Consider a scenario where a decision is made to totally evacuate a high-rise acute care hospital. Now consider how it might be managed in a standalone scenario. There would be no help from the community. What resources would be needed? How long might it take to clear the entire patient population?

To test this scenario, a drill can be devised that would simulate evacuating a single patient incapable of self-preservation from the top floor without the use of an elevator.

How many staff would it take to not only move the patient down the stairs but also to tend to the equipment, the medications and the records that would be required for relocation? Would the stairwell become jammed with other patients being moved to the staging area? Who would manage the traffic?

When the evacuated patient arrived at the staging area, would transport be waiting to move the patient to the alternate site? Or would a bottleneck occur?

Would the team that just completed a transport down the stairs be needed to repeat the process for another patient? Without elevators, they would need to climb back up the high-rise building and do it all over again. Is the team physically capable of cycling back up to the floor of discharge to evacuate the next patient? How long would this process take?

Even with a perfect 96-hour plan for resources and assets, at some point incident command might be confronted with a decision to call for evacuation. Simply stated, if the estimated time to evacuate a building is 10 hours, incident command cannot make the call to evacuate later than the 86th hour into an event. Consumption of available resources must be gauged against the total time to evacuate to ensure that all patients are out of the building before the depletion of resources.