This is the accessible text file for GAO report number GAO-06-790T 
entitled 'Disaster Preparedness: Preliminary Observations on the 
Evacuation of Vulnerable Populations Due to Hurricanes and Other 
Disasters' which was released on May 18, 2006. 

This text file was formatted by the U.S. Government Accountability 
Office (GAO) to be accessible to users with visual impairments, as part 
of a longer term project to improve GAO products' accessibility. Every 
attempt has been made to maintain the structural and data integrity of 
the original printed product. Accessibility features, such as text 
descriptions of tables, consecutively numbered footnotes placed at the 
end of the file, and the text of agency comment letters, are provided 
but may not exactly duplicate the presentation or format of the printed 
version. The portable document format (PDF) file is an exact electronic 
replica of the printed version. We welcome your feedback. Please E-mail 
your comments regarding the contents or accessibility features of this 
document to Webmaster@gao.gov. 

This is a work of the U.S. government and is not subject to copyright 
protection in the United States. It may be reproduced and distributed 
in its entirety without further permission from GAO. Because this work 
may contain copyrighted images or other material, permission from the 
copyright holder may be necessary if you wish to reproduce this 
material separately. 

Testimony: 

Before the Special Committee on Aging, U.S. Senate: 

United States Government Accountability Office: 

GAO: 

For Release on Delivery Expected at 10:00 a.m. EDT: 

Thursday, May 18, 2006: 

Disaster Preparedness: 

Preliminary Observations on the Evacuation of Vulnerable Populations 
due to Hurricanes and Other Disasters: 

Statement of Cynthia Bascetta: 

Director, Health Care: 

GAO-06-790T: 

GAO Highlights: 

Highlights of GAO-06-790T, a testimony before the Special Committee on 
Aging, U.S. Senate. 

Why GAO Did This Study: 

Hurricane Katrina struck near the Louisiana-Mississippi border and 
became one of the worst natural disasters in U.S. history, affecting a 
large geographic area and necessitating the evacuation of people from 
parts of the area, including vulnerable populations, such as hospital 
patients, nursing home residents and transportation-disadvantaged 
populations who were not in such facilities. The disaster highlighted 
the challenges involved in evacuating vulnerable populations due to 
hurricanes. 

GAO was asked to discuss efforts to plan and prepare for the needs of 
seniors in the event of a national emergency. GAO describes its ongoing 
work on evacuation in the event of emergencies, such as hurricanes, and 
provides preliminary observations on (1) challenges faced by hospital 
and nursing home administrators that are related to hurricane 
evacuations; (2) the federal program that supports the evacuation of 
patients needing hospital care and nursing home residents; and (3) 
challenges states and localities face in preparing for and carrying out 
the evacuation of transportation-disadvantaged populations and efforts 
to address evacuation needs. 

This testimony is based in part on a prior GAO report, Disaster 
Preparedness: Preliminary Observations on the Evacuation of Hospitals 
and Nursing Homes Due to Hurricanes, GAO-06-443R (February 16, 2006). 

What GAO Found: 

Hospital and nursing home administrators face challenges related to 
evacuations caused by hurricanes, including deciding whether to 
evacuate and obtaining transportation. Although state and local 
governments can order evacuations, health care facilities can be exempt 
from these orders. Facility administrators are generally responsible 
for deciding whether to evacuate, and if they decide not to evacuate, 
they face the challenge of ensuring that their facilities have 
sufficient resources to provide care until assistance arrives. If they 
evacuate, contractors providing transportation for hospitals and 
nursing homes could be unlikely to provide facilities with enough 
vehicles during a major disaster such as a hurricane because local 
demand for transportation would likely exceed supply. Nursing home 
administrators told us they face unique challenges during evacuations. 
For example, they must locate receiving facilities that can accommodate 
residents who may need a place to live for a long period of time. 

The National Disaster Medical System (NDMS), a partnership of four 
federal departments, is the primary federal program that supports the 
evacuation of patients in need of hospital care during disasters such 
as hurricanes, but the program was not designed nor is currently 
configured to move nursing home residents. NDMS supplements state and 
local emergency response capabilities with federal resources and 
services and helped evacuate about 2,900 people during recent 
hurricanes, including Hurricane Katrina. Although NDMS supported 
evacuation efforts during Hurricane Katrina that included nursing home 
residents, according to program officials it is not designed to 
evacuate this population. Officials explained that the program does not 
have agreements with nursing homes that could receive evacuated nursing 
home residents. 

