Although hospitals play a crucial role in responding to all phases of emergencies, they may face new challenges due to increasing disasters and public health emergencies (DPHE) 1,2. Some emergencies necessitate a total evacuation since hospitals might become the target of an incident, while in other situations, hospitals may need to be unburdened or partially evacuated 3–6. For example, according to the World Health Organization, during the current Ukrainian Hybrid war 7, which violates the International Humanitarian Law and Geneva convention, hospitals were frequently attacked, causing deaths and injuries among civilians living within or adjacent to the targeting area 8,9.
The United Nations Office of Disaster Risk Reduction (UNDRR) defines hospital evacuation as ‘Moving people and assets temporarily to safer places before, during or after the occurrence of a hazardous event to protect them’ 10. Other organizations, such as The Pan American Health Organization (PAHO), describe the goal of hospital evacuation as ‘to safeguard the health and lives of its occupants’ 11. Whereas Tekin et al. emphasize that hospital evacuation is an attempt to empty an entire hospital or a part of it. Irrespective of the reasons and definitions, hospital evacuation appears to present a complex operation in which the hospital’s sick occupants and necessary devices, some connected to the patients, and personnel, may need to be evacuated. Such a process is insecure for patients, staff, and other people nearby due to many internal and external factors that may impact them when transferred to safer zones 12. Especially when some of the hospitals’ occupants are vulnerable, i.e., people who may require additional assistance with evacuation due to physical limitations and hearing and vision insufficiencies 13. In addition, both manmade and nature-caused incidents may impact the infrastructure in the affected area, causing difficulties in responding to an evacuation by directly influencing all vital elements of surge capacity, i.e., staff including medical and non-medical personnel, stuff such as medical devices, space like needed areas to be modified to either treatment zones or shelters, and system which refers to practical or mutual guidelines (4S), thus disrupting the delivery of healthcare resources 14.
The challenges with an evacuation necessitate a risk and vulnerability assessment, strengthening the ability to make clear medical decisions and appropriate planning regarding vital elements of surge capacity (4S) and some collaborative measures in a multi-agency approach, which includes at least healthcare, rescue, and police organizations and needs a more flexible approach 3,8, 15–17. According to the flexible surge capacity (FSC) theoretical framework, communities’ resources can be used when hospitals cannot receive patients, e.g., during a pandemic or when the hospital should be evacuated, e.g., during flooding or explosion. In such scenarios, community resources such as primary care, veterinary, and dental clinics may contribute with their staff, stuff, and spaces, and hotels, schools, and sports halls with food, areas, and other appropriate needs 17–20. A key element in organizing such a process is to create a unanimous system, i.e., rules and guidelines that govern the collaboration between organizations and their staff, stuff, and spaces 16,21. Exercises and training initiatives may enhance this multi-agency and multi-professional synchronization and collaboration 22.
Thailand is a disaster-prone country, where the number of natural hazards like flooding, manmade hazards like protests, and public health emergencies continuously increases 4,21, 23–25. Despite several publications and changes in the national preparedness system, there is still a paucity of pertinent data and research on preparedness and response, particularly in the field of hospital evacuations 9,19. Moreover, the devastating 2004 Southeast Asian Tsunami, which caused numerous casualties and deaths, and other incidents, such as flooding in 2011, have illustrated insufficiencies in several parts of the response system, including command and control, maintenance, and logistics 9, 26–29.
In an earlier publication reporting the current perspectives on hospital evacuation in 15 different nations, most countries, including Thailand, lacked the necessary collaborative elements and readiness for evacuation, and some even lacked an evacuation plan 21. One issue in the Thai system might be its hospitals' organizational characteristics, which contain both public and private organizations. Thai public health facilities provide care to a geographically defined population divided into 12 regions with similar cultures, risks, and environments. Within the areas, the facilities have four tiers of competencies and capacities: primary care (10–120 beds), secondary care (120–500 beds), tertiary care (more than 500 beds), and university hospitals 28,29. The characteristics of secondary and tertiary care hospitals are relevant to major incidents and disaster responses.
Although the diversity of this system can be a drawback, it seems suitable for implementing the FSC concept and enhancing the community response system 20. Thus, this study aims to explore Thai hospitals’ current evacuation readiness and preparation regarding surge capacity and collaboration.