In 2009, Public Health-Seattle & King County contracted Russell Phillips & Associates and embarked on a project to plan for the evacuation of the neonatal and pediatric patient hospital population due to an isolated, regional or catastrophic disaster. The planning included identification of the precise levels of care provided across multiple states and British Columbia, methods of transport for High Acuity Patients (ECMO, Oscillator, Vent) from a Level III NICU across to special Pediatric Intensive Care Patients, Med/Surg and Behavioral Health. Planning then evolved to make critical decisions on patient distribution strategies using a Health & Medical Area Command and escalated to the catastrophic planning elements of having a failure of multiple hospitals in the area. This focused on turning certain acute care hospitals with current pediatric capabilities into Pediatric Disaster Surge Hospitals. A review of equipment, staffing, transportation resources, suppliers/vendors and other special support entities was conducted with information being managed through the Healthcare Coalition and Public Health.

The Community Partners were brought together including air, EMS and regional transit to support planning efforts and provide a breaking point for regional transportation assets. Additionally, the hospitals all underwent a surge capacity review to take the institutions to breaking points assuming that there was no ability to leave the region due to the scope of the disaster. The surge capacity element assumed 100% occupancy and limiting or eliminating the use of Emergency Departments and PACU due to the need to keep those areas at full capacity in an extended emergency.