Disaster Preparedness
Preliminary Observations on the Evacuation of Vulnerable Populations due to Hurricanes and Other Diasasters Gao ID: GAO-06-790T May 18, 2006Hurricane 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.
GAO-06-790T, Disaster Preparedness: Preliminary Observations on the Evacuation of Vulnerable Populations due to Hurricanes and Other Diasasters
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Testimony:
Before the Special Committee on Aging, U.S. Senate:
United States Government Accountability Office:
GAO:
For Release on Delivery Expected at 10:00 a.m. EDT:
Thursday, May 18, 2006:
Disaster Preparedness:
Preliminary Observations on the Evacuation of Vulnerable Populations
due to Hurricanes and Other Disasters:
Statement of Cynthia Bascetta:
Director, Health Care:
GAO-06-790T:
GAO Highlights:
Highlights of GAO-06-790T, a testimony before the Special Committee on
Aging, U.S. Senate.
Why GAO Did This Study:
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).
What GAO Found:
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.
What GAO Recommends:
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-790T].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Cynthia Bascetta at (202)
512-7101 or bascettac@gao.gov.
[End of Section]
Mr. Chairman and Members of the Committee:
Thank you for inviting me here to discuss our preliminary observations
on ongoing work on the evacuation of vulnerable populations due to
hurricanes and other disasters, including patients in hospitals;
residents in nursing homes; and transportation-disadvantaged
populations, such as the elderly, persons with disabilities, and people
who, by choice or circumstances, do not own or have access to a
personal vehicle.
On August 29, 2005, Hurricane Katrina struck near the Louisiana-
Mississippi border and became one of the worst natural disasters in
U.S. history. The hurricane affected a large geographic area and
necessitated the evacuation of people from parts of the area. Among
those needing to be evacuated were hospital patients, nursing home
residents, and transportation-disadvantaged populations who were not in
such facilities. The disaster highlighted the challenges involved in
evacuating these vulnerable populations. For example, administrators of
hospitals and nursing homes must make decisions about the best way to
care for their patients or residents, including whether to evacuate if
the facility becomes unable to support adequate care, treatment, or
other services. Although both hospital patients and nursing home
residents were evacuated during Hurricane Katrina, in the aftermath of
the event, congressional reports have raised questions about how health
care facility administrators plan for hurricanes, how they implemented
their plans, and how the federal government assisted health care
facilities and state and local governments with facility
evacuations.[Footnote 1] Hurricane Katrina also pointed out the
challenges of evacuating transportation-disadvantaged populations who
are not in such facilities during a disaster. State and local
governments are primarily responsible for responding to disasters that
may result in evacuations. When state and local governments are
overwhelmed in their response to a disaster, the federal government can
assume a greater role.
You asked me to discuss issues related to efforts to plan and prepare
for the needs of seniors in the event of a national emergency. My
remarks today will describe our ongoing work on evacuation in the event
of emergencies and will provide preliminary observations on (1) the
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.
My testimony today is based on our February 2006 interim
report[Footnote 2] as well as our ongoing work on the evacuation of
hospitals and nursing homes due to hurricanes, and the evacuation of
transportation-disadvantaged populations due to hurricanes and other
disasters. Our work in this area is being conducted under the
Comptroller General's authority to conduct evaluations on his own
initiative.[Footnote 3] In conducting the work for our interim report,
we interviewed officials in Florida in areas that experienced
hurricanes in 2004, including officials from three hospitals and three
nursing homes that experienced Hurricane Charley,[Footnote 4] state
officials, and local emergency management officials in two counties. In
addition, we interviewed officials from national hospital and nursing
home associations and Florida hospital and nursing home associations.
