A facility evacuation, such as a hospital or long-term care center, represents a unique, high-stakes emergency scenario where the safety of hundreds of people must be managed. Unlike a typical building evacuation, healthcare settings house individuals who cannot simply walk out on their own. Successfully moving this vulnerable population requires a standardized, rapid prioritization system guided by clear protocols that shift the focus from traditional medical care to the immediate logistics of movement.
The Foundation: Prioritizing Mobility Over Medical Status
The fundamental principle guiding patient evacuation is “reverse triage,” which contrasts sharply with standard medical triage. Standard triage prioritizes the most severely injured for immediate treatment to maximize survival. Evacuation triage, however, prioritizes the speed and ease of movement to maximize the number of people moved to safety in the shortest possible time. The primary goal is to clear the immediate danger zone, not to provide definitive medical care.
A patient’s ability to move dictates their place in the evacuation sequence, overriding their medical status. Staff use rapid assessment tools to assign a mobility status, which is simpler than a complex medical assessment. Moving the most mobile patients first conserves staff resources, clears pathways quickly, and prevents bottlenecks, allowing staff to dedicate time and limited equipment to the more dependent patients.
Establishing the Sequential Order of Patient Movement
The sequential order for patient movement is organized from the least resource-intensive to the most, based on the principle of mobility-first prioritization. This system generally defines four tiers of movement, executed in reverse order of difficulty.
The first group (Tier 1) is the Ambulatory Patient group. These individuals can walk unassisted or with minimal verbal guidance, requiring the fewest staff members and equipment resources. Evacuating this group quickly clears the exit routes and frees up staff to assist with the next tiers.
Tier 2 consists of Assisted Patients. These patients require minimal staff support, perhaps one or two personnel, and may rely on walking aids or wheelchairs. They can be moved using standard equipment like wheelchairs or gurneys, but do not require complex life support equipment. Prioritizing this group second maintains the momentum of the evacuation while beginning to use slightly more staff resources.
Tier 3 includes Dependent Patients, who are bed-bound, immobile, or infants, requiring total staff assistance. These patients necessitate specialized, non-wheeled equipment, such as evacuation sleds or mattresses, and a higher staff-to-patient ratio. Moving this group is slow and resource-heavy, which is why they are moved after the pathways have been cleared by the first two tiers.
The final group (Tier 4) is the Critical or Life Support Patient. They require continuous monitoring, mechanical ventilation, or other complex, life-sustaining equipment. This group is moved last because their movement is the most resource-intensive and carries the highest risk of destabilization, demanding the greatest number of highly skilled personnel and specialized transport resources.
Essential Logistical Considerations for High-Acuity Patients
Moving the Dependent and Critical patient tiers requires specific logistical planning and specialized resources. For non-ambulatory and bed-bound patients, specialized equipment like evacuation sleds and flexible mattresses are deployed to allow a single patient to be dragged or carried safely by a small team. When vertical movement is necessary, such as descending stairs without functional elevators, specialized stair chairs are used to safely transport individuals who cannot walk.
Critical patients on life support require that all associated medical equipment remain operational and secured during transit. This includes securing portable ventilators, infusion pumps, and cardiac monitors directly to the patient’s bed or transport device to ensure continuity of care. High-acuity patients often require a dedicated team of clinical personnel to attend to their needs throughout the entire relocation process, demanding a much higher staff-to-patient ratio. Furthermore, the physical demands on staff are substantial, particularly in high-rise facilities where personnel must move patients down multiple flights of stairs. The entire process is a race against the clock, where the consumption of resources must be carefully managed against the estimated time required to evacuate the facility completely.