In preparing for and carrying out the evacuation of transportation-
disadvantaged populations, such as the elderly or persons with 
disabilities, during a disaster, states and localities face challenges 
in identifying these populations, determining their needs, and 
providing for and coordinating their transportation. The elderly are 
likely to be represented among the transportation disadvantaged because 
they are more likely, compared with the general population, to have a 
disability, have a low income, or choose not to drive. GAO has observed 
mixed efforts at the state and local levels to address the evacuation 
needs of the transportation disadvantaged. Some emergency management 
officials told GAO they did not yet have a good understanding of the 
size, location, and composition of the transportation disadvantaged in 
their community. However, GAO also observed efforts in some locations 
to address the evacuation needs of the transportation disadvantaged by 
encouraging citizens to voluntarily register with their local emergency 
management agency, integrating social service providers into emergency 
planning, and other measures. GAO will continue to examine the extent 
to which the transportation disadvantaged are addressed in state and 
local evacuation efforts as part of its ongoing work. 

What GAO Recommends: 

[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-790T]. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Cynthia Bascetta at (202) 
512-7101 or bascettac@gao.gov. 

[End of Section] 

Mr. Chairman and Members of the Committee: 

Thank you for inviting me here to discuss our preliminary observations 
on ongoing work on the evacuation of vulnerable populations due to 
hurricanes and other disasters, including patients in hospitals; 
residents in nursing homes; and transportation-disadvantaged 
populations, such as the elderly, persons with disabilities, and people 
who, by choice or circumstances, do not own or have access to a 
personal vehicle. 

On August 29, 2005, Hurricane Katrina struck near the Louisiana- 
Mississippi border and became one of the worst natural disasters in 
U.S. history. The hurricane affected a large geographic area and 
necessitated the evacuation of people from parts of the area. Among 
those needing to be evacuated were hospital patients, nursing home 
residents, and transportation-disadvantaged populations who were not in 
such facilities. The disaster highlighted the challenges involved in 
evacuating these vulnerable populations. For example, administrators of 
hospitals and nursing homes must make decisions about the best way to 
care for their patients or residents, including whether to evacuate if 
the facility becomes unable to support adequate care, treatment, or 
other services. Although both hospital patients and nursing home 
residents were evacuated during Hurricane Katrina, in the aftermath of 
the event, congressional reports have raised questions about how health 
care facility administrators plan for hurricanes, how they implemented 
their plans, and how the federal government assisted health care 
facilities and state and local governments with facility 
evacuations.[Footnote 1] Hurricane Katrina also pointed out the 
challenges of evacuating transportation-disadvantaged populations who 
are not in such facilities during a disaster. State and local 
governments are primarily responsible for responding to disasters that 
may result in evacuations. When state and local governments are 
overwhelmed in their response to a disaster, the federal government can 
assume a greater role. 

You asked me to discuss issues related to efforts to plan and prepare 
for the needs of seniors in the event of a national emergency. My 
remarks today will describe our ongoing work on evacuation in the event 
of emergencies and will provide preliminary observations on (1) the 
challenges faced by hospital and nursing home administrators that are 
related to hurricane evacuations, (2) the federal program that supports 
the evacuation of patients needing hospital care and nursing home 
residents, and (3) challenges states and localities face in preparing 
for and carrying out the evacuation of transportation-disadvantaged 
populations and efforts to address evacuation needs. 

