The Australian Government’s National Critical Care and Trauma Response Centre (NCCTRC) possesses a 60-bed deployable air-conditioned field hospital that provides equipment for emergency/maternity care, resuscitation and radiology. The field hospital is also equipped with a pathology laboratory, pharmacy, sterilization facility, a morgue, and staff habitats with kitchen and storage. ¹ The NCCTRC field hospital is ideal for scenarios that allow road access and sufficient time for deployment.

Although preparedness through a readily deployable, fit-for-purpose field hospital is valuable, disasters may unfold rapidly and unpredictably, precluding the possibility of relying on such resources. Empirical research is needed to understand the complexity of the challenge (e.g., if a field hospital set up must be managed locally by the evacuating hospital, without any external supports). This research addresses that by presenting the narrative of a field hospital setup that had to be expedited due to immediate risk of flooding in a 60-bed community hospital. The hospital has more than 100 staff members managing an Emergency Department (ED), rehabilitation unit, hemodialysis unit, and an oncology unit, along with in-patient wards. Extensive flooding in 2 Australian states of Queensland and New South Wales in early 2022 impacted 14 million people, 26 of whom died, and destroyed or damaged 8000 homes, triggering insurance claims of $4.29 billion Australian Dollars. ² This large-scale flooding also impacted the community hospital as flood waters were forecasted to enter the hospital building in few hours, leaving insufficient time for the NCCTRC field hospital to reach the site and accommodate evacuated patients. Additionally, most of the roads leading to the site were already submerged, making deployment impossible. Despite the presence of back up mechanisms, hospitals can be forced to create their own underequipped field hospitals or shelters, in circumstances where the facility gets isolated. This research aimed to investigate and briefly report an evacuation and field hospital set up to disseminate the key measures that can help other hospitals plan for similar disaster scenarios.

A qualitative study was undertaken which involved primary data collection through 9 key informant interviews and secondary data collection through analyses of published accounts of hospital’s disaster response. A narrative analysis of the collected data provided an interpretive account of key informants’ experiences in hospital evacuation and field hospital set up. All research participants had either led the flood-affected hospital’s evacuation from the ground or directed the whole operation from the hospital network headquarters or the state health department. This included the perspectives of senior management of the hospital network and state government, the physicians that led the evacuation of ED and the wards, and the senior nursing staff that supported all patients during the evacuation.

Primary data was collected through 9 interviews that took place between January 30, 2023 and April 4, 2024. In 1 interview, the account was provided in-person at the headquarters of the hospital network; all remaining sessions were conducted on MS Teams. Inductive thematic analysis on the model of Kiger and Varpio (2020) was conducted to capture the main themes narrated by participants.Reference Kiger and Varpio ³ Narrations of hospital evacuation in the news and a specialty publication were matched with participants’ accounts to strengthen the validity of narrative analysis.Reference Vennell ^{4 ,} Reference Knaus ⁵

Narrative

In early 2022, coincidence of exceptionally high tides and unprecedented riverine swelling threatened an Australian district hospital located next to an estuary on the east coast of Australia. At 6 pm on March 1, 2022, the local police advised the clinicians to evacuate to a nearby school. The advice triggered a process of internal deliberation on the feasibility of sheltering in place to avoid exposing patients to the risks of unplanned evacuation. The hospital staff cross checked the directive with their supervisors at the headquarters of the hospital network and agreed that risks outweighed benefits as flood waters were expected to rise above the ground floor level of the hospital building in few hours. A whole hospital evacuation was then set in motion, which engaged 4 agencies, namely the State Emergency Services (SES), Local Government, the State Police, and the ambulance service, to evacuate 55 patients, essential equipment, and medications. The SES and Police arranged buses for ambulant patients and specialized vehicles for movement of equipment. Clinicians were split between 2 sites so as to have enough staff at both the evacuating hospital and the receiving site, and to also accompany patients in-transit. The staff in different locations coordinated to track the movement of patients each of whom was sent with identification tags, notes, and medication charts.

Clinicians initiated the evacuation work by identifying patients that could be discharged into their family’s care and staff were tasked to make phone calls to families. A relatively healthy patient was evacuated to the field hospital when her family could not be contacted. On the other hand, an acutely unwell immunocompromised patient was transferred to his family’s care to avoid his exposure to unpredictable risks of evacuation and the field hospital environment. The dialysis patients and those at risk of acute deterioration were transferred to the nearest tertiary hospital. The clinicians interviewed reported putting extra emphasis on providing situational awareness to all patients, including those with cognitive decline, to curb their anxiety and assure them of their safety. Effective patient communication was not deprioritized despite scarcity of time, and all patients received personalized briefings from clinicians with whom they were familiar. A quick exodus of patients was planned to have everyone out well before the entry of flood waters on hospital floors, and so healthier patients were moved first.

A doctor and nurse were dedicated to the task of identifying and gathering essential items for the field hospital. They took all medications that could be needed at the field hospital. Figure 1 lists examples of the items that clinicians determined would be necessary to set up an emergency department and manage potential critical patients in the field hospital setting. Most of the essential resources were collected and transported while evacuating the hospital, but some items were either not available or had to be picked up by making trips to the evacuated facility.

Figure 1. Essential resources required at the field hospital, identified before or after the evacuation.

The hurried identification and transfer of critical medications and equipment, mostly in private cars, proved lifesaving, as within 1 hour of set up, the field ED treated patients suffering from Acute Kidney Injury (AKI), sepsis, dog bites, bowel obstruction, and sodium deficiency.Reference Vennell ⁴ The triage section of the ED was set up in 1 classroom and the resuscitation subsection in another. A separate area was also created to provide privacy to a patient with a life limiting diagnosis, who later passed away in that space while receiving uninterrupted palliative care. The newly created field hospital used air mattresses for all patients except those in resuscitation subsection of the ED and did not have pathology laboratory, morgue, and staff habitats. Many volunteers stepped in to offer help at the field hospital, but there were not enough generic tasks that could be delegated to each volunteer, creating the problem of unmanaged overcrowding at the field hospital. Research participants acknowledged and appreciated the volunteering spirit but also felt that security should have been provided to manage the crowd of volunteers.

During the evacuation, the clinicians had to work around certain significant disruptions which included power and telecommunication outages, and an incoming emergency patient, flown in on a helicopter. Incident command was not clearly defined, so a nurse manager assumed the role of incident controller, and in the physicians’ space, a doctor improvised to coordinate the work towards the goal of safe evacuation. The hospital floor was expected to be a meter underwater, so before the departure of the last staff member, computers, valuable equipment, and patient trolleys were put on high ground and the facility was locked to protect its remaining contents.