Before the Storm: EMS, Hospitals Prepare for Hurricane Season
As June 1 launches hurricane season, hospitals in areas historically affected are planning for worse-case scenarios.
Steve McCoy, Florida Department of Health Division of Emergency Preparedness and Community Support director, noted there is no single answer to how far in advance hospital emergency rooms should begin coordinating with EMS when a hurricane is forecast as each storm presents unique circumstances.
Coordinating Before the Storm
While emergency rooms and EMS coordinate in routine operations, the critical distinction with hurricanes is that evacuation decisions rest with hospital C-Suite leadership, McCoy said.
Every hospital must maintain a Certified Emergency Management Plan (CEMP) approved by the local emergency management director and submitted to the Agency for Health Care Administration (AHCA). Hospitals should consult with local emergency management when circumstances fall outside the plan’s scope, said McCoy.
“Hospitals and EMS communicate continuously before, during, and after a storm to ensure safe patient movement,” he said. “Effective disaster response functions as a regional, coordinated system—not independent agencies operating in isolation. Local healthcare coalitions, associations, EMS, and other hospital partners engage in joint planning efforts and exercises to address locally specific challenges and prepare for worst case scenarios. These partnerships must be cultivated and sustained during routine operations to perform effectively under the pressure of a major disaster.”
Whether the issue is patient placement, transport timing, or crew deployment, the priority is always the protection of medically fragile individuals and the EMS personnel caring for them, McCoy said.
The long-term care setting accounts for 80% of evacuations and facility decompression, McCoy said, adding coordinating the movement of medically fragile individuals is a core function of the Federal Emergency Management Agency (FEMA) emergency support function #8 (ESF-8) patient movement unit.
“Hospitals and long-term care facilities identify and prioritize these individuals in the pre-storm phase, coordinating specialty transport resources—including ventilator-capable, neonatal, and bariatric units—to initiate movement before conditions deteriorate,” he said.
Navigating Capacity Limitations
Prior to a hurricane’s landfall, hospitals need to know the full capabilities of their local EMS agencies and contracted companies listed in their approved CEMP, McCoy said.
“This includes the total number of ALS and BLS vehicles available for evacuations as well as the availability of specialty care vehicles such as bariatric or neonatal-capable units with trained crews,” he added. “In practice, however, the more pressing need flows in the other direction: EMS requires accurate patient information from hospitals, including patient counts by acuity level, ambulatory versus nonambulatory status, and specialty care requirements for patients on ventilators, supplemental oxygen, or intravenous pumps.”
Before a storm, ambulance availability is initially tracked at the local level with state-level coordination activated when local systems become overwhelmed, McCoy said. Hospital bed availability follows a similar progression.
At the state level, patient movement resources are tracked and communicated through ESF-8 at the State Emergency Operations Center (SEOC). Hospital bed availability is managed and reported through the Healthcare Facility Reporting System (HFRS), administered by AHCA. Hospital capacity changes are communicated to ESF-8 through Pulsara live-status updates, direct telephone contact, and situational reports submitted to the SEOC.
McCoy noted when a governor issues an executive order, the state emergency response team is activated, triggering formal coordination among hospitals, local emergency management, and the SEOC.
“At the state patient movement level, this information is also captured through the agency for HFRS,” McCoy said. “When local EMS providers are overwhelmed, they request assistance through their local Emergency Operations Center. County requests are escalated to the state level.”
Although Pulsara provides real-time information, direct confirmation with hospitals remains standard practice before patient transport, McCoy said, adding if a facility reports it is at or over capacity, ESF-8 immediately redirects patient movement to pre-identified hospitals based on distance, clinical capability, and available beds.
Hospitals submit formal evacuation requests through their local emergency management to the SEOC online. ESF-8 deploys strike teams or specialized transport units to move individuals to safe, pre-identified receiving facilities. Special needs shelters managed by county emergency management and health departments provide essential care for medically fragile individuals. Some counties incorporate dedicated transportation resources for those unable to self-evacuate.
“If nearby facilities cannot accept patients due to storm impacts or capacity constraints, ESF-8 identifies hospitals farther from the affected area and coordinates longer-distance ground or air transport when medically necessary,” McCoy said. “Before and after storm impact, EMS conducts welfare checks on this population as resources permit.”
Making Transport Decisions
During active storm operations, street-level paramedics receive operational direction from their strike team leaders, who communicate information received through their chain of command. This includes patient counts by acuity level, ambulatory versus nonambulatory status, and specialty care needs such as ventilator dependency, supplemental oxygen requirements, and intravenous therapy needs.
“The most important information revolves around the safety of the crew and patients,” McCoy said.
Transport decisions when the nearest appropriate facility isn’t available depends on whether the call involves an emergency 9-1-1 response or a planned nonemergent patient movement. ESF-8 assigns the patient to the next closest hospital with confirmed capacity, based on distance, clinical capability, bed availability, and storm-safe access route.