For our ongoing work related to the evacuation of hospitals and nursing
homes, we interviewed officials in Mississippi in areas that were hit
by Hurricane Katrina, including officials from five hospitals,
officials from three nursing homes or assisted living facilities, state
officials, and local officials in two counties. For our ongoing work on
evacuating transportation-disadvantaged populations, we have visited
communities in California, Florida, and New York, and we plan to visit
communities in Louisiana and Washington, D.C. We have interviewed or
will interview state and local emergency management agencies, state and
local transportation departments, local and regional transit agencies,
and local and regional planning organizations. In addition, we
interviewed entities that represent transportation and emergency
management officials, entities such as the Federal Interagency
Coordinating Council on Access and Mobility, and others. We also
interviewed officials from the Department of Defense (DOD), the
Department of Health and Human Services (HHS), the Department of
Homeland Security (DHS), the Department of Veterans Affairs (VA), and
the Department of Transportation (DOT) about federal efforts to support
evacuation of hospitals and nursing homes and transportation-
disadvantaged populations not in such facilities. In addition, we
reviewed documents, including emergency management plans from the
states of Florida, Mississippi and other states, local governments,
hospitals, and nursing homes; and federal documents such as the
National Response Plan.[Footnote 5] Finally, we reviewed the
recommendations on evacuations contained in several recently issued
reports on the Hurricane Katrina response prepared by the U.S. House of
Representatives, U.S. Senate, the White House, and DOT and DHS. We
discussed the facts contained in this statement with officials from
DOD, HHS, DHS, DOT, and VA, and incorporated changes as appropriate.
Our work began in December 2005 and is being performed in accordance
with generally accepted government auditing standards.[Footnote 6]
In summary, hospital and nursing home administrators face challenges
related to evacuations caused by hurricanes, including deciding whether
to evacuate their facilities 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 or not to evacuate, and if
administrators decide not to evacuate, they face the challenge of
ensuring that their facilities have sufficient resources to provide
care or other services until assistance can arrive. If facilities
evacuate, administrators face the challenge of securing transportation;
according to hospital and nursing home officials, contractors providing
transportation for hospitals and nursing homes would 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. According to nursing home administrators, they face
unique challenges during evacuations. For example, when a nursing home
evacuates, the administrator 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) 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 is a federal partnership of DOD, HHS, DHS, and VA that supplements
state and local emergency response capabilities with federal resources
and services. The program helped evacuate about 2,900 people during
recent hurricanes, including Hurricane Katrina. NDMS supported
evacuation efforts during Hurricane Katrina that included nursing home
residents, although officials explained that NDMS does not have
agreements with nursing homes that could receive evacuated nursing home
residents. In contrast, NDMS has agreements with participating
hospitals to receive patients needing hospital care.
In preparing for and carrying out the evacuation of transportation-
disadvantaged populations who are not in institutions during a
disaster, states and localities face challenges in identifying these
populations, determining their needs, and providing for and
coordinating their transportation. Identifying these populations and
determining their needs present challenges because their overall size,
location, and composition can be difficult to determine in advance of
an emergency. For example, while transportation-disadvantaged
populations include the elderly, low-income individuals, and persons
with disabilities, during disasters these populations can also include
people who do not own or have access to cars and people who do not
permanently reside in the community, such as tourists. The elderly are
particularly 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. Providing for and coordinating the transportation of
transportation-disadvantaged populations presents challenges because
evacuating them requires additional planning, time, resources (for
example, evacuating seniors with special medical needs from their
homes), and communication efforts (such as communicating with the
vision or hearing impaired). In the course of our review, we observed
mixed efforts at the state and local level to address the evacuation
needs of the transportation disadvantaged. For example, emergency
management officials in two locations we visited indicated they did not
yet have a good understanding of the size, location, and composition of
the transportation disadvantaged in their communities. However, we 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 agencies, integrating
social service providers into emergency planning, and other measures.
Facility Administrators Face Several Challenges Related to Evacuations,
Including Deciding Whether to Evacuate and Securing Transportation:
Administrators of hospitals and nursing homes face several challenges
related to evacuations caused by hurricanes. Among these challenges,
administrators must decide whether to evacuate their facilities or stay
in facilities and "shelter in place." Although state and local
governments can order evacuations of the population or segments of the
population during various emergencies, health care facilities can be
exempt from these orders.[Footnote 7] Facility administrators are
generally responsible for deciding whether to shelter in place or
evacuate, and administrators told us they generally see evacuation as a
last resort. However, to shelter in place, facility administrators face
the challenge of ensuring that their facilities have sufficient
resources to provide care or other services during the disaster and
then in its aftermath until assistance can arrive. For example, during
hurricanes Katrina and Charley, facility administrators said they had
to ensure that their facilities had staff who could stay for longer
shifts until the storms passed and relief staff could arrive. One
hospital in Mississippi had prepared staff to stay for approximately 3
days; however, staff had to stay 2 weeks before replacement staff could
arrive. The administrator also said they had to have 3 days of food and
supplies stocked and enough fuel to run generators for 1 week.
