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

Ricci KA, Griffin AR, Heslin KC, Kranke D, Dobalian A. Prehosp Disaster Med. 2015 Jun;30(3):233-8. doi: 10.1017/S1049023X15000229. Epub 2015 Mar 18.

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.

KEYWORDS: NYC New York City; NYHHS New York Harbor Healthcare System; VA Department of Veterans Affairs; VAMC VA medical center; VISN Veterans Integrated Service Network; disasters; hospital evacuation; organizational culture; organizational decision making