Wednesday, June 16, 2010

Moving lots of babies

An important aspect of hospital operations is to prepare for the unexpected, a catastrophe that can cause a major disruption to patient care. All hospitals plan for such things, and then we do drills.

Today's drill took place in our Neonatal Intensive Care Unit (NICU). The scenario required an evacuation of two dozen newborns to another floor. The elevators worked at the start but were then simulated to go out of service, so some babies had to be put in baskets and carried down three or four flights of stairs to another nursery. Their life support systems and medications had to be in place the entire time.

I present a short video of some of these scenes. It felt very real. You quickly forget that the "babies" are dolls (as shown in the early frames, complete with simulated medical histories). A more comprehensive video was made of the entire exercise, observers were keeping notes, and there will be a full debrief for the entire staff. My inexpert opinion, though, was that people did a really good job. Especially when you consider (last frame in video) that the real babies still needed to be cared for during the whole exercise.

I later learned, too, that there is a dearth of literature on NICU evacuations. Given hurricanes and tornadoes, you might think that there would be generally accepted standards for dealing with this particularly vulnerable population. A member of our faculty plans to write up this experience and contribute to the literature on the topic.

If you cannot see the video, click here.

14 comments:

adena said...

surprisingly moving video...

Paul Levy said...

Thank you. I felt that way, also. Even though they were lifting and moving dolls, you could understand how they would treat the babies -- so carefully and lovingly.

Paul Levy said...

From Twitter:

@mskyle -- unexpectedly fascinating NICU evacuation drill.

Paul Levy said...

and this one, too:

@KMcCP -- This is a glimpse of where i work and a few friends.

Amy Romano said...

I agree that it is very moving. You inspired me to blog about it, actually (http://www.scienceandsensibility.org/?p=1283)

I'm just wondering what the procedures are for reuniting babies with their mothers. And does the ongoing care of thermally unstable babies include "kangaroo care" (i.e., skin-to-skin care with the mother?)

Paul Levy said...

From Twitter:

@Sphere3CEO - Excellent post and great video.

Anonymous said...

A great video of caring people preparing for a worst case scenario. But I would pose a couple of questions regarding the process:
1.) Is it wise to use the elevators in an "emergency"? The simulation had them stop working ... what if a group of newborns and their caregivers were trapped?
2.) I love the baskets but are they specifically desinged for this purpose and do they have a load rating?

Sorry for the practical point of view.

linda pitler, rn, ms said...

many years ago (1978) I was working in a NICU in CT when we actually had to evacuate 14 babies due to a fire. One of the nurses had just plugged an O2 humidifier into the wall when it exploded and caught on fire. She sustained burns so not only did we have to get the babies out, we also had her immediate care to attend to. Luckily, we were able to go right accros the hall. We had all of those babies, including the ones who were vented out in 5 minutes. In 33 years of nursing, I can still close my eyes and see the whole situation in minute detail.

Anonymous said...

Amazingly moving -- NICU nurses are amazing people!

Paul Levy said...

Amy,

Dr. Pursley, the chief of service replies:

There was much attention paid to these issues. In this exercise (as we do everyday), we wanted to ensure both high quality clinical care for the babies and top level communication and support for the families.

Social work played a central role during the disaster exercise. Positioned next to the patient tracker in the command center and active in the holding areas, their responsibilities included providing support to families and ensuring that each family was informed of the evacuation and clinical status of their baby(ies), their location in the holding areas, and the transfer status of the infant(s). Because of the inherent challenges of ensuring continued safe care of critically ill babies in emergency off-site locations during a disaster, the objective in this exercise was to reunite families with babies at the receiving hospital units after timely transfer. For the small percentage of NICU patients whose mothers are still inpatients this would seem to be a more straightforward task, but in a real life disaster scenario with confined space and limited staff, we anticipate that even this assumed objective would be a significant challenge.

Although kangaroo care is routinely practiced in our NICU, our objective in the disaster exercise was to ensure that each thermally unstable baby had access to a radiant heat source (warming table or incubator) after transfer to the holding area and through transfer to the accepting hospital's NICU. Although temperature stability can be assured in the great majority of babies for limited periods during kangaroo care, there are safety concerns related to relying on this mode for longer periods (especially in extremely low birth weight infants), and during vehicular transports where babies must be individually secured.

Anonymous said...

That Flip is doing some amazing things. Keep it up.

maryjohn said...

Thank you. Surprisingly moving video. you could understand easily from video how they would treat the babies, lifting and moving dolls carefully and lovingly.

Mary John said...

It's great video and post. Everybody can understand from video how to treat babies so carefully and lovingly.

R. Walter Wood said...

Interesting informative video. As the Safety Director for our teaching hospital we purchased several infant evacuation aprons from www.safebabiesaprons.com. These aprons work well for babies in L&D/Birthing Center as well as those in NICU. Our staff utilize the front two pockets for NICU babies and rear pockets for the necessary supplies to sustain them during the emergency or transport to another facility. And, for the well babies four can be carried out by a single caregiver. Something to think about. We stopped using elevators during such emergencies to avoid creating another situation due to entrapment should there be a power failure or fire.