Destruction of communications capabilities due to hurricanes can
complicate the decision to evacuate. For example, during Hurricane
Katrina, the destruction of communications systems left hospital and
nursing home administrators unable to receive information about how
long it would take before assistance would arrive.
If hospital and nursing home administrators decide to evacuate, they
face the challenge of securing sufficient and appropriate
transportation to move their patients or residents. Hospital and
nursing home association representatives told us that facilities are
likely to have local arrangements for transportation services, but the
facilities are less likely to have arrangements in other localities or
states, as was necessary for the evacuations during Hurricane Katrina.
According to hospital and nursing home administrators, their
contractors providing transportation would be unlikely to provide them
with vehicles during a major disaster because local demand for
transportation would exceed supply. For example, during Hurricane
Katrina, two counties in Mississippi had to secure vehicles that were
located in other states.[Footnote 8] Facility administrators also face
the related challenge of obtaining appropriate vehicles. One nursing
home administrator told us the facility had a transportation agreement
with a bus company, but the company supplied only regular buses and
most of the facility's residents needed vehicles with power lifts to
accommodate electric wheelchairs.
While hospital and nursing home administrators face many of the same
challenges during evacuations, there are some challenges nursing home
administrators in particular must address. According to nursing home
administrators, one challenge results from the fact that people in
nursing homes may reside there for a long time. As a result, these
administrators explained that nursing homes cannot reduce the number of
residents in their facilities for whom they are responsible because
nursing home residents may have no other home and cannot care for
themselves. In contrast, hospital administrators told us that it is
common to discharge as many patients as possible before a hurricane in
order to reduce the number of patients who need to be sheltered or
evacuated. In addition, when a nursing home evacuates, the
administrator must locate receiving facilities that can accommodate
residents for a potentially long period of time. For example, a nursing
home administrator in Florida told us that the facility had to relocate
its residents for over 10 months until the facility could be fixed.
NDMS Is the Primary Federal Program That Evacuates Patients Needing
Hospital Care, but It Is Not Designed to Move Nursing Home Residents:
NDMS is the primary federal program that supports efforts to evacuate
patients who need hospital care during disasters such as hurricanes by
moving them from an area affected by the emergency to reception areas
in other locations. Formed in 1984 to care for casualties that could
result from a domestic disaster or an overseas conventional war, NDMS
is a federal program that supplements state and local emergency
response capabilities with federal resources and services. DOD, HHS,
DHS, and VA are federal partners in NDMS, and DHS has the authority to
activate NDMS in response to public health emergencies, including but
not limited to presidentially declared major disasters or
emergencies.[Footnote 9] Among its various functions,[Footnote 10] NDMS
supports the evacuation of hospitals by assisting in efforts to move
patients from a mobilization center, such as an airport near the
incident, to reception areas in other locations where patients can be
placed in a hospital participating in NDMS to continue receiving
medical care. NDMS officials told us that Hurricane Katrina was the
first time that the patient evacuation component of NDMS was used to
evacuate a large number of patients. In response to state requests for
assistance due to recent hurricanes, about 2,900 people were
transported from NDMS mobilization centers to NDMS patient reception
areas.[Footnote 11]
While NDMS supports the evacuation of patients in need of hospital
care, the program was not designed nor is currently configured to move
nursing home residents. As stated in the memorandum of agreement among
the NDMS federal partners, the patient evacuation function of NDMS is
intended to move patients from a mobilization center to a reception
area so they can be admitted to NDMS-affiliated hospitals--typically
nonfederal hospitals that have agreements with NDMS--to receive medical
care. Although during Hurricane Katrina NDMS evacuated nursing home
residents who were brought to mobilization centers, program officials
told us that NDMS was not designed to evacuate this population and the
program did not have agreements with nursing homes that could receive
evacuated nursing home residents. NDMS officials noted the challenge of
meeting the needs of nursing home residents in an NDMS report prepared
after Hurricane Katrina.[Footnote 12]
States and Localities Face Challenges in Addressing the Evacuation
Needs of Transportation-Disadvantaged Populations:
In preparing for and carrying out the evacuation of transportation-
disadvantaged populations due to a disaster, states and localities face
