PC3039: A Method to Focus Disaster Planning for Neonatal & Obstetrical Units

Background: Hazard Vulnerability Assessment (HVA) is a systematic approach for analyzing the risk to an institution from various threats, determined by local factors (e.g., a recurring natural disasters and severe weather events) and institutional vulnerabilities. This process identifies disasters that are most likely to impact that hospital’s ability to function. Pregnant people and neonates are populations with unique health care needs which make them at risk for adverse health outcomes in the face of emerging threats and disasters. The HVA has not been applied previously to address the specific vulnerabilities of obstetrical and neonatal units, nor to identify and inform development of meaningful unit-level emergency preparedness and response plans.

Methods: We reviewed the HVA document from Stanford Hospital and Lucile Packard Children's Hospital focusing on situations most likely to impact our unit (e.g., seasonal wildfires and earthquakes). We initiated discussions with unit leadership and staff, systematically reviewing obstetric and neonatal unit-specific vulnerabilities. We outlined problems and solutions using a “Staff, Stuff, Space, and Systems” framework:
• Staff: How might staffing be impacted to impair function?
• Stuff: How might current supplies or the supply chain be affected?
• Space: How might the physical unit be affected to impair function?
• Systems: How might workflow and communication across the organization be affected?

Results: With initial plans developed according to identified hazards, we will leverage opportunities to test suggested solutions in tabletop exercises and simulations. Findings will inform event-specific policies and practices on obstetric and neonatal units. Additionally, we are looking into ways to add “Sustainability”, a “5th S”, to our preparedness plan. This involves adding disaster response to routine workflow so that it is not forgotten during the interval between a training exercise and an actual event (e.g., using off-unit patient movement as an evacuation exercise).

We also will use a “heat map” data visualization method to allow for identification of common problems and solutions. This can be used to prioritize vulnerabilities and responses that overlap across disasters both within and between units. For example, prioritization of red plugs would be needed for power outages from earthquakes, fires, floods, etc. Identifying these commonalities can result in more focused and cost-effective disaster planning.

Conclusion: The HVA is a useful and required component of hospital emergency preparedness which can be applied to identify unique vulnerabilities of obstetric and neonatal units to inform development of meaningful emergency preparedness and response plans at the unit level. This should be done by all obstetric and neonatal units.