Executive Summary
The reality is that the risks hospitals face today are different than what they imagined a decade ago – and that a rapidly changing climate poses yet unforeseeable hazards for the future. In Santa Rosa, California, Kaiser Permanente has learned from evacuating under the threat of wildfire twice in the past two years. From these experiences, they’ve built systems and solutions that health care systems anywhere can learn from, including conducting a system-wide bed availability assessment, controlling patient transfer prior to mandatory evacuation, preparing for patient evacuation early, and using an evacuation toolkit including a tracking system.
In 2017, as the Tubbs Fire made its dramatic and rapid assault on Santa Rosa, California, our doctors, nurses, and support staff faced the unimaginable task of evacuating the hospital. It was a job that many, if not most, of them never imagined doing in their careers. And yet, again this fall, wildfire threatened the facility. As the Kincade Fire made a slower — though no less deliberate — approach, our staff again halted surgeries, labor deliveries, and more and packed up patients. Both times we safely evacuated more than 120 patients and ensured care continuity under extreme duress.
While it’s practice we wish we never had, these two emergencies have helped us build and prepare a resilient emergency response operation and this year’s evacuation demonstrated significant improvements; we were able to evacuate more efficiently and calmly. Here’s how we’ve refined these practices in two emergencies.
1. Develop a turnkey command center
Kaiser Permanente had previously created regional ad-hoc command centers to respond to specific incidents, but we learned that critical time can be lost during an emergency when summoning personnel to a new location, connecting and re-connecting communications equipment, and establishing the physical command center to accommodate the required support staff.
With this in mind, in 2018 we opened a fully operational, turnkey command center at our regional headquarters in Oakland outfitted with the appropriate telecommunications and IT equipment needed to coordinate emergency response across multiple sites and disaster scenarios. The center has the technology and trained personnel to provide constant visibility into the operational performance of each of our hospitals during an emergency, enabling us to provide the necessary resources and support in real-time.
2. Open a command center before the threat becomes acute
The 2017 Tubbs fire swept quickly through Santa Rosa and up to our hospital’s property line in the middle of the night, with little advance notice. The decision to evacuate and manage the associated logistics was made swiftly at the ground level and was ultimately carried out safely. At our debrief after the incident we reviewed ways to gain additional time and improve communication in a similar scenario. The answer lay in a common medical practice: Treat potential problems before they become acute.
Now we open a command center at the first sign of a potential threat. This allows emergency teams to communicate issues in real-time, develop planning scenarios and anticipated reactions, and set expectations and priorities across multiple locations. This is done long before emergency decisions must be made.
In October 2019, we opened our command center long before the Kincade Fire became a presiding emergency situation. And we began the process of proactively transferring patients out of our Santa Rosa Medical Center eight hours before the formal evacuation notice came through. In this instance we had the benefit of time; the regional electric utility had announced planned power outages across multiple counties due to the high possibility of fire. Still, the decision to not wait until we felt seriously threatened helped us improve our response by putting critical steps in motion sooner. These steps included preemptively reducing hospital patient count through a controlled transfer process and moving patients to other nearby Kaiser Permanente medical centers. Early patient evacuation preparation was initiated as well, including assessment for evacuation transport needs, printing of evacuation reports, and completing patient evacuation tags well in advance of the actual evacuation.
3. Identify interdependencies and activate resources
Urgently evacuating 122 patients from the hospital in the dead of night in 2017, our sole initial focus was getting them out of harm’s way as the air filled with smoke and flames came within yards of the hospital grounds. Ambulance resources were scarce as our neighbor hospital had begun evacuating 45 minutes prior. Out of necessity, many of our patients were transported by city buses and private cars with hospital staff. There was no time to distribute patients equally between nearby Kaiser Permanente medical centers; instead, most went to the closest one.
During the 2019 Kincade Fire we connected with our unaffected hospitals and medical centers early on, as conditions deteriorated, asking them to proactively assess their patient capacity, and open additional inpatient capacity in anticipation of planned transfers from the evacuation of the Santa Rosa hospital. We also asked them to activate their command centers to ensure operations were in place 24/7 to manage potential transfers to their hospitals. This allowed our unaffected hospitals to be ready and able to receive Kaiser Permanente Santa Rosa Medical Center’s patients safely and expeditiously, while our integrated electronic medical record system allowed physicians at the receiving hospitals to provide seamless continuity of care for patients.
But we still had to get the patients to those open beds. As part of the command center structure, our regional transportation hub organized all ambulance and medical transport required for the evacuation and transfers. We had dozens of emergency service transports lined up and waiting as our first patients from Kaiser Permanente Santa Rosa Medical Center were readied for transfer to another medical center. Not all hospital systems are integrated to this level, but the lesson is that coordinated responses happen most seamlessly with advance planning. Knowing who was in our network, and who we could call on for help, was key to making the plan work.
4. Consider incremental action
There are many intermediate steps a hospital can take before a full evacuation is required. For example, a strategy to begin sending non-critical patients and those who may take the longest to prepare for transfer to other nearby hospitals in planned transfers can help avoid overwhelming the receiving facility and reduce the at-risk patient population in case of emergency.
In addition, time spent gathering equipment, filling out paperwork, and doing any other “pre-work” will enable a rapid evacuation of the remaining patients should that become necessary. Ideally this will be part of a comprehensive evacuation plan and toolkit — including evacuation checklists, evacuation tags, and a patient tracking system — already tested and in place. Educating and training for employees and physicians on these processes in advance of an emergency will help achieve optimal performance and the best possible outcomes for patients in a real event.
The reality is that the risks our facilities face today are different than what we imagined a decade ago — and that a rapidly changing climate poses yet unforeseeable hazards for the future. Some of our solutions may best fit a multi-hospital integrated delivery system like Kaiser Permanente, but we also believe that hospitals and health systems of any size can learn from our experiences and changes we made between the two fires — and then had the opportunity to pressure test — including conducting a system-wide bed availability assessment, controlling patient transfer prior to mandatory evacuation, preparing for patient evacuation early, and using an evacuation toolkit including a tracking system. While we hope that we won’t have to evacuate again, analyzing these experiences, learning from them, and continuing to develop emergency plans is part of what we know we have to do to keeping our patients and communities safe.
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