PC3040: Lessons Learned from an OB/ Newborn/neonatal Intensive Care Full-scale Exercise

Background: Children are frequently victims of disasters. However, gaps remain in disaster planning for pediatric patients. The New York City Pediatric Disaster Coalition (NYC PDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty incidents that involve large numbers of pediatric victims. The PDC is comprised of experts in emergency preparedness, pediatric critical care, surgery, and emergency medicine, as well as representatives from local emergency management, first responder, and public health agencies.

Methods: The NYC PDC conducted a first in NYC full-scale exercise with the New York Fire Department (FDNY) testing evacuation, patient tracking, communications, and emergency response of the Obstetrics, Newborn and Neonatal units at a NYC Hospital. The goal of the exercise was to evaluate current Ob/Newborn/Neonatal plans and assess the hospital’s ability to evacuate patients during an emergency situation. The exercise also provided an opportunity to identify best practices and common issues for NYC PDC to assist other hospitals with Ob/Newborn/Neonatal disaster planning. The exercise planning process included a review of existing hospital Ob/Newborn/Neonatal plans, four interdisciplinary planning meetings, and additional targeted area meetings and plan revisions. The exercise incorporated scenario-driven, operations-based activities, which challenged participants to employ the facility's existing evacuation plans during an emergency. The Exercise assessed the following: Communication, Emergency Operation Plans, Evacuation, Patient Tracking, Supplies and Staffing. Evaluators completed an exercise evaluation guide based on the Master Scenario Event List.

Results: An After-Action Report was written based on the information from the exercise evaluation guides, participant feedback forms, hot-wash session, and after-action review meeting. Strengths included the meaningful improvement of hospital and fire department plans before the exercise, and the overall meeting of exercise objectives.

Conclusion: Conducting the Full Scale Exercise yielded significant lessons learned including: addressing gaps in effective internal communications by eliminating dead zones and improving external communication with the fire department; providing training and adequate staff and specialized equipment for vertical evacuation and providing staging and alternate care sites with electrical-power resources and patient care equipment. This can serve as a model for exercising Ob/Newborn/Neonatal units.