“For emergency responses, the nearest available facility may require a longer transport or, in extreme situations, diversion to an alternate treatment site,” McCoy said. “For nonemergent patients being moved out of an evacuation area, decisions are supported by local and state EOC guidance and communicated to transport crews in real time.”
Pulsara can assist in identifying available beds, but final placement decisions are confirmed through direct communication with the receiving hospital, underscoring why hospital census decompression prior to landfall is a critical preparedness priority, McCoy said. When hospitals are overwhelmed, ESF-8 immediately activates alternate receiving facilities outside the impacted region.
“If nearby hospitals are at capacity, the search is expanded. Placements are coordinated with facilities farther from the storm zone, even when this results in longer transport times,” McCoy said. “Early evacuation and patient movement planning are critical to avoid this scenario. If a patient requires temporary reassessment while a destination is being confirmed, that individual may be directed to an appropriate sheltering location with medical support; however, this is not intended as a long-term strategy.”
For critical patients, air transport resources may be activated—weather and aircraft safety permitting—to facilitate movement to higher-level facilities with available capacity, McCoy said.
EMS units are required to notify the receiving hospital of a pending patient arrival prior to transport, McCoy said.
“If a hospital is on diversion or has transitioned to evacuation or shelter-in-place status, that status is communicated to the county emergency operations center and shared with EMS to prevent patients from being directed to an unavailable facility,” he added. “When a hospital becomes unavailable mid-transport, ESF-8 redirects incoming units to alternate receiving facilities. A continuously updated list of backup hospitals outside the impact zone is maintained, and the patient movement unit communicates changes to strike teams in real time.”
Factors evaluated in rerouting decisions include additional transport distance, fuel availability, the time phasing of approaching winds, and hours a given crew has already worked. Both EMS agencies and hospitals incorporate a designated sustained wind speed threshold into their operational plans, at which point all field operations are required to cease, McCoy said.
Establishing Safe Operations
ESF-8 establishes a specific cutoff time for EMS movement based on storm speed, projected landfall timing, and estimated transport durations. The Florida Division of Emergency Management’s meteorology unit provides wind speed data to the SEOC, which is then evaluated from a responder safety perspective to determine and communicate field operations shutdown timelines to deployed personnel.
Once winds reach unsafe thresholds, EMS units are removed from the field and sheltered in predetermined locations. Hospitals are informed of these cutoff times in advance and plan patient movement requests accordingly. No transports are authorized once conditions exceed established safety limits, McCoy said.
“This is precisely why completing patient movements during the pre-landfall phase is operationally critical,” he added.
Communication systems are driven at the local level through each jurisdiction’s approved communications plan, McCoy noted. “EMS providers are required to operate approved radio systems, including UHF MED channels using narrowband technology (12.5 kHz), which reduces congestion and maintains interoperability across agencies,” he said. “The Department of Emergency Management Services serves as the state frequency coordinator and approves all EMS telecommunications systems. Patient tracking during disaster operations is conducted through Pulsara.”
ESF-8 deploys units capable of reaching isolated areas.
“Response in these communities relies on staged resources, alternate transport methods, and close coordination with local emergency management for access and logistical support,” McCoy said. “If roads are blocked or conditions are unsafe, movement is delayed until field operations can resume safely. Coordination with local emergency management ensures medically fragile individuals in isolated communities are prioritized once access is restored.”
Hospitals, as part of their CEMP, are required to maintain essential operations.
“As landfall approaches, hospital staff may be required to remain on site until wind speeds subside, with operations encompassing rest, shelter, and medical care for both patients and staff,” McCoy said.
At the state level, base camps are established outside the impact area prior to storm landfall to provide EMS crews with rest, food, medical support, and shelter. Sheltering protocols for EMS crews are typically addressed within each hospital’s CEMP and is coordinated through ESF-8.
“Hospitals are notified in advance when crews may need to remain in place. These protocols are designed to protect EMS personnel without disrupting core hospital operations,” McCoy said.
Once operations can safely resume, resource deployment is re-evaluated based on incoming requests and identified areas of need, said McCoy, adding staffing levels are planned to ensure adequate rest rotation and prevent fatigue-related incidents.
Support for EMS personnel during prolonged disaster operations is coordinated through multiple mechanisms.
Scheduled crew rotations and relief staffing are managed through EMS and ESF-8 command structures. Safety officers operating under the Incident Command System evaluate and mitigate field-level risks, including identifying the closest trauma centers, burn centers, and facilities with helicopter landing capability for injured responders.
“ESF-8 ensures that personnel have access to medical care, rest areas, behavioral health support, and temporary lodging for those who are displaced,” said McCoy.
