples of Facilities Affected by Disasters. 5
Lesson Learned from the Cases. 6
Significant Disasters in Saudi Arabia. 6
An Implication of the Disasters Occurrences. 9
Evacuation Process Overview.. 11
Staging and External Transport. 13
Patients Tracking, Family Notification, and Patient Destination Team. 14
- Moving the patients to the assembly point within the facility setting. 15
- Waiting for a notification from the Incident Commander 16
III. Determining the patients to discharge and those to transfer to the receiving facility. 16
- Evacuating patients from the assembly point to an external facility that is nearby. 16
- Evacuating staffs to the receiving hospital 17
Evacuation Emergency Operation Plan
The rate at which emergencies and disasters are taking place has increased over the last three decades (Bish et al., 2014). These incidents take place at any time in any place, and therefore, there is a need to make prior preparation. According to Bish et al. (2014), different types of emergencies and disasters have taken place within the last few decades, causing a significant impact not only to the communities involved but also in the healthcare facilities (Bish et al., 2014). Several centers have been affected by emergencies such as fire outbreak and terror attacks, among others. In response to the incident, several hospitals have prepared themselves for future events in different ways. King Abdulaziz Specialty Hospital is one of the hospitals that has made prior preparations to avoid any injuries to the patients and the staff in case of an occurrence of an emergency or a disaster. In this case, one of the preparations that King Abdulaziz Specialty Hospital has put in place is the partial evacuation of patients among other individuals and resources to ensure continuity of operations. Currently, the facility has built a structure within the hospital setting for the partial evacuation of patients when an incident such as flooding takes place. However, only a few incidents, such as a fire outbreak, can be avoided through such a kind of movement. These include the minor events of fire and terror attacks. However, if a natural disaster such as an earthquake, a tornado, or flooding takes place, the partial evacuation plan that the facility has set cannot be effective (Bish et al., 2014). Since no one can predict the type of an emergency or a disaster that can take place at a given time, King Abdulaziz Specialty Hospital needs to develop a plan for a full evacuation of its people and resources to improve on the current partial evacuation plan. The developed program will also ensure the continuity of the facility’s operation and reduce the chances of patients and staff from being affected by the impact of the incident.
Statement of Need
A full evacuation of patients and other resources within King Abdulaziz Specialty Hospital is necessary due to the rate at which emergencies and disasters are taking place within healthcare settings. Though the hospital has already set up a partial evacuation plan, the program may not be effective in case of an occurrence of a major disaster such as floods, earthquakes, or tornadoes. This is because when such incidents take place, they will not affect only a particular structure but the entire region. In this case, full evacuation involves moving patients and other necessary operations from the facility to another area away from the affected region. Besides, partial evacuation is moving from one area to another within the facility settings. Therefore, it is necessary to develop a project involving the full shifting of King Abdulaziz Specialty Hospital in case of an occurrence of a disaster.
Purpose
The key reason for developing the capstone project is to improve the current evacuation plan of King Abdulaziz Specialty Hospital from partial to full evacuation to ensure continuity of operations in case of an occurrence of an incident. The partial evacuation plan is only necessary when the event that takes place is of little magnitude in that it only affects a small area within the facility. Within Saudi Arabia, almost every healthcare facility has set up a full evacuation plan due to the rate at which various institutions are affected by disasters. This implies that King Abdulaziz Specialty Hospital also needs to make such a plan. However, multiple procedures and policies are necessary for the program to be effective. Therefore such practices need to be discussed in the project, among other essential operations in King Abdulaziz Specialty Hospital.
Need for the Project
Examples of Facilities Affected by Disasters. Both human-made and natural disasters are real-life occurrences (Rimstad et al., 2014). Hospitals may spend a large amount of money and much time while preparing for emergencies to ensure that their existence does not interfere with their normal operations. In this case, every hospital needs to prepare for such situations since some come without posing a warning. There is a need for every institution to make a plan for evacuating whenever an incident occurs, since disasters may take place in any country regardless of their conditions. Whenever such events take place, they may affect a large number of hospitals, and if such facilities were not prepared, their operations might come to a standstill. For example, in August 2017, many healthcare facilities in the southeastern region of Texas were significantly affected by the occurrence of Hurricane Harvey (Bish & Gausche-Hill, 2017). The hurricane caused flooding in a large area where some of the facilities could not continue with their operations due to the condition. All patients within the affected facilities were evacuated to different healthcare facilities where the flood could not reach.
