P3.S363: The logistics of evacuating a Children’s Hospital in Florida after Hurricane Ian

Background: On September 28, 2022, Southwest Florida was directly impacted by Hurricane Ian, a category V Hurricane impacting more than 1 million people. Our Children’s Hospital prepared proactively by discharging selective patients and sheltering vulnerable children that could not be safely managed elsewhere. There was major flooding and winds more than 150 mph which caused damage including a water main break with loss of water pressure to our Hospital System; this resulted in complete loss of running water and fire suppression system. For that reason, government agencies mandated urgent evacuation of our Children’s Hospital.

Methods: Within 36 hours, we evacuated a total of 81 patients to 15 out-of-county facilities throughout FL. The NICU census on the day after the storm was 68; all babies had to be transferred out. Standard emergency triage criteria could not be used as we faced constrains related to available resources and bed placement. Evacuation criteria had to be modified and became primarily dependent on determining which facility had beds, geographical location, acuity of neonatal level (level II or III NICU), whether there was a helipad, and did they have a transport team available to assist. Moreover, ground vs flight had to be accounted for – 32% were transferred out by air.

Results: Our hospital plus FNPTNA and the FL Association of Critical Care Transport Specialists activated our disaster plan developed in 2017. Using a live asset document, our command center worked with transport teams across the state for the deployment of staff/assets. Triage of in-patients during an evacuation is different from trauma/emergency triage; top priorities include ensuring that the patients are transferred to the appropriate facility for the level of care, acuity, available resources, treatments necessary and parental wishes. Patient factors and location of the receiving hospital had to be considered. Neonates in an open crib were transported on a stretcher with an appropriate neonatal restraint harness system and transported with adult EMS staff.

Conclusion: Disaster planning and collaboration were key drivers for successful evacuation – there was not a single adverse event or negative outcome.