Disaster Series: The Abrupt NICU Evacuation – Disasters without a Plan

Abstract

An abrupt disaster brings the environment physically into the NICU. We describe immediate evacuation measures taken because of a ruptured water pipe, hospital fire, unexploded WWII bomb, and two earthquakes. These abrupt changes thrust the Neonatologist into an environment with new structures, rules, and threats. The intruding environment dictates actions at first as the Neonatologist addresses safety for the neonates and staff while continuing medical care for the infants. The environment has just become the pathology, a new comorbidity. Operations during abrupt change mean the Neonatologist must hand off direct minute-to-minute care for the neonates, trust staff, then begin the more demanding work of figuring out next and future steps. Personal stress and fear responses must be modulated while supporting staff during the uncertainty. While these events at first appear disparate, they share the common problem of rapid movement of neonates to safety, ensuring the safety of infants and staff while solving problems embedded in a threatening environment. Faced with an abrupt environmental threat, we must maintain awareness that disaster and medical professionals will not appreciate the unique responses of the neonate to the raw environment. We must accept and rely on our colleagues' strength, fortitude, and creativity in the NICU to resolve problems embedded in the environment.

Disaster Series: Prolonged Improvisation during Hurricanes – High Reliability Organizing in the NICU

“…The physician in charge then called the New Orleans NICU to assist (17). This, again, is similar to the Northridge earthquake when the Neonatologist called a friend at an outlying NICU who called the US Marine Corps who sent two helicopters (52,58).…”

“…An approaching hurricane means the Neonatologist must simultaneously prepare to evacuate the NICU and shelter in response to a wildland fire (43). Prophylactic evacuation of the NICU is not rapid -it is labor and resource-intensive and takes part of a day (52). To shelter in place, the NICU could bring in extra staff and increase stockpiled supplies except for roads rendered dangerously impassable from flooding.…”

“…After evacuating, the Neonatologists began contacting NICUs out of the region. Complicating these contacts were competing for requests from other NICUs, a problem identified and discussed after the Northridge Earthquake in 1994 (44,52), and failure of phone lines (15) necessitating some physicians to use personal cell phones (44). For others, help outside the NICU facilitated the process, such as Hospital Incident Command Systems, other NICUs hearing of the problem, and the initiative of regional hospitals to step in (14,17,41,44).…”

“…Helicopters are more tightly integrated into the disaster infrastructure than NICUs (54). Government agencies may have other missions for helicopters or lack awareness of the NICU situation or needs (17,52,58,59). Helicopters-of-opportunity may become available for NICU evacuation (15,16,18), in which case knowledge of air operations by the neonatal team can increase their practical use.…”