Shortly after the occurrence of Hurricane Harvey, another incident of Hurricane Irma took place, leading to the closure of about 40 healthcare facilities in Florida. Patients who were in these facilities were evacuated to different healthcare facilities to ensure the continuity of their healthcare practices. During the evacuation period, significant challenges were experienced due to impassable roads and power outages. These real-life instances should serve as examples for other facilities to prepare for such events (Bish & Gausche-Hill, 2017). Though the two incidents had taken place in the United States, they occurred in different states. This is an indication that such conditions may take place in any region. The fact that impassable roads and power outages significantly affected the evacuation process, it implies that every healthcare facility should consider how the evacuation will be conducted in the case where the power and the condition of roads may be affected. Since many hospitals are affected every year by different disasters, King Abdulaziz Specialty Hospital has no unique characteristics that can exclude it from experiencing such events.
Lesson Learned from the Cases. Healthcare systems in the entire world have learned significant lessons from the occurrence of the two recent disasters in the United States alongside other incidents of Hurricanes Sandy and Katrina (Bish & Gausche-Hill, 2017). Every country across the world is susceptible to natural disasters. Besides, different types of human-made incidents such as biological weapons and bombing may strike any country anytime. Such events cannot be predicted, and that is the reason as to why various institutions are supposed to be prepared for any occurrence. Among different areas where the incidents can take place, healthcare facilities are considered to be the most susceptible place due to its condition. The reason why healthcare facilities are considered to be more vulnerable to disasters and emergencies is that the majority of individuals found in the area cannot support themselves when an incident takes place (Bish & Gausche-Hill, 2017). Most of the individuals within the facility already have health problems, which can deteriorate even when a low magnitude incident takes place. This implies that healthcare facilities are supposed to be the areas where disasters need to be mitigated in all ways possible.
Significant Disasters in Saudi Arabia. King Abdulaziz Specialty is located in Saudi Arabia, and therefore it is necessary to review substantial disasters in the region. Saudi Arabia is considered to be prone to several types of natural disasters. The north-western part of the country is susceptible to volcanic hazards and earthquakes while the western and the central part of the nation is prone to floods, mainly during heavy season periods. In mountainous areas, landslides may occur at any time, especially in the southwestern regions of the country. Besides, dust storms and shifting sand-dunes are considered to be a severe natural hazard experienced in cities found in the eastern and central areas of Saudi Arabia. Dust storms are significant in the current years due to the cities expanded recently as well as the development of infrastructure and roads.
Flash Floods. According to natural hazards statistical analysis conducted in Saudi Arabia over the last few decades specifically from 1982 to 2005, it was found that floods were the most frequent type of disaster experienced in the country (Chen et al., 2015). The average rate at which floods occurred in the region was found to be seven times in every year. The occurrence of floods in the country caused a significant impact, which was estimated to be worth $19 million every year. The floods were found to be brought about by the substantial change in global patterns in different arid regions, especially Saudi Arabia. In Saudi Arabia, areas that received a little amount of rainfall are considered to be prone to floods when heavy rain is experienced in such areas. Due to the increased rainfall intensity along with improper planning of the urban development and settlements have been considered as one of the reasons why Saudi Arabian regions are experiencing massive floods (Chen et al., 2015). These conditions have increased the severity of flooding since the rate of absorption of water into the ground has reduced.
One of the instances of floods was found around Jeddah region in 2009, where rainfall of over 90mm was experienced in the area. The rain fell for about four hours, causing significant floods that made several people evacuate from the affected regions to the places where there were little or no floods. The floods were deemed to be the worst incident experienced in the country over the last 27 years. The event killed over 100 people, and approximately 350 individuals were reported to be missing (Rimstad et al., 2014). Economically, the loss that was incurred in the affected region was found to be approximately one billion Saudi Riyal. A similar hazard was experienced in the country two years later, causing a more significant loss compared to the previous one. The rainfall was about 110mm that occurred on 26th January 2011 in Jeddah City. The death cases experienced in the region were uncountable along with significant loss of property, especially in the low lying areas.
