The reality is that the risks our facilities face today are different from what we imagined a decade ago — and that a rapidly changing climate poses yet unforeseeable hazards for the future. Here’s a case study from Kaiser Permanente.
In 2017, as the Tubbs Fire made its dramatic and rapid assault on Santa Rosa, California, our doctors, nurses, and support staff faced the unimaginable task of evacuating the hospital. It was a job that many, if not most, of them never imagined doing in their careers. And yet, again this fall, wildfire threatened the facility. As the Kincade Fire made a slower — though no less deliberate — approach, our staff halted surgeries, deliveries and more and packed up our patients. We safely evacuated more than 120 and ensured care continuity under extreme duress.
While it’s a practice we wish we had never had, these two emergencies have helped us build and prepare a resilient response operation and this year’s evacuation demonstrated significant improvements; we were able to evacuate more efficiently and calmly. Here’s how we’ve refined these practices.
DEVELOP A TURNKEY COMMAND CENTER
Kaiser Permanente had previously created regional ad hoc command centers to respond to specific incidents, but we learned that critical time can be lost during an emergency when summoning personnel to a new location, connecting and re-connecting communications equipment and establishing a physical command center to accommodate the required support staff.
With this in mind, in 2018 we opened a fully operational, turnkey command center at our regional headquarters in Oakland outfitted with the appropriate telecommunications and IT equipment needed to coordinate our emergency response across multiple sites and disaster scenarios. The center has the technology and trained personnel to provide constant visibility into the operational performance of each of our hospitals during an emergency, enabling us to provide resources and support in real time.
OPEN A COMMAND CENTER BEFORE THE THREAT BECOMES ACUTE
The 2017 Tubbs fire swept through Santa Rosa and up to our hospital’s property line in the middle of the night, with little advance notice. At our debrief after the incident we reviewed ways to gain additional time and improve communications in a similar scenario. The answer lay in a common medical practice: Treat potential problems before they become acute.
Now we open a command center at the first sign of a potential threat. This allows emergency teams to communicate issues in real time, develop planning scenarios and anticipated reactions and set expectations and priorities across multiple locations. This is done long before emergency decisions have to be made.
In October 2019, we opened our command center long before the Kincade Fire became an emergency situation. And we began the process of proactively transferring patients out of our Santa Rosa Medical Center eight hours before a formal evacuation notice came through. In this instance we had the benefit of time; the regional electric utility had announced planned power outages across multiple counties due to the high possibility of fire. Still, the decision to not wait until we felt seriously threatened helped us improve our response by putting critical steps in motion earlier. These steps included preemptively reducing the hospital patient count through a controlled transfer process, and moving patients to other nearby Kaiser Permanente medical centers. Early patient evacuation preparation was initiated as well, including assessment for evacuation transport needs, printing of evacuation reports and completing patient evacuation tags well in advance of the actual evacuation.
IDENTIFY INTERDEPENDENCIES AND ACTIVATE RESOURCES
Urgently evacuating 122 patients from a hospital in the dead of night in 2017, our sole initial focus was getting them out of harm’s way as the air filled with smoke and flames came within yards of the hospital grounds. Ambulance resources were scarce. Out of necessity, many of our patients were transported by city buses and private cars with hospital staff. There was no time to distribute patients equally between nearby Kaiser Permanente medical centers; most went to the closest one.
During the 2019 Kincade Fire we connected with our unaffected hospitals and medical centers early, as conditions deteriorated, asking them to proactively assess their patient capacity and open additional inpatient facilities in anticipation of planned transfers from the evacuation of the Santa Rosa hospital. We also asked them to activate their command centers to ensure operations were in place at all hours to manage potential transfers. This allowed our unaffected hospitals to be prepared to receive Kaiser Permanente Santa Rosa Medical Center’s patients safely and expeditiously, while our integrated electronic medical record system allowed physicians at the receiving hospitals to provide seamless continuity of care.
We still had to get the patients to those open beds. As part of the command center structure, our regional transportation hub organized all ambulance and medical transport required. We had dozens of emergency service transports lined up and waiting as our first patients from Kaiser Permanente Santa Rosa Medical Center were readied for transfer. Not all hospital systems are integrated to this level, but the lesson is that coordinated responses can proceed most seamlessly with advance planning. Knowing who was in our network, and who we could call on for help, was key to making the plan work.
CONSIDER INCREMENTAL ACTION
There are many intermediate steps a hospital can take before a full evacuation is required. For example, a strategy to begin sending noncritical patients and those who may take the longest to prepare for transfer to other nearby hospitals in planned transfers can help avoid overwhelming the receiving facility and reduce the at-risk patient population in case of an emergency.
In addition, time spent gathering equipment, filling out paperwork and doing any other preparatory work will enable a rapid evacuation of the remaining patients should it be necessary. Ideally this will be part of a comprehensive evacuation plan — including evacuation checklists, evacuation tags and a patient tracking system — already tested and in place. Educating and training for employees and physicians in these processes in advance of an emergency will help achieve the best possible outcomes for patients in a real event.
The reality is that the risks our facilities face today are different from what we imagined a decade ago — and that a rapidly changing climate poses yet unforeseeable hazards for the future. Some of our solutions may best fit a multi-hospital integrated delivery system like Kaiser Permanente, but we also believe that hospitals and health systems of any size can learn from our experiences and changes we made between the two fires — and then had the opportunity to pressure test — including conducting a systemwide bed availability assessment, controlling patient transfer before mandatory evacuation, preparing for patient evacuation early, and using an evacuation tool kit including a tracking system. While we hope that we won’t have to evacuate again, analyzing these experiences, learning from them, and continuing to develop emergency plans is part of what we know we have to do to keeping our patients and communities safe.
Copyright 2019 Harvard Business School Publishing Corp. Distributed by The New York Times Syndicate.