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Disaster preparedness plans in hospitals are indispensable for a successful completion of a hospital evacuation. Disasters like the flooding of 2002 in the Oder-Elbe-region in Germany, the South-East Asia tsunami in 2004, or the flooding of New Orleans, Louisiana, USA during hurricane Katrina in 2005, and Galveston, Texas during hurricane Ike in 2008 has let us become aware that flood catastrophes are not only documented far away from us, but they can happen everywhere and could also occur in our neighborhood. Catastrophes do not follow any rules and are barely predictable according to time and location. To become ready for catastrophic cases, it is relevant to develop localized structures, disaster plans and to establish drills. The following functional sections should be established: incident commander, incident planning, logistics, administration, communication (internal, with committees and media), and security (Born et al., 2007a, 2007b; Zane & Prestipino, 2004). At UTMB in Galveston, valuable lessons have been learned from the sequential evacuation of the university hospital. An adequate disaster preparedness plan and logistics were crucial for the success. The lessons learned from both experiences included especially the following:

1. Appointment of an Incident Commander. This person must be given sole authority for decision making. He or she should also have clinical experience, and occupy an executive leadership position (Sexton et al., 2007).

2. Having an emergency operations center or Incident Command center utilizing National Incident Management System (NIMS) principles (DHS, 2008) to support the incident commander is crucial for success. The center helps to communicate decisions and developments internally and externally, and serves as advisor for the incident commander. It is the responsibility of this leadership to not delay the decision to evacuate or worry about anyone second guessing the decision. The sooner an evacuation may be started, the higher the likelihood that the evacuation will proceed accordingly to the emergency plans. The Incident Command center has to keep track of evacuated patients and on-site personnel, to utilize expert clinical staff (MDs and RNs) to coordinate loading of ambulances and helicopters for patient transfer, or to reassign staff as necessary to care for transferred patients (Zane & Prestipino, 2004).

3. Having reliable in-house communication system not dependent on telephone lines or electricity; During hurricane Rita it was discovered that some of the communication devices such as walkie-talkies or cell-phones were either outdated or did not work in too many „dead" areas of the campus. These issues had been addressed and could be solved during drills before hurricane Ike approached Galveston (Sexton et al., 2007).

4. Having a reliable telephone system for contacting outside facilities is very helpful to keep track on patients, because ambulances may become stuck in traffic on evacuation routes or have to take alternative routes to make their way to the admitting hospital; or even reroute patients to another health care center. The lack of this information may hinder the ability to communicate effectively with family members (Maybauer et al., 2009).

5. Maintaining a paper record of all patients, and patient transfers as well as all other business transactions; The data of electronic medical records may not be accessed in a different hospital because of software or system differences (Sexton et al., 2007).

6. Every healthcare facility - hospitals, urgent care facilities, ambulatory care facilities, long-term care and skilled nursing facilities etc. - should develop evacuation plans beyond the typical fire evacuation plan, that anticipate interruptions in services. Any internal or external cause should be anticipated including power, water or medical gas failures, wind and/or rain damage, loss of critical internal services such as pharmacy, food preparation and/or distribution, non-functional operating rooms, and any other vulnerability identified for the facility or location. The regular testing of these plans is an essential component of preparedness and ultimately successful execution of the plan. Flooding will occur in coastal areas resulting from a hurricane surge. Emergency power and temporary cooling systems are essential after the evacuation and after the storm moves inland. Emergency evacuation of a large university hospital requires extensive effort from both the hospital staff and the community. It is to remark positively that no patient inside UTMB was hurt directly by the hurricane or indirectly by the evacuation. The UTMB leadership and emergency preparedness officers continue to refine the emergency plan and related procedures on the basis of the experience during the hurricanes Rita and Ike. The authors encourage physicians, as essential members of the health care team, to become prepared to respond to disasters. A significant part of this preparation is formal training in Incident Command System and National Incident Management System concepts, which can by accessed through local emergency management officials, regional training centers or electronically from the Federal Emergency Management Agency.

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The Basic Survival Guide

The Basic Survival Guide

Disasters: Why No ones Really 100 Safe. This is common knowledgethat disaster is everywhere. Its in the streets, its inside your campuses, and it can even be found inside your home. The question is not whether we are safe because no one is really THAT secure anymore but whether we can do something to lessen the odds of ever becoming a victim.

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