My testimony today is based on our February 2006 interim 
report[Footnote 2] as well as our ongoing work on the evacuation of 
hospitals and nursing homes due to hurricanes, and the evacuation of 
transportation-disadvantaged populations due to hurricanes and other 
disasters. Our work in this area is being conducted under the 
Comptroller General's authority to conduct evaluations on his own 
initiative.[Footnote 3] In conducting the work for our interim report, 
we interviewed officials in Florida in areas that experienced 
hurricanes in 2004, including officials from three hospitals and three 
nursing homes that experienced Hurricane Charley,[Footnote 4] state 
officials, and local emergency management officials in two counties. In 
addition, we interviewed officials from national hospital and nursing 
home associations and Florida hospital and nursing home associations. 
For our ongoing work related to the evacuation of hospitals and nursing 
homes, we interviewed officials in Mississippi in areas that were hit 
by Hurricane Katrina, including officials from five hospitals, 
officials from three nursing homes or assisted living facilities, state 
officials, and local officials in two counties. For our ongoing work on 
evacuating transportation-disadvantaged populations, we have visited 
communities in California, Florida, and New York, and we plan to visit 
communities in Louisiana and Washington, D.C. We have interviewed or 
will interview state and local emergency management agencies, state and 
local transportation departments, local and regional transit agencies, 
and local and regional planning organizations. In addition, we 
interviewed entities that represent transportation and emergency 
management officials, entities such as the Federal Interagency 
Coordinating Council on Access and Mobility, and others. We also 
interviewed officials from the Department of Defense (DOD), the 
Department of Health and Human Services (HHS), the Department of 
Homeland Security (DHS), the Department of Veterans Affairs (VA), and 
the Department of Transportation (DOT) about federal efforts to support 
evacuation of hospitals and nursing homes and transportation- 
disadvantaged populations not in such facilities. In addition, we 
reviewed documents, including emergency management plans from the 
states of Florida, Mississippi and other states, local governments, 
hospitals, and nursing homes; and federal documents such as the 
National Response Plan.[Footnote 5] Finally, we reviewed the 
recommendations on evacuations contained in several recently issued 
reports on the Hurricane Katrina response prepared by the U.S. House of 
Representatives, U.S. Senate, the White House, and DOT and DHS. We 
discussed the facts contained in this statement with officials from 
DOD, HHS, DHS, DOT, and VA, and incorporated changes as appropriate. 
Our work began in December 2005 and is being performed in accordance 
with generally accepted government auditing standards.[Footnote 6] 

In summary, hospital and nursing home administrators face challenges 
related to evacuations caused by hurricanes, including deciding whether 
to evacuate their facilities and obtaining transportation. Although 
state and local governments can order evacuations, health care 
facilities can be exempt from these orders. Facility administrators are 
generally responsible for deciding whether or not to evacuate, and if 
administrators decide not to evacuate, they face the challenge of 
ensuring that their facilities have sufficient resources to provide 
care or other services until assistance can arrive. If facilities 
evacuate, administrators face the challenge of securing transportation; 
according to hospital and nursing home officials, contractors providing 
transportation for hospitals and nursing homes would be unlikely to 
provide facilities with enough vehicles during a major disaster, such 
as a hurricane, because local demand for transportation would likely 
exceed supply. According to nursing home administrators, they face 
unique challenges during evacuations. For example, when a nursing home 
evacuates, the administrator must locate receiving facilities that can 
accommodate residents who may need a place to live for a long period of 
time. 

The National Disaster Medical System (NDMS) is the primary federal 
program that supports the evacuation of patients in need of hospital 
care during disasters such as hurricanes, but the program was not 
designed nor is currently configured to move nursing home residents. 
NDMS is a federal partnership of DOD, HHS, DHS, and VA that supplements 
state and local emergency response capabilities with federal resources 
and services. The program helped evacuate about 2,900 people during 
recent hurricanes, including Hurricane Katrina. NDMS supported 
evacuation efforts during Hurricane Katrina that included nursing home 
residents, although officials explained that NDMS does not have 
agreements with nursing homes that could receive evacuated nursing home 
residents. In contrast, NDMS has agreements with participating 
hospitals to receive patients needing hospital care. 