Volcanic Hazards and Earth Quakes. Between April and June 2009, over 30,000 cases of the earthquake were experienced in the northwestern part of Saudi Arabia. After the analysis of the incident was conducted on 19th May 2009, 19 earthquakes were recorded simultaneously, where all of them were found to have a magnitude of four (Hanfling et al., 2013). Among the earthquakes experienced in the region, the most significant one had a magnitude of 5.4. Large magnitude earthquakes caused much damage to structures, especially in Al-Eis town, which is located 40 miles from Medina City. A surface rupture of 8 miles was experienced in the area from the northwestern part towards the northern side due to the volcanic effect of the earthquakes. Some of the earthquakes that occurred in the area were found to be significant since they originated from volcanic fields. However, it was unclear whether the volcanic activity resulted from tectonic forces or triggered by the effect of magma movement beneath the volcanic areas. The earthquakes that occurred in Saudi Arabia in 2009 due to the volcanic activities were considered to be historical since such an incident took place approximately 1400 years ago (Hanfling et al., 2013). According to the investigation that was conducted by scientists during the period, it was found that there are high chances of other volcanic eruptions to take place in the near future since the magma activity is still active, especially near Madinah City.
Dust Storms. Dust storms are also a frequent and potential natural hazard experienced in Saudi Arabia. Such incidents significantly affect daily activities conducted within various parts of the country within short time intervals. The most significant problem associated with the occurrence of dust storms is reduced visibility that causes a high rate of traffic accidents and aircraft issues within the susceptible regions (Hunt, 2016). Such incidents also cause severe environmental effects in the areas affected, especially the spread of diseases from one area to another. Patients experiencing lung problems are considered to be among the individuals who are more susceptible to illnesses brought about by dust storms. Dust storms are also associated with an increased level of mechanical and telecommunication damage, as well as interfering with soil fertility and crop damage. Sandstorm incidents are deemed to be frequent between March and May, and therefore people tend to prepare themselves between these months to avoid potential impact (Hunt, 2016). The dust that strikes the area is deemed to originate from arid parts of the country through the Arabian Peninsula. Winds transport these dust from southwestern parts to the east. One of the most significant incidents of dust storm was experienced between March 26 and 27 in 2011. The storm moved for over 500 miles affecting various structures across the Arabian Peninsula.
An Implication of the Disasters Occurrences. Based on the instances of disasters experienced in different parts of the world, especially in the United States and Saudi Arabia, it implies that every country can experience an incident at any time (Kearns & Cairns, 2014). These disasters are considered to be associated with a significant loss of life and damage to structures. In such cases, healthcare facilities are among the most affected areas due to the occurrence of such events. When the disasters take place within a healthcare facility, it tends to affect the operations undertaken within the region, thus causing more harm to the patients. Such effects have called for the development of projects for mitigating the impact caused by such events. Besides, several healthcare facilities have developed evacuation programs to enhance the continuity of care among the patients within the affected regions to reduce more impact on them (Kearns & Cairns, 2014). Based on the magnitude and severity of such events, partial evacuation programs cannot be the best solution for these cases. This implies that a full evacuation plan is necessary among the facilities where the incidents take place. The increased level of disaster occurrences calls for a project to be conducted to enhance the process of evacuation for the patients, among other necessary resources.
Literature Review
Guiding Principles
During the evacuation period, various guidelines have to be considered. Moving the patients, staff, and visitors who are within the affected healthcare facility needs a high level of safety. In this case, security is considered to be the primary goal for evacuation (Agca, 2013). Depending on the severity of the scenarios, it is necessary to understand that the routine processes and care may not be optimal due to the condition brought about by the incident. During the occurrence of an event, the staff within the affected facility needs to understand the fundamental principles that enable them to make the right evacuation decisions (Agca, 2013). In this case, nine significant decisions need to be considered.
The first one indicates that the full evacuation of the facility needs to be considered as the last practice when the mitigation process, among other response efforts of an emergency, fails (Agca, 2013). The second principle asserts that safety is usually the primary objective during an emergency, and therefore, every individual should ensure that the practices carried out need to enhance security. Third, since simplicity is considered as the key, the staff needs to make a simple plan that can be applied during an emergency. Next, flexibility is critical during the emergency period since every procedure taken has to be adaptable to various situations (Haverkort & Leenen, 2016).
