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Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making

Published online by Cambridge University Press:  18 March 2015

Karen A. Ricci ,
Anne R. Griffin ,
Kevin C. Heslin ,
Derrick Kranke  and
Aram Dobalian
Karen A. Ricci
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, California USA Adjunct Staff, RAND Corporation, Santa Monica, California USA
Anne R. Griffin
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, California USA
Kevin C. Heslin
Affiliation:
US Department of Health and Human Services, Center for Delivery, Organizations, and Markets (CDOM), Agency for Healthcare Research and Quality, Rockville, Maryland USA
Derrick Kranke
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, California USA
Aram Dobalian*
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, California USA Department of Health Policy and, Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California USA School of Nursing, University of California, Los Angeles, Los Angeles, California USA
*
Correspondence: Aram Dobalian, PhD, JD Veterans Emergency Management Evaluation Center (VEMEC) 16111 Plummer St. MS-152, North Hills, California 91343 USA E-mail: Aram.Dobalian@va.gov
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Abstract

Problem

Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System’s (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012.

Methods

Semi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event.

Results

The most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City’s (NYC’s) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city’s order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit.

Conclusions

Results suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.

RicciKA , GriffinAR , HeslinKC , KrankeD , DobalianA . Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making. Prehosp Disaster Med2015;30(3):1-6

Keywords

disastershospital evacuationorganizational cultureorganizational decision making
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 3 , June 2015 , pp. 233 - 238
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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