In preparing for and carrying out the evacuation of transportation- 
disadvantaged populations who are not in institutions during a 
disaster, states and localities face challenges in identifying these 
populations, determining their needs, and providing for and 
coordinating their transportation. Identifying these populations and 
determining their needs present challenges because their overall size, 
location, and composition can be difficult to determine in advance of 
an emergency. For example, while transportation-disadvantaged 
populations include the elderly, low-income individuals, and persons 
with disabilities, during disasters these populations can also include 
people who do not own or have access to cars and people who do not 
permanently reside in the community, such as tourists. The elderly are 
particularly likely to be represented among the transportation 
disadvantaged because they are more likely, compared with the general 
population, to have a disability, have a low income, or choose not to 
drive. Providing for and coordinating the transportation of 
transportation-disadvantaged populations presents challenges because 
evacuating them requires additional planning, time, resources (for 
example, evacuating seniors with special medical needs from their 
homes), and communication efforts (such as communicating with the 
vision or hearing impaired). In the course of our review, we observed 
mixed efforts at the state and local level to address the evacuation 
needs of the transportation disadvantaged. For example, emergency 
management officials in two locations we visited indicated they did not 
yet have a good understanding of the size, location, and composition of 
the transportation disadvantaged in their communities. However, we also 
observed efforts in some locations to address the evacuation needs of 
the transportation disadvantaged by encouraging citizens to voluntarily 
register with their local emergency management agencies, integrating 
social service providers into emergency planning, and other measures. 

Facility Administrators Face Several Challenges Related to Evacuations, 
Including Deciding Whether to Evacuate and Securing Transportation: 

Administrators of hospitals and nursing homes face several challenges 
related to evacuations caused by hurricanes. Among these challenges, 
administrators must decide whether to evacuate their facilities or stay 
in facilities and "shelter in place." Although state and local 
governments can order evacuations of the population or segments of the 
population during various emergencies, health care facilities can be 
exempt from these orders.[Footnote 7] Facility administrators are 
generally responsible for deciding whether to shelter in place or 
evacuate, and administrators told us they generally see evacuation as a 
last resort. However, to shelter in place, facility administrators face 
the challenge of ensuring that their facilities have sufficient 
resources to provide care or other services during the disaster and 
then in its aftermath until assistance can arrive. For example, during 
hurricanes Katrina and Charley, facility administrators said they had 
to ensure that their facilities had staff who could stay for longer 
shifts until the storms passed and relief staff could arrive. One 
hospital in Mississippi had prepared staff to stay for approximately 3 
days; however, staff had to stay 2 weeks before replacement staff could 
arrive. The administrator also said they had to have 3 days of food and 
supplies stocked and enough fuel to run generators for 1 week. 
Destruction of communications capabilities due to hurricanes can 
complicate the decision to evacuate. For example, during Hurricane 
Katrina, the destruction of communications systems left hospital and 
nursing home administrators unable to receive information about how 
long it would take before assistance would arrive. 

If hospital and nursing home administrators decide to evacuate, they 
face the challenge of securing sufficient and appropriate 
transportation to move their patients or residents. Hospital and 
nursing home association representatives told us that facilities are 
likely to have local arrangements for transportation services, but the 
facilities are less likely to have arrangements in other localities or 
states, as was necessary for the evacuations during Hurricane Katrina. 
According to hospital and nursing home administrators, their 
contractors providing transportation would be unlikely to provide them 
with vehicles during a major disaster because local demand for 
transportation would exceed supply. For example, during Hurricane 
Katrina, two counties in Mississippi had to secure vehicles that were 
located in other states.[Footnote 8] Facility administrators also face 
the related challenge of obtaining appropriate vehicles. One nursing 
home administrator told us the facility had a transportation agreement 
with a bus company, but the company supplied only regular buses and 
most of the facility's residents needed vehicles with power lifts to 
accommodate electric wheelchairs. 

While hospital and nursing home administrators face many of the same 
challenges during evacuations, there are some challenges nursing home 
administrators in particular must address. According to nursing home 
administrators, one challenge results from the fact that people in 
nursing homes may reside there for a long time. As a result, these 
administrators explained that nursing homes cannot reduce the number of 
residents in their facilities for whom they are responsible because 
nursing home residents may have no other home and cannot care for 
themselves. In contrast, hospital administrators told us that it is 
common to discharge as many patients as possible before a hurricane in 
order to reduce the number of patients who need to be sheltered or 
evacuated. In addition, when a nursing home evacuates, the 
administrator must locate receiving facilities that can accommodate 
residents for a potentially long period of time. For example, a nursing 
home administrator in Florida told us that the facility had to relocate 
its residents for over 10 months until the facility could be fixed. 