challenges in identifying these populations, determining their needs,
and providing for and coordinating their transportation. Identifying
these populations and determining their needs present challenges
because their overall size, location, and composition can be difficult
to determine in advance of an emergency. For example, while these
populations include the elderly, low-income individuals, and persons
with disabilities, during disasters transportation-disadvantaged
populations can also include people who either by choice or
circumstance do not own or have access to cars. They can also include
people with limited English proficiency and people who do not
permanently reside in the community, such as tourists, temporary
workers, and the homeless. In addition, transportation-disadvantaged
populations may have specialized medical needs; people may move within
the community, and these populations may harbor beliefs about privacy
and fears of discrimination that discourage participation in outreach
efforts. The elderly are particularly 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.
Providing for and coordinating the evacuation of transportation-
disadvantaged populations also present challenges because evacuating
these populations requires additional planning, time, and resources.
For example, evacuating seniors with special medical needs who are
residing in their own homes may require additional planning of pick up
routes; extra time to load and unload evacuation vehicles; and special
resources, such as buses equipped with wheelchair lifts. In addition,
communicating evacuation information to these populations during
disasters may be challenging because they may be vision or hearing
impaired or have limited English proficiency.
In the course of our review, we observed mixed efforts at the state and
local level to address the evacuation needs of the transportation
disadvantaged during a disaster. In some locations we visited,
emergency management officials indicated they did not yet have a good
understanding of the overall size, location, and composition of the
transportation disadvantaged in their community and acknowledged the
need to better integrate transportation-disadvantaged populations into
emergency response planning. For example, emergency management
officials in one city stated that their participation in the February
2006 National Plan Review alerted them to the fact that they should
better provide for and coordinate the needs of transportation-
disadvantaged populations in their evacuation planning.[Footnote 13]
One state official described coordination challenges and evacuation
delays that occurred for transportation-disadvantaged populations in
one community during an approaching wildfire and attributed these
problems to coordination difficulties between emergency management and
other agencies.
However, we also observed efforts underway in some locations to address
the evacuation needs of the transportation disadvantaged. In three
locations, local governments and regional organizations have conducted
or were conducting studies to identify the number and location of
transportation-disadvantaged populations in their jurisdiction. This
information has been or was to be used to facilitate evacuation
planning on resource use and deployment during disasters. Also, in
three locations, emergency management officials were using preexisting
citizen networks and community outreach activities to help inform and
prepare transportation-disadvantaged populations for disasters. For
example, in one city, emergency management officials used an existing
neighborhood watch network to facilitate community outreach to
transportation-disadvantaged populations, better preparing them for a
disaster. In another city, emergency management officials worked with
home health organizations, doctors, and the Red Cross to inform
transportation-disadvantaged populations about evacuation preparedness.
In one location that had a well-developed program for evacuating the
transportation disadvantaged, we observed that emergency management
officials did the following:
* Had emergency plans that clearly articulated methods of providing for
and coordinating the evacuation of transportation-disadvantaged
populations, including the roles and responsibilities of various
agencies. This plan clearly articulated how local and state emergency
management, school boards, and transit agencies would work together to
evacuate transportation-disadvantaged populations. Emergency management
officials stated that this level of coordination enabled them to
successfully conduct several evacuations.
* Encouraged citizens who have special medical needs to voluntarily
register with their local emergency management agency. This registry
placed individuals into categories, including those who would need
special transport, such as an ambulance. According to emergency
management officials, in several recent evacuations, the voluntary
registry assisted emergency personnel in efficiently evacuating
transportation-disadvantaged populations. However, the same emergency
management officials also pointed out challenges that exist for
voluntary registries including the administrative costs of keeping the
information up to date, the limited number of participants, and a surge
in the number registrations immediately prior to an approaching storm.
