Preemptive hospital evacuation during the 2021 European floods: A qualitative study on factors influencing decision-making

Introduction: In July 2021, several European countries were affected by severe floods, with water levels of the river Meuse reaching a record high. It was decided to completely evacuate VieCuri Medical Center (Venlo, The Netherlands), a hospital located directly adjacent to this river. The aim of this study was to explore the decision-making process of this emergency hospital evacuation. Methods: This descriptive qualitative study assessed factors influencing the decision-making process of this hospital evacuation. Data were collected through semi-structured interviews with 11 key stakeholders. Data were analyzed by reflexive thematic analysis. Results: Three themes were constructed from the interviews: risk-assessment and estimation; prior experience; and prerequisites for evacuation. The decision to evacuate was made when there was uncertainty regarding maximum water level forecasts. Therefore, the risks of a hospital evacuation were balanced against the risk of the loss of essential services in case of a dike breach. Prior experiences with crises played a major role, and the use of a national patient coordination center (NPCC), which was established during the COVID-19 pandemic, enabled rapid assessment of the capacity of destination hospitals and facilitated patient transfers. It was determined that prerequisites for evacuation include clear evacuation guidelines, concise communication and collaboration. Conclusion: The decision to evacuate was made when there was uncertainty regarding maximum expected water levels, while administrators balanced the risk of hospital evacuation against the risk of essential services failure in case of a dike breach. Prior experience with crises and the availability of a NPCC were decisive factors in this evacuation procedure. The NPCC allowed for swift identification of available capacity in appropriate destination hospitals.