Disaster Series: The Abrupt NICU Evacuation – Disasters without a Plan

Abstract

An abrupt disaster brings the environment physically into the NICU. We describe immediate evacuation measures taken because of a ruptured water pipe, hospital fire, unexploded WWII bomb, and two earthquakes. These abrupt changes thrust the Neonatologist into an environment with new structures, rules, and threats. The intruding environment dictates actions at first as the Neonatologist addresses safety for the neonates and staff while continuing medical care for the infants. The environment has just become the pathology, a new comorbidity. Operations during abrupt change mean the Neonatologist must hand off direct minute-to-minute care for the neonates, trust staff, then begin the more demanding work of figuring out next and future steps. Personal stress and fear responses must be modulated while supporting staff during the uncertainty. While these events at first appear disparate, they share the common problem of rapid movement of neonates to safety, ensuring the safety of infants and staff while solving problems embedded in a threatening environment. Faced with an abrupt environmental threat, we must maintain awareness that disaster and medical professionals will not appreciate the unique responses of the neonate to the raw environment. We must accept and rely on our colleagues' strength, fortitude, and creativity in the NICU to resolve problems embedded in the environment.