Disaster planning for obstetric units

Dr. Kay I. DanielsKay I. Daniels, MD, clinical professor of ob-gyn, Stanford University School of Medicine

Medical facilities are often at the center of disasters. The majority of hospital disaster protocols have been developed to address a mass casualty event that occurs outside of the hospital. In this commonly cited scenario, the hospital will receive a large influx of injured people in a short period of time.

What have not been fully developed are plans if the hospital itself is severely damaged, either from a natural disaster, such as an earthquake or a tornado, or a massive electrical failure. Planning for that scenario is daunting. Now consider disaster planning for a hospital that has an active maternity ward.

Obstetrics is unique
Obstetric units have unique needs in the world of disaster planning. In these units you’ll find healthy women prepared for rapid discharge in addition to women who are medically fragile and require close monitoring and treatment.

Equally important are labor and delivery units. Throughout the nation, these units operate as an emergency department, operating room, post-operative unit, and acute care center for pregnant patients. Nowhere else in the hospital are this many layers of patient care housed within the same unit. In addition, obstetric units have the task of caring for two patients—mother and fetus or mother and newborn.

The job of ensuring that mothers and their newborns are evacuated together during a time of chaos is neither trivial nor simple. During Hurricane Katrina, reports identified 125 critically ill newborn babies and 154 pregnant women who were evacuated to Woman’s Hospital in Baton Rouge. Some of the newborns arrived without their mothers. It took 10 days for some of these infants and mothers to be reunited. Obstetric staff must play an integral part in disaster planning in any hospital with a maternity unit.

Disaster planning overview
It is easiest to envision three approaches to disaster planning:

  1. Rapid evacuation: Creating a plan for evacuation of your patients because the hospital is damaged
  2. Surge planning: Accepting a sudden influx of patients because a neighboring hospital is damaged, thereby stretching your abilities to provide care
  3. Shelter in place: Caring for patients in your hospital despite limited resources because you are unable to transfer them

Obstetric triage and collaborative networks        
Stanford Hospital is developing an evacuation triage system considering the specific needs of obstetric patients. This system can be used to proceed with a rapid and safe evacuation of an individual facility. In addition, if it is used regionally, it will create a universal language that allows collaboration among local facilities and the transportation of patients to hospitals that can properly care for them.

Advancing the ideas of an obstetric-specific triage system and developing a collaborative network of obstetric units are crucial steps toward a regional, and ultimately national, disaster plan for obstetric units.

For more information on disaster planning, please contact me at k.daniels@stanford.edu.