Disaster Preparedness

Hurricane Katrina struck near the Louisiana-Mississippi border and became one of the worst natural disasters in U.S. history, affecting a large geographic area and necessitating the evacuation of people from parts of the area, including vulnerable populations, such as hospital patients, nursing home residents and transportation-disadvantaged populations who were not in such facilities. The disaster highlighted the challenges involved in evacuating vulnerable populations due to hurricanes. GAO was asked to discuss efforts to plan and prepare for the needs of seniors in the event of a national emergency. GAO describes its ongoing work on evacuation in the event of emergencies, such as hurricanes, and provides preliminary observations on (1) challenges faced by hospital and nursing home administrators that are related to hurricane evacuations; (2) the federal program that supports the evacuation of patients needing hospital care and nursing home residents; and (3) challenges states and localities face in preparing for and carrying out the evacuation of transportation-disadvantaged populations and efforts to address evacuation needs. This testimony is based in part on a prior GAO report, Disaster Preparedness: Preliminary Observations on the Evacuation of Hospitals and Nursing Homes Due to Hurricanes, GAO-06-443R (February 16, 2006).

Hospital and nursing home administrators face challenges related to evacuations caused by hurricanes, including deciding whether to evacuate and obtaining transportation. Although state and local governments can order evacuations, health care facilities can be exempt from these orders. Facility administrators are generally responsible for deciding whether to evacuate, and if they decide not to evacuate, they face the challenge of ensuring that their facilities have sufficient resources to provide care until assistance arrives. If they evacuate, contractors providing transportation for hospitals and nursing homes could be unlikely to provide facilities with enough vehicles during a major disaster such as a hurricane because local demand for transportation would likely exceed supply. Nursing home administrators told us they face unique challenges during evacuations. For example, they must locate receiving facilities that can accommodate residents who may need a place to live for a long period of time. The National Disaster Medical System (NDMS), a partnership of four federal departments, is the primary federal program that supports the evacuation of patients in need of hospital care during disasters such as hurricanes, but the program was not designed nor is currently configured to move nursing home residents. NDMS supplements state and local emergency response capabilities with federal resources and services and helped evacuate about 2,900 people during recent hurricanes, including Hurricane Katrina. Although NDMS supported evacuation efforts during Hurricane Katrina that included nursing home residents, according to program officials it is not designed to evacuate this population. Officials explained that the program does not have agreements with nursing homes that could receive evacuated nursing home residents. In preparing for and carrying out the evacuation of transportation-disadvantaged populations, such as the elderly or persons with disabilities, during a disaster, states and localities face challenges in identifying these populations, determining their needs, and providing for and coordinating their transportation. The elderly are likely to be represented among the transportation disadvantaged because they are more likely, compared with the general population, to have a disability, have a low income, or choose not to drive. GAO has observed mixed efforts at the state and local levels to address the evacuation needs of the transportation disadvantaged. Some emergency management officials told GAO they did not yet have a good understanding of the size, location, and composition of the transportation disadvantaged in their community. However, GAO also observed efforts in some locations to address the evacuation needs of the transportation disadvantaged by encouraging citizens to voluntarily register with their local emergency management agency, integrating social service providers into emergency planning, and other measures. GAO will continue to examine the extent to which the transportation disadvantaged are addressed in state and local evacuation efforts as part of its ongoing work.