The fifth principle indicates that self-sufficiency is necessary at the unit level since timely communication between the facility leaders might be impossible or difficult. In such a case, every employee within the healthcare facility needs to understand what role he or she can play when a disaster arises. The other principle asserts that it is recommended to consider the evacuation of patient care sites first before transporting other resources. Since horizontal evacuation sites may not be available during the emergency period, every healthcare facility needs to look for a Designated Assembly Point outside the facility’s environment (Haverkort & Leenen, 2016). Such assembly points allow essential patient care practices to be conducted while the arrangements for transporting patients to an evacuation hospital are being made.
The next principle is that individual patient care units have to be kept together at the Designated Assembly Point, if possible, to enhance various practices to be carried out efficiently (Haverkort & Leenen, 2016). When such units care kept together, the unit teams responsible for carrying out different operations can efficiently manage their activities based on their familiarity. The other principle indicates that the Emergency Medical Service provider and external patient transporters are not supposed to be called to the hospital unit to carry out their roles since time delays, risks, and inefficiency may be caused due to a large number of patients that need to be attended (Haverkort & Leenen, 2016). Instead of calling such personnel, evacuating patients are supposed to be taken to designated areas where such professionals can carry out their roles. The last principle indicates that when challenging choices have to be made, the facility staff and leaders need to focus on the best idea that favors the majority of the patients involved (Haverkort & Leenen, 2016). If such principles are considered well, the evacuation process can be effective and efficient.
Evacuation Process Overview
The Hospital evacuation process needs to be organized in different key components (Vugrin & Wyte-Lake, 2015). It is difficult to make an evacuation decision since it involves the presence of the hospital leaders and the external authorities after conducting a careful assessment of safety threats as well as the alternatives that can be considered (Vugrin & Wyte-Lake, 2015). However, once the decision has been made, the actual process of evacuating can be carried out with minimal or no challenges. During a hospital evacuation process, the stages that need to be considered are indicated in the diagram below.
Figure 1: https://www.mass.gov/files/documents/2016/07/tx/planning-guide.pdf
Clinical Unit Preparation. A unit leader is the one responsible for managing the Clinical Unit Preparation. In such cases, an individual who takes the responsibility of this section needs to be a resource nurse or any other individual who can serve as a site leader (Vugrin & Wyte-Lake, 2015). The clinical unit preparation stage starts with the preparation of the equipment necessary, medications, and medical records. These elements are supposed to accompany every patient during the transportation process and end as the patient is about to be transported from the section (Petinaux & Yadav, 2013). The unit leader also takes the responsibility of working with various clinical professionals to identify the patients who need to be discharged from the facility after the occurrence of an emergency. For such patients, it is not necessary to move them to the evacuation hospital or care unit (Petinaux & Yadav, 2013).
Internal Patient Transport. A floor coordinator is considered to be the person in charge of internal patient transport (Bish et al., 2014). He or she works in collaboration with the Unit Leader to make sure that every patient is taken to the Staging Area, Assembly Point, or Discharge Unit Area through elevators, stairs, or any appropriate means (Bish et al., 2014). The Transport Coordinator makes sure that every patient has been taken to a proper area on the ground level, depending on his or her condition.
Discharge Site Operations. The personnel in charge of the discharge site operations is responsible for caring for the patients who have been considered to be safe after conducting the evacuation order (Rimstad et al., 2014). Such patients need rapid discharge from the facility to avoid being injured as well as reduce the activities required to be carried out during the evacuation process (Rimstad et al., 2014). The leaders responsible for the discharge site ensure that the staff and supplies are organized and ready to monitor the patients as they wait to be transported to their respective homes or any other appropriate area. For the patient to be taken to the discharge site, they have to be allowed by various professionals who were taking care of them before the occurrence of the emergency (Rimstad et al., 2014). Besides, the patients have to “check-in” to this site.
Assembly Point Operations. At the assembly point, various leaders within the affected facility make sure that the staff, equipment, and supplies are well organized and available for the operations necessary at the Assembly Point (Chen et al., 2015). The patients are taken to this point as they “check-in” for the management of patient care before they are taken to the evacuation hospital.
