Morbidity and Mortality Weekly Report Weekly / Vol. 69 / No. 36 September 11, 2020 Hurricane Evacuation Laws in Eight Southern U.S. Coastal States — December 2018 Judy Kruger, PhD1; Michael J. Smith, MS2; Brenda Chen, MS1; Brandon Paetznick1; Belen Moran Bradley3; Rosa Abraha, MPH2; Marinda Logan, MPH4; Erich R. Chang, JD5; Gregory Sunshine, JD5; Sandra Romero-Steiner, PhD6 National Preparedness month is observed every September and communication to populations at risk. Implementation as a public service reminder of the importance of personal of state evacuation laws and policies that support hurricane and community preparedness for all events; it coincides with evacuation management can help affected persons avoid harm the peak of the hurricane season in the United States. Severe and enhance community resiliency (5). Newly emerging and storms and hurricanes can have long-lasting effects at all com- re-emerging infectious diseases, such as SARS-CoV-2, the virus munity levels. Persons who are prepared and well-informed that causes coronavirus disease 2019 (COVID-19), have and are often better able to protect themselves and others (1). will continue to additionally challenge hurricane evacuations. Major hurricanes can devastate low-lying coastal areas and cause injury and loss of life from storm surge, flooding, and high winds (2). State and local government entities play a INSIDE significant role in preparing communities for hurricanes and 1238 Frequent Mental Distress Among Adults, by by evacuating coastal communities before landfall to reduce Disability Status, Disability Type, and Selected loss of life from flooding, wind, and power outages (3). Laws Characteristics — United States, 2018 can further improve planning and outreach for catastrophic 1244 Prevalence of Underlying Medical Conditions events by ensuring explicit statutory authority over evacuations Among Selected Essential Critical Infrastructure of communities at risk (4). State evacuation laws vary widely Workers — Behavioral Risk Factor Surveillance and might not adequately address information and communi- System, 31 States, 2017–2018 cation flows to reach populations living in disaster-prone areas 1250 Delay or Avoidance of Medical Care Because of who are at risk. To understand the range of evacuation laws COVID-19–Related Concerns — United States, in coastal communities that historically have been affected by June 2020 hurricanes, a systematic policy scan of the existing laws sup- 1258 Community and Close Contact Exposures porting hurricane evacuation in eight southern coastal states Associated with COVID-19 Among Symptomatic (Alabama, Florida, Georgia, Louisiana, Mississippi, North Adults ≥18 Years in 11 Outpatient Health Care Carolina, South Carolina, and Texas) was conducted. After Facilities — United States, July 2020 conducting a thematic analysis, this report found that all eight 1265 Infants with Congenital Disorders Identified Through states have laws to execute evacuation orders, traffic control Newborn Screening — United States, 2015–2017 (egress/ingress), and evacuation to shelters. However, only four 1269 Newborn Screening Practices and Alpha- of the states have laws related to community outreach, delivery Thalassemia Detection — United States, 2016 of public education programs, and public notice requirements. 1273 QuickStats The findings in this report suggest a need for authorities in hurricane-prone states to review how to execute evacuation Continuing Education examination available at policies, particularly with respect to community outreach https://www.cdc.gov/mmwr/mmwr_continuingEducation.html U.S. Department of Health and Human Services Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report Consistent with the principles of legal epidemiology,* public outreach, 2) populations at risk (e.g., inform limited- evacuation laws enacted as of December 31, 2018, in southern English language or diverse populations), and 3) evacuation coastal states were collected and systematically examined. State to shelters. Under the populations at risk domain, none of the laws related to large-scale evacuation were identified using the states required alternative language use to inform those with search string SD((evacuat! Egress ((leave vacat!) /s area))) in limited English proficiency during hurricane evacuation orders. Thomson Reuters Westlaw (Eagan, Minnesota), a subscription- Only one state (Florida) authorized creation of a registry for based legal research service. Statutes and regulations were persons with access and functional needs for the purposes of analyzed using an