Evacuation Decision-making process of Hospital Administrators in Hurricane Harvey

医院是灾害期间和灾后照顾弱势人群的关键基础设施。问题是，医院与它们所在的社区一样，也面临着同样的灾难风险。就像飓风促使人群疏散一样，医院也发现自己需要决定是在登陆前疏散病人，还是在风暴期间就地避难。几乎没有证据表明医院管理者如何在保护患者健康和生命方面做出这一关键决定。该项目将采访德克萨斯州东南部受飓风哈维影响的医院的管理人员和应急管理人员。这项研究将探索决策中考虑了哪些信息，这些信息是如何获得的，以及与转移患者相关的危险与留在可能被洪水淹没或遭受其他基础设施破坏的医院相关的危险是如何平衡的。该项目收集的信息将帮助应急管理人员更好地了解医院作为灾难期间关键基础设施组成部分的作用。虽然有大量关于医院疏散的文献，但大多数文章反映了疏散过程的案例研究，而没有讨论是疏散还是原地避难的决策过程。这个项目的研究目标是收集所需的数据，以了解医院管理者在飓风事件之前或期间决定疏散医院或原地避难所时的决策过程。了解这一过程对于规划社区将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非常重要。本研究是在保护行动决策模型的指导下进行的。这项研究将探索人们对危险的严重性、疏散或避难的准备程度、病人负荷的特征、疏散相对于就地避难的净效益、疏散命令的存在/缺失以及风暴的环境线索的感知如何。研究小组将从受哈维影响的县的医院中进行有目的的抽样，对医院管理人员进行关键线人访谈。网上新闻文章显示，该地区的25家医院在风暴的某个时候被疏散。抽样方法将根据沿海地区收到飓风警报的医院进行分层，这些警报基于预测的风暴潮和主要面临洪水风险的内陆医院，还将基于疏散状态(影响前疏散；影响后疏散；以及未疏散)。研究小组将选择25%的医院(42家)，确保6个确定的阶层中的每一个都有医院。问题将审查哪些人被包括在决策过程中；寻求了什么信息；信息是从哪里获得的；以及决策者如何权衡撤离风险与原地避难所？了解有助于医院在灾难期间保持开放的因素是社区抗灾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.