Staging and External Transport. This stage involves the practices carried out by various staff during the “checking-out” of patients from the point that they had assembled waiting to be taken to the evacuation hospital (Chen et al., 2015). Such practices involve loading patients and various equipment into ambulances, among other vehicles ready to be taken to another facility. The leaders who are in charge of managing such practices ensure that the travel needs for the patients are met. Such requirements include staff supervision, necessary equipment, and medical records (Chen et al., 2015). The leaders also confirm the identity of every patient as they are transferred to the identified destination. If there is any document that has been left behind, it has to be recorded.
Patients Tracking, Family Notification, and Patient Destination Team. The patient tracking personnel coordinates the Patient Tracking process. The staff is responsible for managing this process tracks and reporting the location where the patients have been taken during the evacuation process to ensure that they are easily accessed when necessary (Hanfling et al., 2013). Such information is sent either to the healthcare providers or to the respective family members.
Unit members take the responsibility of notifying family members among other relevant people regarding the process, the condition of the patients, and where they are at the moment. These members should have every information regarding the patients since they take the responsibility of answering any question asked by the people notified (Hanfling et al., 2013). Besides, the unit members have to look for a means of identifying whether the information passed has successfully received by the relevant people.
The facility team starts working on the evacuation process as soon as the plan has been activated. Various patients have to be matched with their respective units and beds in the evacuation facility (Hanfling et al., 2013). Due to the complexity of the evacuation procedure, individuals who take various roles in the process have to be accompanied by a Chief Medical Officer, case managers, admitting office representatives, and the senior nurse. The team comprising of these individuals work in collaboration with the Emergency Medical Service providers and the public health professional to identify the ambulances and the beds available for the patient transfer (Hanfling et al., 2013).
The evacuation and emergency operation plans have to consider the possibility of failure of various systems due to the occurrence of a disaster (Hunt, 2016). In such cases, contingency strategies have to be considered for the development of alternative ways to use in case of such failures (Hunt, 2016). For instance, when Hurricane Sandy took place, several evacuating healthcare facilities lost their radio system, internet, and telephone network. When such failure took place, it was challenging to communicate with various leaders who were responsible for playing a critical role during the process (Hunt, 2016).
Methods
It was necessary to visit the King Abdulaziz Specialty Hospital to conduct an interview with the manager regarding the evacuation procedure to be applied in the facility in case an incident takes place. Several questions regarding the emergency operation plan of King Abdulaziz Specialty Hospital were available to provide assistance in conducting the interview. The questions were based on the type of evacuation that the facility had designed in case of an occurrence of an event. However, some of the questions led to the emergence of the others since the available ones did not cater for every evacuation procedure. As the manager answered various questions asked during the interview, the questions that rose were recorded to be asked later. After the manager produced the emergency operation plan, it was reviewed and analyzed based on the type of disasters that are common in the region. Since most of the frequent hazards in the region usually affect a large area, the idea of partial evacuation that the facility had considered was not the best choice. Therefore, it was necessary to consider full evacuation in case of the occurrence of an incident. Various steps were considered for the full evacuation of the patients, healthcare providers, and equipment from King Abdulaziz Specialty Hospital to the nearby receiving facility necessary for the continuity of operation. The steps considered are as follows.
I. Moving the patients to the assembly point within the facility setting.
The patients shall be moved from the affected building by following the instructions given by the disaster manager. The response team and the patients shall use the staircase rather than the elevators. No one is supposed to use the lifts or elevators since they may fail, leading to more risk of injury to the people involved. Patients shall be moved from the facility in groups. The first group shall be comprised of the patients who are categorized as walking patients. These are the individuals who can move by themselves. These patients shall be led to the exit with much attention to avoid injuries. The second group shall involve mobility-impaired patients. This group shall be comprised of individuals who use wheelchairs, among other wheeled equipment. The third group shall include bed-ridden patients. This group shall be made of individuals who remain in bed all the time. Stretchers shall be applied to move these individuals from the affected building. If such equipment is not available, it has to be improvised by the use of blankets or bedsheets. The patient shall be put on an appropriate coverage and dragged on the floor to safer places.
II. Waiting for a notification from the Incident Commander
After everyone has moved from the affected region to the assembly point, the disaster manager shall notify the leaders about the procedure to be used to move the patients to the receiving facility. In such a case, the disaster manager shall determine whether there will be any patient who will be discharged to reduce the evacuation costs and the risk of being injured more. If there will be any patient to be discharged, the doctors in charge shall be notified.
