Evacuation of a Tertiary Neonatal Centre: Lessons from the 2016 Kumamoto Earthquakes

An Evacuation Simulation in Multiple Neonatal Intensive Care Units Across a Single City: Lessons Learned

OBJECTIVE

Evacuations of neonatal intensive care units (NICUs) in emergency situations pose specialized challenges given their population of critically-ill neonates. Most of the literature on this topic describes planned evacuations and simulations due to natural disasters, usually involving only NICU staff. This study examines a unique emergent NICU evacuation simulation involving multiple responders occurring on a citywide scale.

METHODS

A simulated evacuation in response to a fire was conducted in 6 different NICUs in El Paso, Texas. The exercise utilized response from NICU staff and first responders. A standardized tool, by independent evaluators, was used to evaluate staff competencies while reactions were assessed using post-exercise surveys.

RESULTS

This city-wide multidisciplinary simulation improved NICU personnel skills in evacuation and also introduced first responders to this specialized patient population. Areas of strength across all NICUs included teamwork, knowledge of evacuation equipment, and patient tracking. Areas for improvement included lack of adequate equipment for post-evacuation care, understanding implications of smoke exposure, alternative evacuation routes, incident command structure, and unified communication.

CONCLUSIONS

This successful, citywide NICU evacuation simulation improved knowledge among participants, introduced first responders to a specialized patient population, and provided valuable lessons on neonate-specific themes that can be incorporated to improve citywide emergency preparedness.

A New Quantitative Triage System for Hospitalized Neonates to Assist with Decisions of Hospital Evacuation Priorities

INTRODUCTION

Hospitalized neonates are vulnerable to natural and man-made disasters because of their persistent requirement for medical resources and may need to be evacuated to safe locations when electricity and medical gas supply become unreliable. In Japan, a triage system for hospitalized neonates, or the Simple Triage and Rapid Treatment for Neonates, Revised (START-Neo-R), has been used to determine whether neonates are in suitable conditions for transportation. However, this scale is not useful to determine the evacuation order of neonates because a considerable number of evacuees are classified into the same categories.

STUDY OBJECTIVE

To solve this problem, a novel triage system, Neonatal Extrication Triage (NEXT) was developed. This study tested the validity and reproducibility of both triages and compared them with a standardized prognostic scoring system for hospitalized neonates, the Neonatal Therapeutic Intervention Scoring System (NTISS).

METHODS

In this retrospective observational study, physicians and nurses independently assessed each neonate hospitalized at a tertiary neonatal intensive care unit (NICU) twice weekly using NEXT and START-Neo-R. The NEXT system comprises six questionnaires regarding medical resources required during transition and transportation, providing composite scores on a 12-point scale. The START-Neo-R classified neonates into five levels based on the severity of disease and dependence on medical care. Inter-rater reliability of both systems was assessed using Cohen's kappa coefficient, whereas the criterion validity with NTISS was assessed using Spearman's correlation coefficient.

RESULTS

Overall, 162 neonates were assessed for 49 days, resulting in triage data for 1,079 accumulated patients. Both NEXT scores and START-Neo-R ranks were well-dispersed across different levels without excessive accumulation in specific categories. Inter-rater reliability of NEXT (kappa coefficient, 0.973; 95% confidence interval, 0.969-0.976) and START-Neo-R (kappa coefficient, 0.952; 95% confidence interval, 0.946-0.957) between physicians and nurses was sufficiently high. The correlation coefficient of NEXT and START-Neo-R scores with NTISS scores were 0.889 (P <.001) and 0.850 (P <.001), respectively.

CONCLUSIONS

Both START-Neo-R and NEXT had good reproducibility and correlation with the severity of neonates indicated by NTISS. With its well-dispersed scores across different levels, the NEXT system might be a powerful tool to determine the priority of evacuation objectively.

Experience of Mass Intrahospital Neonatal Transport: Impact on Vitals

Background

Mass transport of neonates is required in cases of disasters and calamities such as fire. It may also be required when there is a need for the upgradation of infrastructure. Neonatal transport even for a short period is a period of stress for the neonate. Mass transport of neonates needs much planning, and even after diligent planning, may result in the destabilization of neonates.

Objectives

The objectives of this study were to assess the impact of mass intrahospital neonatal transport on the vital parameters of neonates, the occurrence of any adverse event during transport. To study the frequency of adverse events in mass intrahospital neonatal transport and factors related to it.

Materials and methods

This was a retrospective observational study on a cohort of 16 neonates who were transported to an alternate site in the hospital so that renovation and upscaling of the infrastructure of the newborn intensive care unit (NICU) could be undertaken. Site selection, preparation, and transport details were observed. Vital parameters pre and post-transport were noted, and the occurrence of adverse events during transport was documented and analyzed.

Results

Sixteen neonates were transported over a span of 90 minutes with a mean travel time of 5.62±3.03 minutes. There was a statistically significant rise in the heart rate of the neonates post transport (137.7±8.51vs 141.3±9.01, p-value .00769) though not clinically significant. Six point two-five percent (6.25%) of neonates deteriorated post transport and needed extra efforts for stabilization. Equipment malfunction was responsible for deterioration.

