Several days after Category 5 Hurricane Irma blew through the Caribbean and Florida in September 2017, more than a half-dozen seniors died in a steamy hot Florida nursing home when the air conditioning failed due to lack of power. As rescue crews evacuated the surviving residents to a hospital across the street, people began questioning whether sheltering in place during a disaster is wise. The answer is complicated. For some, staying put makes a lot of sense. For others, however, it can have catastrophic consequences.
Such was the case in the Hollywood, Florida nursing home. As Irma ripped through the state, millions were left without electricity. When the air conditioning system failed at the nursing facility, it became unbearably hot. For whatever reason, administrators didn't evacuate the 150 residents to the hospital just next door, despite temperatures outside reaching 90 degrees Fahrenheit (32 degrees Celsius). Eight people between the ages of 71 and 99 ultimately died. Authorities, who immediately launched a criminal investigation, believed the intense heat was a factor.
The tragedy underscored the perils of sheltering in place. Keeping the elderly safe during a disaster is especially tricky. However, because the elderly have a range of age-related disabilities and medical conditions, evacuation can be deadlier than the disaster itself. Studies have shown staying put might be the best option if communities and facilities are prepared.
Moving the Elderly
"Frail ... residents are adversely affected by hurricane disasters," concluded a 2012 study in the Journal of Post-Acute and Long-Term Care Medicine. "While there is significant increased morbidity and mortality related to exposure, there is added risk in evacuation. While it is important that facilities, public health and emergency management officials evacuate homes likely to flood during a hurricane, in light of the significant increase in mortality and morbidity associated with evacuation, the policy of universal evacuation of facilities requires careful reconsideration."
"Elderly do not do well when moved," Claire B. Rubin, a social scientist with nearly 40 years of experience in emergency management," says in an e-mail. "It stresses them, and those on life support machines have to be near a power source. Transporting nursing home patients usually results in some deaths."
Yet, Rubin adds, the decision to stay or go is a dicey one, especially when it comes to the elderly. "Unless the nursing facility is a safe structure, it does not make sense to shelter in place. [It's a] tough tradeoff between risks of staying and [the] risk of moving."
When You Can't Leave
Sheltering in place can be a damned-if-you-do, damned-if-you-don't decision. In general, according to the U.S. Department of Homeland Security, people should shelter in place "when conditions require that you seek immediate protection in your home, place of employment, school or other location when disaster strikes ... local officials are the best source of information when determining whether to evacuate or shelter in place."
Staying put can be a smart move, or in the case of one couple, a really dumb thing to do. The couple tried to ride out Irma, get this, on their sailboat off Jensen Beach north of Palm Beach. The inevitable happened. Sheriff's deputies had to rescue the pair before the storm struck with all its fury.
Despite such a poor decision, there are many sensible reasons why people choose to stay during major storms. For one, they might have no place to go. That generally occurs when emergencies pop up quickly. Tornados, for example, can roar through a neighborhood with little notice, forcing people to seek refuge in their homes, at work or at school. In other instances, people cannot afford to leave, or they might not have transportation out of town. And as was the case before Hurricane Irma, most major freeways were jammed with traffic and fuel was in short supply, and all flights out of Florida were booked, leaving people with few options.
A traffic nightmare scenario was part of the reason Texas didn't order Houston residents to evacuate before Hurricane Harvey hit in August. Officials there were afraid a mass evacuation would be worse than the storm itself. That's because in 2005, 60 of the 118 storm-related deaths from Hurricane Rita in Texas were people trapped during the evacuation. Harvey ended up dumping more than 50 inches of rain, ultimately flooding the entire city of Houston and displacing more than 32,000 people.
So, when officials do issue mandatory evacuations and people are too stubborn, or in the words of Rubin, "too stupid" to leave even though the threat is imminent and dangerous, what then? "Often people say 'I survived the last hurricane/flood/whatever and I will be fine this time if I shelter-in-place,'" Rubin says. "Usually, that is a mistake since characteristics of each threat [and] hazard is different."
Gender and age play a role in the decision to leave, too. "Men behave differently than women," Rubin says, "and older people are reluctant or unable to move quickly or dread relocation."
Rubin says communities need to prepare if residents shelter in place. Some communities plan for a "vertical evacuation." In other words, they shelter people in buildings that have been designated safe, like schools or in Irma's case, the Miami-Dade County Fair Expo Center. Public safety officers and other first responders also hunker down in these buildings. "It makes sense to create or designate safe structures," Rubin says. Still, there are emergencies when Rubin says sheltering in place should always be avoided, such as during a wildfire or dangerous chemical spill, unless authorities say otherwise.