NICU Evacuation: Disaster Planning Critical

Ricki Lewis, PhD

November 10, 2014

The evacuation of 21 critically ill infants down nine flights of stairs at New York University Langone Medical Center the night of Monday, October 29, 2012, is a lasting image of the effect of Hurricane Sandy. An article published online November 10 in Pediatrics reviews the challenges and "lessons learned" from the experience, providing strategies to prepare for the next natural disaster.

Because data on evacuating neonatal intensive care units (NICUs) are sparse, Michael Espiritu, MD, and other neonatologists and pediatricians from New York University reconstructed and evaluated exactly what transpired as Sandy struck. They had experienced a small taste of the possible scenario from Hurricane Irene, which had come through 14 months earlier.

As Sandy arrived, the East River surged shortly before the 7 PM shift change and the power blinked off. Physicians made arrangements for patients, using their cell phones, and staff grabbed whatever paper reports they could find. At first, authorities ordered the NICU to stay open. But by 8:30, when fuel from the basement could not reach backup generators on the roof, evacuation began.

By 9 PM, the "vertical evacuation" was underway, with each infant having a physician and a nurse, and some having a respiratory therapist. "Medsleds" and "evacvests" were deemed unsafe, so nurses carried the infants down the stairs as physicians used Ambu-bags to provide positive pressure breaths to some infants as needed. Students lit the stairwells with flashlights. The Federal Emergency Management Agency had coordinated a fleet of ambulances, but more than half of the infants who were prearranged to go to Maimonides Medical Center in Brooklyn had to change destination as roads and tunnels shut down.

Each vertical transport took 10 minutes, and within 6 hours, all 21 infants were evacuated. Two were on ventilators, four received nasal continuous positive airway pressure, and the rest were premature. Four of the infants had congenital heart disease (some postoperative), and one had just undergone a laparotomy for necrotizing enterocolitis.

All occupants of the New York University NICU survived Sandy. The staff members followed the patients with weekly telephone calls. In later weeks, one child died of heart-lung disease and another of sepsis.

Looking back, the primary challenges were finding beds, arranging transportation, and maintaining chain of command and communication. The authors also highlight "situational awareness," such as not wasting time contacting facilities that would obviously be unable to help because they, too, were in the direct path of destruction.

The authors also suggest using other agencies, such as the availability of ambulances from the Federal Emergency Management Agency. Although planning is critical, "on-the-spot thinking was crucial in determining how to safely transport our patients down 9 flights of stairs without transport isolettes or infant-sized evacuation equipment," the authors write.

The team has developed checklists and formalized NICU evacuation plans. A social worker has been assigned to serve as liaison between families and staff, should a Sandy-level disaster strike again, and evacuation equipment has been moved to an easily found site on the ground floor. An electronic medical record server is now located in New Jersey.

The authors conclude that "backups, clear command structure, communication and situational awareness, regional coordination, and flexibility are...critical elements in ensuring that continued care of critically ill neonates and, if needed, their evacuation can be carried out in an emergency."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 10, 2014. Abstract


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