NDMS Is the Primary Federal Program That Evacuates Patients Needing 
Hospital Care, but It Is Not Designed to Move Nursing Home Residents: 

NDMS is the primary federal program that supports efforts to evacuate 
patients who need hospital care during disasters such as hurricanes by 
moving them from an area affected by the emergency to reception areas 
in other locations. Formed in 1984 to care for casualties that could 
result from a domestic disaster or an overseas conventional war, NDMS 
is a federal program that supplements state and local emergency 
response capabilities with federal resources and services. DOD, HHS, 
DHS, and VA are federal partners in NDMS, and DHS has the authority to 
activate NDMS in response to public health emergencies, including but 
not limited to presidentially declared major disasters or 
emergencies.[Footnote 9] Among its various functions,[Footnote 10] NDMS 
supports the evacuation of hospitals by assisting in efforts to move 
patients from a mobilization center, such as an airport near the 
incident, to reception areas in other locations where patients can be 
placed in a hospital participating in NDMS to continue receiving 
medical care. NDMS officials told us that Hurricane Katrina was the 
first time that the patient evacuation component of NDMS was used to 
evacuate a large number of patients. In response to state requests for 
assistance due to recent hurricanes, about 2,900 people were 
transported from NDMS mobilization centers to NDMS patient reception 
areas.[Footnote 11] 

While NDMS supports the evacuation of patients in need of hospital 
care, the program was not designed nor is currently configured to move 
nursing home residents. As stated in the memorandum of agreement among 
the NDMS federal partners, the patient evacuation function of NDMS is 
intended to move patients from a mobilization center to a reception 
area so they can be admitted to NDMS-affiliated hospitals--typically 
nonfederal hospitals that have agreements with NDMS--to receive medical 
care. Although during Hurricane Katrina NDMS evacuated nursing home 
residents who were brought to mobilization centers, program officials 
told us that NDMS was not designed to evacuate this population and the 
program did not have agreements with nursing homes that could receive 
evacuated nursing home residents. NDMS officials noted the challenge of 
meeting the needs of nursing home residents in an NDMS report prepared 
after Hurricane Katrina.[Footnote 12] 

States and Localities Face Challenges in Addressing the Evacuation 
Needs of Transportation-Disadvantaged Populations: 

In preparing for and carrying out the evacuation of transportation- 
disadvantaged populations due to a disaster, states and localities face 
challenges in identifying these populations, determining their needs, 
and providing for and coordinating their transportation. Identifying 
these populations and determining their needs present challenges 
because their overall size, location, and composition can be difficult 
to determine in advance of an emergency. For example, while these 
populations include the elderly, low-income individuals, and persons 
with disabilities, during disasters transportation-disadvantaged 
populations can also include people who either by choice or 
circumstance do not own or have access to cars. They can also include 
people with limited English proficiency and people who do not 
permanently reside in the community, such as tourists, temporary 
workers, and the homeless. In addition, transportation-disadvantaged 
populations may have specialized medical needs; people may move within 
the community, and these populations may harbor beliefs about privacy 
and fears of discrimination that discourage participation in outreach 
efforts. The elderly are particularly likely to be represented among 
the transportation disadvantaged because they are more likely, compared 
with the general population, to have a disability, have a low income, 
or choose not to drive. 

Providing for and coordinating the evacuation of transportation- 
disadvantaged populations also present challenges because evacuating 
these populations requires additional planning, time, and resources. 
For example, evacuating seniors with special medical needs who are 
residing in their own homes may require additional planning of pick up 
routes; extra time to load and unload evacuation vehicles; and special 
resources, such as buses equipped with wheelchair lifts. In addition, 
communicating evacuation information to these populations during 
disasters may be challenging because they may be vision or hearing 
impaired or have limited English proficiency. 

In the course of our review, we observed mixed efforts at the state and 
local level to address the evacuation needs of the transportation 
disadvantaged during a disaster. In some locations we visited, 
emergency management officials indicated they did not yet have a good 
understanding of the overall size, location, and composition of the 
transportation disadvantaged in their community and acknowledged the 
need to better integrate transportation-disadvantaged populations into 
emergency response planning. For example, emergency management 
officials in one city stated that their participation in the February 
2006 National Plan Review alerted them to the fact that they should 
better provide for and coordinate the needs of transportation- 
disadvantaged populations in their evacuation planning.[Footnote 13] 
One state official described coordination challenges and evacuation 
delays that occurred for transportation-disadvantaged populations in 
one community during an approaching wildfire and attributed these 
problems to coordination difficulties between emergency management and 
other agencies. 

