The current pandemic situation caused by SARS-CoV-2 has made hospital boards of directors have to change their management substantially to be able to adapt to the immense flow of patients received to the point that it has looked like practicing medicine in war times.

In this context, hospitals, and intensive care units (ICU) alike have had to keep taking care of all the other ordinary diseases and conditions by adapting the services offered to the new reality. Also, the standard risks associated with safety and the ER at the hospital setting have multiplied following the collapse experienced during most of the pandemic.

Hospitals and ICUs alike have sustained several incidents and catastrophes to the point of having to evacuate these facilities, totally or partially. This has led to the death of patients who could not be evacuated due to the difficulties involved in their transfer, especially critically ill patients whose complexity and vulnerability is much greater. This reality has become complicated during the COVID-19 pandemic because the extreme severity of the patients adds to the problem of biosafety for the healthcare personnel because the high transmissibility and transmission of the virus requires much more complex measures for evacuation purposes.1,2 As an example of this, we should mention that just when we were being hit by the worst part of the pandemic, several fires were declared in the ICUs of large hospitals, like the fires reported in Saint Petersburg, Russia (May 2020), and Romania (November 2020). A total of 5 and 10 patients, respectively, were killed in these fires, all of them with COVID-19. No one could be evacuated.

It is of paramount important to design a self-protection plan that should include an evacuation plan properly drafted and based on the current legislation. Also, this plan should be compiled in a physical document approved by the competent authorities, delivered to all the healthcare workers involved, and updated on an ongoing basis. Also, following this plan should be mandatory for all hospitals and ICUs, as a matter of fact, to this date, the design of such a plan is highly recommended by bodies like the World Health Organization (WHO).3

We have a self-protection program available in our ICU, and a classification or triage system to prioritize evacuations that is implemented by the treating physician of every patient on a daily basis.4 Therefore, we always take into consideration, on the one hand, the patient’s clinical situation and need for life support, and on the other hand, the therapeutic effort received by the patient and type of isolation he requires.

If an evacuation is mandatory in a situation of pandemic, the system of triage works by prioritizing the transfer of patients with more chances of survival, and less need for life support. It is of paramount importance to implement the system of triage in normal conditions of medical attention, and not in emergency situations for the evacuation to occur in an orderly fashion and without unexpected events. In our own opinion, this is a need per se inside a healthcare system that manages and monitors the quality of the healthcare it provides.