* Involved social service providers in the emergency response planning
process. Social service providers' transportation resources were used
to evacuate many of the clients on a voluntary registry administered by
the city. These social service providers have expertise and ongoing
contact with the transportation-disadvantaged populations, and are
familiar with their day-to-day and nonemergency needs.
* Established formal agreements that alleviate legal liability and
reimbursement concerns when securing transportation resources to assist
in evacuating transportation-disadvantaged populations during any type
of disaster.
* Conducted regular exercises of emergency response plans in order to
test coordination between agencies involved in evacuations and their
resources, and the integration of social service providers.
In addition to these efforts by state and local governments, recent
reports released by the federal government have put forth
recommendations that address evacuation preparedness and response
generally and for transportation-disadvantaged populations in
particular. The White House report[Footnote 14] recommends that DOT be
the primary federal agency responsible for developing the federal
government's capability to conduct mass evacuations and that DHS
require that state and local governments to conduct evacuation planning
and exercises as a condition for receiving Homeland Security grants.
The Senate report[Footnote 15] recommends that DOT should, in
coordination with DHS and the states, plan, train and exercise for
evacuations, including provisions for those populations that do not
have the means to evacuate.
Concluding Observations:
Hospital and nursing home administrators generally face multiple
challenges in weighing the risks of sheltering in place or evacuating.
Although evacuation is a last resort, Hurricanes Charley and Katrina
resulted in both hospitals and nursing homes having to evacuate. When
evacuating, administrators faced problems specifically related to
transportation, including securing vehicles. Hurricane Katrina, the
first emergency in which NDMS was used to evacuate a large number of
people, brought to light that NDMS was not set up nor is currently
configured to provide assistance to nursing homes. As a result, it does
not have agreements with nursing homes to accept evacuated patients. In
addition, states and localities face multiple challenges in ensuring
that transportation-disadvantaged populations who are not in such
facilities are evacuated. We will be monitoring federal efforts to
improve preparing for and carrying out evacuations of these
populations. Our ongoing work will continue to examine the
vulnerabilities posed by disasters for hospital patients, nursing home
residents, and transportation-disadvantaged populations living in their
communities.
Mr. Chairman, this concludes my prepared remarks. I would be happy to
respond to any questions you or other members of the committee have at
this time.
Contacts and Acknowledgments:
For further information regarding this statement, please contact
Cynthia Bascetta at (202) 512-7101 or at bascettac@gao.gov regarding
issues related to the evacuation of hospitals and nursing homes. For
issues related to the evacuation of transportation-disadvantaged
populations, please contact Katherine Siggerud at (202) 512-2834 or
siggerudk@gao.gov. Contact points for our Offices of Congressional
Relations and Public Affairs may be found on the last page of this
statement. Key contributors to this statement were Steve Cohen,
Assistant Director; Linda T. Kohn, Assistant Director; La Sherri Bush;
Krister Friday; Christopher Lyons; Nkeruka Okonmah; Laina Poon; Tina
Won Sherman; and William Simerl.
[End of section]
Related GAO Products:
Hurricane Katrina: Status of the Health Care System in New Orleans and
Difficult Decisions Related to Efforts to Rebuild It Approximately 6
Months After Hurricane Katrina. GAO-06-576R. Washington, D.C.: March
28, 2006.
Hurricane Katrina: GAO's Preliminary Observations Regarding
Preparedness, Response, and Recovery. GAO-06-442T. Washington, D.C.:
March 8, 2006.
Disaster Preparedness: Preliminary Observations on the Evacuation of
Hospitals and Nursing Homes Due to Hurricanes. GAO-06-443R. Washington,
D.C.: February 16, 2006.
Transportation Services: Better Dissemination and Oversight of DOT's
Guidance Could Lead to Improved Access for Limited English-Proficient
Populations. GAO-06-52. Washington, D.C.: November 2, 2005. (This
report is also available in Spanish, Chinese, Vietnamese, and Korean.)