However, we also observed efforts underway in some locations to address 
the evacuation needs of the transportation disadvantaged. In three 
locations, local governments and regional organizations have conducted 
or were conducting studies to identify the number and location of 
transportation-disadvantaged populations in their jurisdiction. This 
information has been or was to be used to facilitate evacuation 
planning on resource use and deployment during disasters. Also, in 
three locations, emergency management officials were using preexisting 
citizen networks and community outreach activities to help inform and 
prepare transportation-disadvantaged populations for disasters. For 
example, in one city, emergency management officials used an existing 
neighborhood watch network to facilitate community outreach to 
transportation-disadvantaged populations, better preparing them for a 
disaster. In another city, emergency management officials worked with 
home health organizations, doctors, and the Red Cross to inform 
transportation-disadvantaged populations about evacuation preparedness. 

In one location that had a well-developed program for evacuating the 
transportation disadvantaged, we observed that emergency management 
officials did the following: 

* Had emergency plans that clearly articulated methods of providing for 
and coordinating the evacuation of transportation-disadvantaged 
populations, including the roles and responsibilities of various 
agencies. This plan clearly articulated how local and state emergency 
management, school boards, and transit agencies would work together to 
evacuate transportation-disadvantaged populations. Emergency management 
officials stated that this level of coordination enabled them to 
successfully conduct several evacuations. 

* Encouraged citizens who have special medical needs to voluntarily 
register with their local emergency management agency. This registry 
placed individuals into categories, including those who would need 
special transport, such as an ambulance. According to emergency 
management officials, in several recent evacuations, the voluntary 
registry assisted emergency personnel in efficiently evacuating 
transportation-disadvantaged populations. However, the same emergency 
management officials also pointed out challenges that exist for 
voluntary registries including the administrative costs of keeping the 
information up to date, the limited number of participants, and a surge 
in the number registrations immediately prior to an approaching storm. 

* Involved social service providers in the emergency response planning 
process. Social service providers' transportation resources were used 
to evacuate many of the clients on a voluntary registry administered by 
the city. These social service providers have expertise and ongoing 
contact with the transportation-disadvantaged populations, and are 
familiar with their day-to-day and nonemergency needs. 

* Established formal agreements that alleviate legal liability and 
reimbursement concerns when securing transportation resources to assist 
in evacuating transportation-disadvantaged populations during any type 
of disaster. 

* Conducted regular exercises of emergency response plans in order to 
test coordination between agencies involved in evacuations and their 
resources, and the integration of social service providers. 

In addition to these efforts by state and local governments, recent 
reports released by the federal government have put forth 
recommendations that address evacuation preparedness and response 
generally and for transportation-disadvantaged populations in 
particular. The White House report[Footnote 14] recommends that DOT be 
the primary federal agency responsible for developing the federal 
government's capability to conduct mass evacuations and that DHS 
require that state and local governments to conduct evacuation planning 
and exercises as a condition for receiving Homeland Security grants. 
The Senate report[Footnote 15] recommends that DOT should, in 
coordination with DHS and the states, plan, train and exercise for 
evacuations, including provisions for those populations that do not 
have the means to evacuate. 

Concluding Observations: 

Hospital and nursing home administrators generally face multiple 
challenges in weighing the risks of sheltering in place or evacuating. 
Although evacuation is a last resort, Hurricanes Charley and Katrina 
resulted in both hospitals and nursing homes having to evacuate. When 
evacuating, administrators faced problems specifically related to 
transportation, including securing vehicles. Hurricane Katrina, the 
first emergency in which NDMS was used to evacuate a large number of 
people, brought to light that NDMS was not set up nor is currently 
configured to provide assistance to nursing homes. As a result, it does 
not have agreements with nursing homes to accept evacuated patients. In 
addition, states and localities face multiple challenges in ensuring 
that transportation-disadvantaged populations who are not in such 
facilities are evacuated. We will be monitoring federal efforts to 
improve preparing for and carrying out evacuations of these 
populations. Our ongoing work will continue to examine the 
vulnerabilities posed by disasters for hospital patients, nursing home 
residents, and transportation-disadvantaged populations living in their 
communities. 

