Evacuation Decision-making process of Hospital Administrators in Hurricane Harvey

医院是灾害期间和灾后照顾弱势群体的关键基础设施。问题是，医院也面临着与它们所在的社区同样的灾难风险。正如飓风促使人群疏散一样，医院也发现自己需要做出决定，是在登陆前疏散患者，还是在风暴期间就地避难。几乎没有证据表明医院管理者是如何做出这一至关重要的决定来保护病人的健康和生命的。本项目将采访德克萨斯州东南部受哈维飓风影响的医院的行政人员和应急管理人员。该研究将探讨在决策中考虑了哪些信息，如何获得这些信息，以及如何平衡与移动患者相关的危险与与可能被洪水淹没或维持其他基础设施损坏的医院相关的危险。本项目收集的信息将有助于应急管理人员更好地了解医院在灾害期间作为关键基础设施组成部分的作用。虽然有大量关于医院后送的文献，但大多数文章反映了后送过程的案例研究，并没有讨论是撤离还是就地避难的决策过程。该项目的研究目的是收集所需的数据，以了解医院管理者在飓风事件发生之前或期间决定撤离医院或就地避难所时的决策过程。了解这一过程对于规划社区如何应对灾害及其对医院作为关键基础设施组成部分的依赖具有重要意义。本研究以保护行为决策模型为指导。该研究将探讨对危险严重程度的感知、疏散或避难的准备程度、患者负荷的特征、疏散相对于避难的感知净收益、疏散命令的存在/不存在以及风暴的环境线索。研究小组将对来自受哈维影响县的医院的有目的样本的医院管理人员进行关键信息者访谈。网上的新闻报道显示，该地区的25家医院在风暴的某个时刻被疏散。抽样方法将根据沿海地区根据预测的风暴潮收到飓风警报的医院和内陆地区主要面临洪水风险的医院，以及疏散状况（影响前疏散；影响后疏散；和未疏散）进行分层。研究小组将选择25%的医院（42家），确保6个确定的阶层中每个阶层都有医院。问题将检查哪些个人被纳入决策过程；需要什么信息；信息从何而来？决策者是如何权衡疏散和原地避难的风险的？了解影响医院在灾难期间保持开放能力的因素是社区恢复能力的关键组成部分。

Hospitals are a critical infrastructure during and after disasters to care for vulnerable populations. The problem is that hospitals are also at risk to the same disasters that the communities they are part of are. Just as hurricanes prompt the evacuation of populations, hospitals also find themselves needing to make decisions about whether to evacuate their patient population prior to landfall or shelter-in-place during the storm. There is little evidence about how hospital administrators make this crucial decision in protecting the health and lives of their patients. This project will interview administrators and emergency managers from a sample of hospitals affected by Hurricane Harvey in Southeast Texas. The research will explore what information was considered in the decision, how was the information obtained, and how are the dangers associated with moving patients balanced against the dangers associated with staying in a hospital that may be flooded or sustain other infrastructure damage. The information gathered in this project will help emergency managers better understand the role of hospitals as a critical infrastructure component during a disaster. While there is a significant literature on hospital evacuation, the majority of articles reflect case studies of the evacuation process and do not discuss the decision-making process of whether to evacuate or to shelter-in-place. The research objective of this project is to collect the data needed to understand hospital administrators' decision making processes when deciding to evacuate the hospital or shelter-in-place in advance of or during a hurricane event. Understanding this process is important for planning how communities will respond to disasters and their reliance on hospitals as a critical infrastructure component. The research is guided by the Protective Action Decision Model. The research will explore how the perceptions of the severity of the hazard, the level of preparedness to evacuate or shelter in place, characteristics of the patient load, the perceived net benefit of evacuating over sheltering in place, the presence/absence of evacuation orders, and environmental cues from the storm. The research team will conduct key informant interviews with hospital administrators from a purposive sample of hospitals in Harvey-effected counties. Online news articles suggest that 25 hospitals in the region evacuated at some point of the storm. The sampling methodology will be stratified by hospitals in the coastal region that received hurricane warnings based on predicted storm surge and those inland that were primarily at risk from flooding, and also based on evacuation status (evacuated pre-impact; evacuated post-impact; and did not evacuate). The research team will select 25% of hospitals (42) ensuring that there are hospitals from each of the 6 defined strata. Questions will examine which individuals were included in the decision process; what information was sought; where was the information obtained from; and how did decision makers weigh the risk of evacuation vs. shelter-in-place? Understanding the factors contributing to a hospitals ability to stay open during a disaster is a critical component for the resilience of the community.