Conclusion

Unforeseen events can occur during neonatal transport. Despite adequate planning, preparation, and care during transport, it remains a period of stress for a neonate.

The Role of Emergency Medical Services in Earthquake Response: Integrating the ABC Approach of Israel's Magen David Adom

Throughout history, earthquakes have caused devastation and loss of life. Emergency medical services (EMS) plays a vital role in the response to any mass-casualty incident or disaster. Magen David Adom, Israel's premier EMS organization, has a unique strategy known as the ABC approach to earthquake response. It involves thousands of salaried workers and trained volunteers who are prepared to respond to an earthquake based on the extent of the disaster. Depending on the amount of destruction, they will be working locally or available to help in other areas. A Level A earthquake causes local destruction and minimal casualties. Any EMS responders in that area as well as in surrounding areas will be available to help. Furthermore, all responders will need to work automatically and autonomously. A Level B earthquake causes extensive destruction, and all responders in the region will be busy caring for the victims. Anyone available outside of the region will come and help. A Level C earthquake is completely devastating, and all workers nationwide will be involved in responding to the catastrophe. The role of EMS responders using the ABC approach to earthquake response, as described here, may be integrated in part or whole in other EMS systems.

A wolf from Gravettian site Pavlov I, Czech Republic: Approach to skull pathology

OBJECTIVE

Describe pathological features on internal and external aspects of the skull of an ancient grey wolf.

MATERIALS

Wolf remains that were found at the southwestern settlement Area A of Gravettian site Pavlov I.

METHODS

Visual observation and description; microcomputed tomography; porosity and fragmentation indices for internal and external skull features; histological section of the fourth upper premolar tooth.

RESULTS

Dorsally, the sagittal crest revealed bone healing and remodeling. The sagittal lesion differential diagnosis was blunt trauma with or without fracture. Ventrally, otic region pathology included severe proliferation and lysis (osteomyelitis). The pathology was not resolvable among differential (microbial) causes of osteomyelitis, although other potential etiologies were ruled out.

CONCLUSIONS

Probable first report of otic region osteomyelitis in an ancient grey wolf.

SIGNIFICANCE

The proximity of the wolf remains to human-related findings, and presence of red ochre and shells, suggest human involvement in the burial.

LIMITATIONS

This is a single specimen with differential diagnoses that were not resolvable to a single definitive diagnosis.

SUGGESTIONS FOR FURTHER RESEARCH

Further investigation of the possible anthropological significance of the burial circumstances.

Neonatal Intensive Care Unit Evacuation and Care During a Natural Disaster: The Experience of Cyclone Idai in Beira, Mozambique

Global warming has increased the frequency of natural disasters, such as cyclones. Mozambique is considered one of the most vulnerable countries to extreme weather events. Natural disasters particularly affect vulnerable people, including preterm and critical ill infants of Neonatal Intensive Care Units (NICUs). Literature on NICU evacuations in the case of a natural disaster has been reported in high-resource settings, but it is lacking in low-resource settings. On the 14th of March 2019, a tropical cyclone (Idai) hit Mozambique. This report is a descriptive analysis of the experience of the NICU evacuation and care during and after cyclone Idai at Beira Central Hospital, Beira, Mozambique.

Differences in infant and child mortality before and after the Great East Japan Earthquake and Tsunami: a large population-based ecological study

OBJECTIVES

To examine associations between access to medical care, geological data, and infant and child mortality in the area of North-Eastern Japan that was impacted by the Great East Japan Earthquake and Tsunami (GEJET) in 2011.

DESIGN

A population-based ecological study using publicly available data.

SETTING

Twenty secondary medical areas (SMAs) in the disaster-affected zones in the north-eastern prefectures of Japan (Iwate, Fukushima and Miyagi).

PARTICIPANTS

Children younger than 10 years who died in the 20 SMAs between 2008 and 2014 (n=1 748). Primary and secondary outcome measures: Multiple regression analysis for infant and child mortality rate. The mean values were applied for infant and child mortality rates and other factors before GEJET (2008-2010) and after GEJET (2012-2014).

RESULTS

Between 2008 and 2014, the most common cause of death among children younger than 10 years was accidents. The mortality rate per 100 000 persons was 39.1±41.2 before 2011, 226.7±43.4 in 2011 and 31.4±39.1 after 2011. Regression analysis revealed that the mortality rate was positively associated with low age in each period, while the coastal zone was negatively associated with fewer disaster base hospitals in 2011. By contrast, the number of obstetrics and gynaecology centres (β=-189.9, p=0.02) and public health nurses (β=-1.7, p=0.01) was negatively associated with mortality rate per person in 2011.

CONCLUSIONS

In 2011, the mortality rate among children younger than 10 years was 6.4 times higher than that before and after 2011. Residence in a coastal zone was significantly associated with higher child mortality rates.