Mr. Chairman, this concludes my prepared remarks. I would be happy to 
respond to any questions you or other members of the committee have at 
this time. 

Contacts and Acknowledgments: 

For further information regarding this statement, please contact 
Cynthia Bascetta at (202) 512-7101 or at bascettac@gao.gov regarding 
issues related to the evacuation of hospitals and nursing homes. For 
issues related to the evacuation of transportation-disadvantaged 
populations, please contact Katherine Siggerud at (202) 512-2834 or 
siggerudk@gao.gov. Contact points for our Offices of Congressional 
Relations and Public Affairs may be found on the last page of this 
statement. Key contributors to this statement were Steve Cohen, 
Assistant Director; Linda T. Kohn, Assistant Director; La Sherri Bush; 
Krister Friday; Christopher Lyons; Nkeruka Okonmah; Laina Poon; Tina 
Won Sherman; and William Simerl. 

[End of section] 

Related GAO Products: 

Hurricane Katrina: Status of the Health Care System in New Orleans and 
Difficult Decisions Related to Efforts to Rebuild It Approximately 6 
Months After Hurricane Katrina. GAO-06-576R. Washington, D.C.: March 
28, 2006. 

Hurricane Katrina: GAO's Preliminary Observations Regarding 
Preparedness, Response, and Recovery. GAO-06-442T. Washington, D.C.: 
March 8, 2006. 

Disaster Preparedness: Preliminary Observations on the Evacuation of 
Hospitals and Nursing Homes Due to Hurricanes. GAO-06-443R. Washington, 
D.C.: February 16, 2006. 

Transportation Services: Better Dissemination and Oversight of DOT's 
Guidance Could Lead to Improved Access for Limited English-Proficient 
Populations. GAO-06-52. Washington, D.C.: November 2, 2005. (This 
report is also available in Spanish, Chinese, Vietnamese, and Korean.) 

Transportation-Disadvantaged Seniors: Efforts to Enhance Senior 
Mobility Could Benefit from Additional Guidance and Information. GAO- 
04-971. Washington, D.C.: August 30, 2004. 

Transportation-Disadvantaged Populations: Federal Agencies Are Taking 
Steps to Assist States and Local Agencies in Coordinating 
Transportation Services. GAO-04-420R. Washington, D.C.: February 24, 
2004. 

HHS Bioterrorism Preparedness Programs: States Reported Progress but 
Fell Short of Program Goals for 2002. GAO-04-360R. Washington, D.C.: 
February 10, 2004. 

Transportation-Disadvantaged Populations: Some Coordination Efforts 
Among Programs Providing Transportation Services, but Obstacles 
Persist. GAO-03-697. Washington, D.C.: June 30, 2003. 

Transportation-Disadvantaged Populations: Many Federal Programs Fund 
Transportation Services, but Obstacles to Coordination Persist. GAO-03- 
698T. Washington, D.C.: May 1, 2003. 

FOOTNOTES 

[1] See U.S. House of Representatives, A Failure of Initiative: Final 
Report of the Select Bipartisan Committee to Investigate the 
Preparation for and Response to Hurricane Katrina (Feb. 15, 2006). See 
also Committee on Homeland Security and Governmental Affairs, U.S. 
Senate, Hurricane Katrina: A Nation Still Unprepared (May 2006). 

[2] GAO, Disaster Preparedness: Preliminary Observations on the 
Evacuation of Hospitals and Nursing Homes Due to Hurricanes, GAO-06-
443R (Washington, D.C.: Feb. 16, 2006). See related GAO products later 
in this statement. 

[3] 31 U.S.C.  717(b)(1) (2000). 

[4] Hurricane Charley struck the Gulf Coast of Florida on August 13, 
2004, and continued across the state to exit on the Atlantic Coast on 
August 14, 2004. 

[5] The National Response Plan describes how the federal government 
assists in managing incidents of national significance. 