III. Determining the patients to discharge and those to transfer to the receiving facility.
Patients who have recovered from their conditions shall be discharged. There is no need for such patients to be taken to the receiving facility; instead, they shall be discharged to ensure their safety. However, before they are discharged, the unit leader shall be required to inform their family members.
IV. Evacuating patients from the assembly point to an external facility that is nearby.
The Hospital Disaster Coordinator and the Transport Unit Leader shall take the responsibility of transferring the patients to the evacuation facility. Every patient shall be provided with an identification tag during the transfer process. The inpatient medical staff or patient’s physician shall take the responsibility of determining the beds through which the patients will be transferred. Every patient transferred shall be assumed to have been discharged from King Abdulaziz Specialty Hospital to the next facility. A copy of their medical records shall accompany the patients to the new hospital. The receiving hospital shall take the responsibility of readmitting every patient bought in. After the disaster is over and renovation is done, the patients shall be taken back to the affected facility.
V. Evacuating staffs to the receiving hospital
Healthcare providers are necessary since they provide healthcare services to evacuated patients. Their urgency shall determine the evacuation of healthcare providers in providing services to various patients. The staff who are in charge of the patients who are in critical conditions shall be given the priority, followed by the rest in the order of their urgency.
Final Product
Every activity carried out has its results. The results are necessary since they determine the effectiveness of the practice carried out. For my final work, the product will involve an education program for training healthcare providers to respond to emergencies whenever they occur. In this case, two major programs will be developed. These aspects include a training program to handle high-dependent patients as well as independent patients.
High-dependent patients are the individuals within a healthcare facility who depend on other healthcare providers for every support. Such patients need close monitoring to ensure that all their needs are adequately addressed. During an emergency, such patients are more vulnerable to injuries due to their inability to support themselves. However, to enhance their safety during emergencies, healthcare providers who are responsible for caring for such patients will be trained on how to handle them with care to avoid causing more injury to them.
Besides, independent patients involve individuals who can support themselves when necessary. Though such patients are still under medication, they can move from one place to another within the healthcare facility. Healthcare providers will be trained on how to offer additional support to such patients since they can walk by themselves. For the patient to walk properly, they will be provided with supportive equipment such as working sticks to minimize the chances of falling. The healthcare providers assigned to handle such patients will be trained on how to show the patients to walk with minimal adverse effects to their bodies.
References
Agca, E. (2013). Optimization-Based Logistics Planning and Performance Measurement for Hospital Evacuation and Emergency Management (Doctoral dissertation, Virginia Tech).
Bish, D. R. & Gausche-Hill, M. (2017). Modeling to optimize hospital evacuation planning in EMS Systems. Prehospital Emergency Care, 21(4), 503-510.
Bish, D. R., Agca, E., & Glick, R. (2014). Decision support for hospital evacuation and emergency response. Annals of Operations Research, 221(1), 89-106.
Chen, W., Guinet, A., & Ruiz, A. (2015). Modeling and simulation of a hospital evacuation before a forecasted flood. Operations Research for Health Care, 4, 36-43.
Hanfling, D., Powell, T., & Gostin, L. O. (2013). Hospital evacuation decisions in emergency situations—reply. JAMA, 309(15), 1585-1586.
Haverkort, J. M. & Leenen, L. P. (2016). Hospital evacuation: Exercise versus reality. Injury, 47(9), 2012-2017.
Hunt, A. L. E. (2016). Simulating hospital evacuation (Doctoral dissertation, University of Greenwich).
Kearns, R. D. & Cairns, B. A. (2014). Disaster planning: transportation resources and considerations for managing a burn disaster. Journal of Burn Care & Research, 35(1), e21-e32.
Petinaux, B., & Yadav, K. (2013). Patient-driven resource planning of a health care facility evacuation. Prehospital and disaster medicine, 28(2), 120-126.
Rimstad, R., Njå, O., Rake, E. L., & Braut, G. S. (2014). Incident command and information in an emergency operation. Journal of Contingencies and Crisis Management, 22(1), 29-38.
Vugrin, E. D. & Wyte-Lake, T. (2015). Modeling evacuation of a hospital without electric power. Prehospital and disaster medicine, 30(3), 279-287.
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