In September 2005, the University of Texas Medical Branch at Galveston (UTMB) was threatened by Hurricane Rita, a category five storm. Abandoning its historic practice of clearing the hospital of all but the sickest patients, UTMB rapidly organized and conducted the first total evacuation in its 114-year history. The authors report how this was accomplished and lessons learned. Specific factors were crucial for success, including identifying an incident commander with sole authority to make decisions, developing and communicating a set of guiding principles, setting patient safety as our top priority, establishing an incident command center that consolidated vital institutional functions, avoiding delays in deciding to evacuate, identifying strategic partners, selecting essential personnel who would not be distracted by personal concerns during the emergency, and conducting periodic trial runs of emergency preparedness. Complex demands for communication were not met as well as was hoped. Technical problems were encountered with some communication devices that proved inoperable; trial runs would have probably revealed these problems in advance. Also, in-transit communication could be improved-not always knowing which patients were where, what vehicles were mired in stalled traffic, and what relocations occurred impeded optimal communication with patients' family members. Finally, a system ensuring that the recipients of UTMB's electronic records had the proper software to receive them would have facilitated communication and helped record keeping. The authors encourage physicians, as essential members of the health care team, to become better prepared to respond to disasters.

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