[6] We anticipate completing our work and issuing reports on the 
evacuation of hospitals and nursing homes and on the evacuation of 
transportation-disadvantaged populations later this year. 

[7] For example, officials in two counties in Florida told us they can 
recommend that hospitals and nursing homes evacuate their facilities, 
but the final decision is made by each facility's administrator. 

[8] The two counties contract with a national ambulance company, which 
is able to obtain vehicles from its fleet located in other states. 

[9] A presidentially declared major disaster or emergency can be 
declared under the Robert T. Stafford Disaster Relief and Emergency 
Assistance Act, 42 U.S.C.  5121-5206, which establishes the programs 
and processes by which the federal government supplements state and 
local resources in major disasters and emergencies. 

[10] NDMS consists of three functions. One is medical response, which 
includes medical equipment and supplies, patient triage, and other 
primary and emergency health care services provided to disaster victims 
at a disaster site. Another is patient evacuation, which includes 
communication and transportation to evacuate patients from a 
mobilization center near the disaster site, such as an airport, to 
reception areas in other locations. The third is "definitive care," 
which is additional medical care--beyond emergency care--that begins 
once disaster victims are placed into an NDMS inpatient treatment 
facility (typically a nonfederal hospital that has an agreement with 
NDMS). NDMS functions are included in the Public Health and Medical 
Services Annex of the National Response Plan. 

[11] This figure represents the approximate number of people moved 
during Hurricane Katrina and Hurricane Rita, which struck the Gulf 
Coast several weeks after Hurricane Katrina. 

[12] See National Disaster Medical System, National Disaster Medical 
System (NDMS) After Action Review (AAR) Report on Patient Movement and 
Definitive Care Operations in Support of Hurricanes Katrina and Rita 
(Jan. 12, 2006). 

[13] The National Plan Review is a DHS review of the emergency plans, 
including catastrophic planning and mass evacuation planning, of the 50 
states and 75 largest urban areas. 

[14] Assistant to the President for Homeland Security and 
Counterterrorism, The Federal Response to Hurricane Katrina: Lessons 
Learned (February 2006). 

[15] Committee on Homeland Security and Governmental Affairs, U.S. 
Senate, Hurricane Katrina: A Nation Still Unprepared (May 2006). 

GAO's Mission: 

The Government Accountability Office, the audit, evaluation and 
investigative arm of Congress, exists to support Congress in meeting 
its constitutional responsibilities and to help improve the performance 
and accountability of the federal government for the American people. 
GAO examines the use of public funds; evaluates federal programs and 
policies; and provides analyses, recommendations, and other assistance 
to help Congress make informed oversight, policy, and funding 
decisions. GAO's commitment to good government is reflected in its core 
values of accountability, integrity, and reliability. 

Obtaining Copies of GAO Reports and Testimony: 

The fastest and easiest way to obtain copies of GAO documents at no 
cost is through GAO's Web site (www.gao.gov). Each weekday, GAO posts 
newly released reports, testimony, and correspondence on its Web site. 
To have GAO e-mail you a list of newly posted products every afternoon, 
go to www.gao.gov and select "Subscribe to Updates." 

Order by Mail or Phone: 

The first copy of each printed report is free. Additional copies are $2 
each. A check or money order should be made out to the Superintendent 
of Documents. GAO also accepts VISA and Mastercard. Orders for 100 or 
more copies mailed to a single address are discounted 25 percent. 
Orders should be sent to: 

U.S. Government Accountability Office 441 G Street NW, Room LM 
Washington, D.C. 20548: 

To order by Phone: Voice: (202) 512-6000 TDD: (202) 512-2537 Fax: (202) 
512-6061: 

To Report Fraud, Waste, and Abuse in Federal Programs: 

Contact: 

Web site: www.gao.gov/fraudnet/fraudnet.htm E-mail: fraudnet@gao.gov 
Automated answering system: (800) 424-5454 or (202) 512-7470: 

Congressional Relations: 

Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400 U.S. 
Government Accountability Office, 441 G Street NW, Room 7125 
Washington, D.C. 20548: 

Public Affairs: 

Paul Anderson, Managing Director, AndersonP1@gao.gov (202) 512-4800 
U.S. Government Accountability Office, 441 G Street NW, Room 7149 
Washington, D.C. 20548: