Preparing Communities to Evacuate for Major Hurricanes

Evacuation plans can be activated to take lifesaving measures. Emergency evacuation is often recommended when authorities determine that moving people away from an area that contains an imminent threat will likely reduce morbidity and mortality related to the pending disaster (e.g., hurricanes, floods). This editorial offers that public health could be more effectively leveraged to promote evacuation recommendations in the face of an impending disaster.

Successful evacuations involve a range of governmental organizations and require internal partners’ collaboration across different sectors, services, and jurisdictional boundaries.¹ Public information officers advance multiagency emergency response capabilities as trusted sources of information across sectors, and they readily tap into communication resources across communities and government entities (https://www.cdc.gov/cpr/readiness/capabilities.htm). Public information officers can leverage existing community partnerships and increase public confidence in evacuation orders through informative communications by trusted agents.^2,3

Community outreach by state and local public health officials can assist with preparing communities for evacuations by hosting regular year-round community engagements that provide information about services such as mass care and shelters, assistance for people with access and functional needs, and emergency supplies to be self-sufficient. Educating communities about the rationale for evacuation before an event might increase compliance by impacted communities when actual orders are issued.

ROLE OF PUBLIC HEALTH AS PARTNERS IN EVACUATION

Delivery of emergency public health information and warnings is a core function of state, local, tribal, and territorial public health (https://www.cdc.gov/cpr/readiness/capabilities.htm). State governors, working through the state’s emergency management agency, develop and generally implement guidelines for state-mandated evacuations involving large-scale disasters such as major hurricanes. Local government and law enforcement might also order evacuations on the basis of threats to their localities.

State and local public health agencies are well positioned to support coastal community evacuations by sharing essential health information related to the incident through existing public health alerts and communication systems. For an evacuation to be successful, evacuees need to know when to evacuate, what roads to take, and the location of available shelters (https://www.justice.gov/crt/fcs/EmergenciesGuidance). Public health professionals regularly develop educational resources (e.g., fact sheets, pamphlets) to disseminate information about safe practices and oftentimes engage in outreach efforts that could be leveraged before a disaster to raise community awareness. For example, public health can raise community awareness about driving in floodwaters and posting real-time storm surge maps from the National Hurricane Center to inform residents about storm predictions (e.g., estimated landfall, flooding).⁴

Public health is an essential partner for evacuees needing shelter and health care support during and after a large-scale natural disaster. Public health public information officers can enhance communication efforts by providing materials about emergency services and sharing information about evacuation threats, routes, redirection signage (e.g., controlled flow barriers, reverse lanes, one-way exists), and shelter locations before a storm affects them.⁵

To facilitate evacuation, reunification, and safe re-entry in affected communities requires cross-sector coordination; public health has well-established collaborations with health care coalitions, hospital programs, and nongovernmental organizations that can be leveraged. Public health is an essential partner for ensuring continued operations given medical surge, patient movement, and support for the continuity of basic public health and preventive care for populations likely to be disproportionately affected by the disaster. Public health provides support for evacuating populations to mass care sites and tracking the medical needs of individuals in shelters (e.g., electricity-dependent durable medical equipment, prescription medicines), and can promote evacuation and community preparedness more widely as an accepted practice.

LESSONS LEARNED

After-action reports (AARs) rely on qualitative methodology and are summative reports containing lessons learned and recommendations to improve evacuation plans, policies, and procedures; these reports also inform quality improvement for preparedness and response plans.⁶ The AAR following Hurricane Florence’s (2018) North Carolina evacuation documented extended partnerships and collaborations before an event strengthened contingency plans to reverse the flow of traffic on interstates to assist outbound traffic and decrease evacuation clearance time. However, communications and awareness of shelter operations were noted as not working as well because of the length of the storm, which required shelters to be open longer than expected and led to shortages of medical supplies.²

The 2017 Atlantic hurricane season was described as hyperactive and catastrophic. Recommendations from multiple storms that made landfall in quick succession suggested the need for enhanced coordination across critical infrastructure sectors to improve situational awareness of systems capabilities and address previous challenges.⁷ Because major weather-related events can devastate communities and overwhelm the health system, it is important that public health be an irrevocable partner in emergency management.

Through increased public awareness, increased communication efforts, and expanded partnerships, communities can be better equipped with information to appropriately react to a natural disaster threat and implement life-saving decisions to ensure public safety. Strong partnerships need to be established before disaster strikes and involve collaborations from a variety of sectors. Public health is a trusted community partner and focused engagement should increase preparedness efforts in populations at risk for large-scale natural disasters.