Prioritizing Patients for Evacuation from a Health-Care Facility

The success of a health-care facility evacuation depends on communication and decision making at all levels of the organization, from the coordinators at incident command to the clinical staff that carry out the evacuation. One key decision is the order in which each patient is chosen for transport. While a health-care facility evacuation is largely dependent on the availability of transportation resources (both personnel and vehicles) as well as receiving facilities, the typical planning assumption is that all patients will be transferred. However, the availability of these resources, as well as time, may not allow for the successful evacuation of all patients. The proposed two-phase modeling approach develops a decision framework for prioritizing patient evacuations, with unique classifications of patient health, rates of evacuation, and survivability affecting the choice. The question of who is transported next is explored in several scenarios (in terms of physical processing estimates as well as competing, ethically motivated objectives). Insights and observations into the creation of a prioritization policy follow. The observations from dynamic programming are extended; simulation analysis is used to observe system performance under many of the same scenarios. The prioritization guidelines developed in this paper will help determine the need and allocation of transportation resources.