Transportation-Disadvantaged Seniors: Efforts to Enhance Senior
Mobility Could Benefit from Additional Guidance and Information. GAO-
04-971. Washington, D.C.: August 30, 2004.
Transportation-Disadvantaged Populations: Federal Agencies Are Taking
Steps to Assist States and Local Agencies in Coordinating
Transportation Services. GAO-04-420R. Washington, D.C.: February 24,
2004.
HHS Bioterrorism Preparedness Programs: States Reported Progress but
Fell Short of Program Goals for 2002. GAO-04-360R. Washington, D.C.:
February 10, 2004.
Transportation-Disadvantaged Populations: Some Coordination Efforts
Among Programs Providing Transportation Services, but Obstacles
Persist. GAO-03-697. Washington, D.C.: June 30, 2003.
Transportation-Disadvantaged Populations: Many Federal Programs Fund
Transportation Services, but Obstacles to Coordination Persist. GAO-03-
698T. Washington, D.C.: May 1, 2003.
FOOTNOTES
[1] See U.S. House of Representatives, A Failure of Initiative: Final
Report of the Select Bipartisan Committee to Investigate the
Preparation for and Response to Hurricane Katrina (Feb. 15, 2006). See
also Committee on Homeland Security and Governmental Affairs, U.S.
Senate, Hurricane Katrina: A Nation Still Unprepared (May 2006).
[2] GAO, Disaster Preparedness: Preliminary Observations on the
Evacuation of Hospitals and Nursing Homes Due to Hurricanes, GAO-06-
443R (Washington, D.C.: Feb. 16, 2006). See related GAO products later
in this statement.
[3] 31 U.S.C. § 717(b)(1) (2000).
[4] Hurricane Charley struck the Gulf Coast of Florida on August 13,
2004, and continued across the state to exit on the Atlantic Coast on
August 14, 2004.
[5] The National Response Plan describes how the federal government
assists in managing incidents of national significance.
[6] We anticipate completing our work and issuing reports on the
evacuation of hospitals and nursing homes and on the evacuation of
transportation-disadvantaged populations later this year.
[7] For example, officials in two counties in Florida told us they can
recommend that hospitals and nursing homes evacuate their facilities,
but the final decision is made by each facility's administrator.
[8] The two counties contract with a national ambulance company, which
is able to obtain vehicles from its fleet located in other states.
[9] A presidentially declared major disaster or emergency can be
declared under the Robert T. Stafford Disaster Relief and Emergency
Assistance Act, 42 U.S.C. §§ 5121-5206, which establishes the programs
and processes by which the federal government supplements state and
local resources in major disasters and emergencies.
[10] NDMS consists of three functions. One is medical response, which
includes medical equipment and supplies, patient triage, and other
primary and emergency health care services provided to disaster victims
at a disaster site. Another is patient evacuation, which includes
communication and transportation to evacuate patients from a
mobilization center near the disaster site, such as an airport, to
reception areas in other locations. The third is "definitive care,"
which is additional medical care--beyond emergency care--that begins
once disaster victims are placed into an NDMS inpatient treatment
facility (typically a nonfederal hospital that has an agreement with
NDMS). NDMS functions are included in the Public Health and Medical
Services Annex of the National Response Plan.
[11] This figure represents the approximate number of people moved
during Hurricane Katrina and Hurricane Rita, which struck the Gulf
Coast several weeks after Hurricane Katrina.
[12] See National Disaster Medical System, National Disaster Medical
System (NDMS) After Action Review (AAR) Report on Patient Movement and
Definitive Care Operations in Support of Hurricanes Katrina and Rita
(Jan. 12, 2006).
[13] The National Plan Review is a DHS review of the emergency plans,
including catastrophic planning and mass evacuation planning, of the 50
states and 75 largest urban areas.
[14] Assistant to the President for Homeland Security and
Counterterrorism, The Federal Response to Hurricane Katrina: Lessons
Learned (February 2006).
[15] Committee on Homeland Security and Governmental Affairs, U.S.
Senate, Hurricane Katrina: A Nation Still Unprepared (May 2006).
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