Neonatologists and other providers within neonatal intensive care units are critical for the creation of emergency preparedness plans, including the development of appropriate staffing to ensure safe and effective care during a disaster, according to joint recommendations from the AAP Disaster Preparedness Advisory Council and the Committee on Fetus and Newborn.
“NICU patients are particularly vulnerable [in disaster situations], not only because of their small size and physiologic immaturity, but also because of their baseline dependence on technology for warmth, nutritional supplementation, medication administration cardiorespiratory monitoring, diagnostic information gathering and life-sustaining physiologic support,” Wanda D. Barfield, MD, MPH, FAAP, RADM USPHS, from the CDC, and colleagues wrote.
The review, which suggests how mass pediatric, critical care strategies can be applied to NICUs in disaster scenarios, analyzed the use of regionalized perinatal systems; disaster-based drills; and training, equipment, medication and personal needs. The researchers included previously published information on care during natural disasters, infectious epidemics and bioterrorism.
Researchers assessed NICU responses to two different natural disasters: Hurricane Katrina and Superstorm Sandy. They noted that infants who received care in these units survived, but those who were treated in New York during Superstorm Sandy had an easier time with placement in other facilities because of advanced planning. The researchers highlighted that the negative impacts of emergency unpreparedness during Hurricane Katrina exemplify the need for maintenance plans, local and regional care coordination and communication, interfacility patient transport and established evacuation procedures.
The researchers also noted infectious disease epidemics disproportionally affect neonates and pregnant women, citing the H1N1 influenza pandemic in 2009, concerns with Zika and the survival rate of children with Ebola. They urged for strict adherence to infection control policies to prevent the further spread of these diseases. Additionally, Barfield and colleagues noted the specific risks that certain biological and chemical agents, such as anthrax, would create for a neonate, as symptoms and presentations may differ in each child.
As fewer than half of U.S. hospitals with an ED had a pediatric disaster plan, Barfield and colleagues offered resources to help prepare both the facilities and clinicians, including The Emergency Medical Services for Children Innovation and Improvement Center; The California Hospital Association’s Hospital Preparedness Program, The Pediatric Preparedness Resource Kit of the AAP, and The New York City Pediatric Disaster Coalition’s customizable Neonatal Critical Care Surge Capacity Plan.
The researchers also cited hospitals where they have made templates for staffing, bedside backpacks, mobile disaster boxes, pre-made forms for patient care, resources for testing equipment, rotating inventory and staff training for response protocols.
The researchers provided the following suggestions for NICUs to optimize their disaster responses:
- Know and prepare for the most likely disaster scenarios in specific communities, such as hurricane, earthquakes or floods, and consider unanticipated events (eg, bioterrorism) that could lead to a mass casualty event and impact surge capacity and capabilities;
- Participate in the ED and disaster-planning activities of facilities, health care systems or regional, state and local emergency management agencies;
- Develop staffing support for safe and effective operations during disasters;
- Maintain situational awareness for decision-making, including patient volume and illness severity, and available equipment, medication and staffing, and crisis standards of care;
- Continue to research best practices, neonatal medications and dosing, and the effects of altered standards of care in disaster situations; and
- Consider the medical and psychosocial needs of postpartum mothers and families, as parents and families should keep in contact with patients if feasible. — by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.