title: Hospital-based emergency preparedness: evacuation of the neonatal intensive care unit-the smallest and most vulnerable population.
abstract: OBJECTIVE
  The objective of this study was to report an experience with a full-scale neonatal intensive care unit evacuation exercise.
  
  
  METHODS
  This was a retrospective review of lessons learned from a full-scale evacuation exercise following a simulated catastrophe. Thirty-four realistically simulated neonatal intensive care unit infants (including 12 infants who required respiratory support and 3 with very complex medical issues) were horizontally evacuated emergently to limit immediate danger, followed by a vertical evacuation down several flights of stairs to a temporary holding area. The infants were then set up for transport for ongoing care to other regional hospitals. As with a real emergency, the drill involved the hospital incident management resources plus external partners (e.g., police, public health, and fire departments).
  
  
  RESULTS
  We found that effective and constant communication was critical. Essential health care personnel resources included (1) staff to physically transport patients, (2) a central communication/coordinating site, and (3) on-site triage in the holding areas. Because it is impossible to anticipate every eventuality, flexibility and creativity are essential in disaster management. Adult tracking forms, equipment, and emergency procedures were nontransferable and often inappropriate for infants.
  
  
  CONCLUSIONS
  When a disaster occurs, hospital clinical staff, emergency management, and administrators may help avoid unnecessarily high morbidity and mortality among the smallest and most vulnerable patients by developing and practicing contingency plans. We learned what our rate-limiting steps are and how we would mitigate these.
authors.affiliation: Division of Emergency Management, Department of Health Care Quality, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. mfemino@bidmc.harvard.edu
authors.forename: Meg
authors.initials: M
authors.lastname: Femino
authors.forename: Susan
authors.initials: S
authors.lastname: Young
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Smith
mesh_terms: D004189:Disaster Planning; D006752:Hospital Planning; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D008348:Manikins; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000458:organization & administration*; D035862:Vulnerable Populations