abstraction instrument with guidance from evacuation and sheltering. Laws in only three of the examined legal professionals. Each law was reviewed by two independent states (Florida, Louisiana, and Texas) included requirements to reviewers. Discrepancies were resolved in consultation with inform persons with disabilities or access and functional needs CDC’s Public Health Law Program. in general emergency evacuation plans. The search identified 2,150 laws; 91 of those laws (including Laws in all eight southern coastal states granted government 72 statutes and 19 regulations) specifically addressed evacu- officials authority to order large-scale evacuation in the event of ation procedures. Domain and thematic analyses of existing a natural disaster (Figure). States differ on who has the author- laws were conducted. Seven relevant domains were identified ity to issue the evacuations orders. In Texas, for example, local (evacuation decision-making, communications, populations jurisdictions are responsible for issuing evacuation orders, but at risk, responder protection, plan agreements, transportation, only the governor has this authority in Florida, Georgia, and and shelter) that encompassed 24 related themes informed by a South Carolina. literature review. Abstracted laws were collapsed into 17 relevant Discussion themes for analysis and comparison between states (Table). All eight states have laws in place regarding evacuation Hurricane evacuations in coastal areas can prevent illness, decision-making, responder protection, and agreements that injury, disability, and premature death by directing the move- include memoranda of understanding and plans for trans- ment of persons at risk out of harm’s way. Evacuation decision- portation and evacuation to shelters. Gaps were identified making has evolved in the United States to address changing in three domains: 1) communications to alert the public and political and social environments to protect communities from anticipated hazards (3). Laws can further enable governments * https://www.cdc.gov/phlp/publications/topic/resources/legalepimodel/index.html. to improve planning for outreach and response to catastrophic The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30329-4027. Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2020;69:[inclusive page numbers]. Centers for Disease Control and Prevention Robert R. Redfield, MD, Director Anne Schuchat, MD, Principal Deputy Director Chesley L. Richards, MD, MPH, Deputy Director for Public Health Science and Surveillance Rebecca Bunnell, PhD, MEd, Director, Office of Science Arlene Greenspan, PhD, Acting Director, Office of Science Quality, Office of Science Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services MMWR Editorial and Production Staff (Weekly) Charlotte K. Kent, PhD, MPH, Editor in Chief Martha F. Boyd, Lead Visual Information Specialist Jacqueline Gindler, MD, Editor Alexander J. Gottardy, Maureen A. Leahy, Paul Z. Siegel, MD, MPH, Guest Associate Editor Julia C. Martinroe, Stephen R. Spriggs, Tong Yang, Mary Dott, MD, MPH, Online Editor Visual Information Specialists Terisa F. Rutledge, Managing Editor Quang M. Doan, MBA, Phyllis H. King, Douglas W. Weatherwax, Lead Technical Writer-Editor Terraye M. Starr, Moua Yang, Glenn Damon, Soumya Dunworth, PhD, Information Technology Specialists Teresa M. Hood, MS, Donald G. Meadows, MA Technical Writer-Editors MMWR Editorial Board Timothy F. Jones, MD, Chairman Michelle E. Bonds, MBA Katherine Lyon Daniel, PhD Patricia Quinlisk, MD, MPH Matthew L. Boulton, MD, MPH Jonathan E. Fielding, MD, MPH, MBA Patrick L. Remington, MD, MPH Carolyn Brooks, ScD, MA David W. Fleming, MD Carlos Roig, MS, MA Jay C. Butler, MD William E. Halperin, MD, DrPH, MPH William Schaffner, MD Virginia A. Caine, MD Jewel Mullen, MD, MPH, MPA Morgan Bobb Swanson, BS Jeff Niederdeppe, PhD 1234 MMWR / September 11, 2020 / Vol. 69 / No. 36 US Department of Health and Human Services/Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report TABLE. Coverage of state evacuation laws or policies — eight southern U.S. coastal states, December 31, 2018 North South Domain Themes* Alabama Florida Georgia Louisiana Mississippi Carolina Carolina Texas Evacuation Law requires an emergency operation and Y Y Y Y Y Y Y Y decision-making evacuation plan Law specifies who may order an evacuation Y Y Y Y Y Y Y Y Law specifies a trigger for ordering an Y Y Y Y Y Y Y Y evacuation Law requires or recommends a plan to have Y Y Y Y Y Y Y N provisions for mandatory or voluntary evacuation Communications to Law requires or recommends jurisdiction to N Y