Every one of these is a valid concern and falls under the purview of the state because it requires hospitals, nursing homes and assisted living facilities to submit emergency plans detailing contracts for the transport of patients and where they will be sheltered.

The number of variables is too numerous to outline, and many rest on coordination of agencies and facilities not only in South Carolina but from Florida to North Carolina. Refugees during Hurricane Floyd remember the stalled traffic all across lower South Carolina, Georgia and Florida because the most massive evacuation in the nation's history was under way. Floridians, Georgians and South Carolinians were told to get out of harm's way, and the target area kept moving northeast along the coast.

No one wants to leave particularly early from a coastal tourist destination because it costs money to close resorts and other businesses and evacuate hospitals, nursing homes and assisted living facilities. Hospitals have the greatest choice because they can curtail elective surgery and discharge some patients, but nursing and assisted living homes don't move until the governor declares an emergency.But the biggest issue may be supplying enough transportation to evacuate the very sick and the elderly, who require more delicate treatment and bathroom facilities as they are being moved. While a storm is not a war, it creates refugees nonetheless, and the solution should be a massive humanitarian effort coordinated by the S.C. Department of Health and Environmental Control, which licenses the facilities and requires each to have an evacuation plan. The state has the resources, but utilizing them will require extreme coordination -- and time to implement the plan.