6/8/2018 Kay Daniels MD Clinical Professor Earthquakes and fires and Obstetrics and Gynecology floods…OH MY!! Disaster Preparedness I have nothing to disclose for OB Units Kay Daniels MD Clinical Professor Obstetrics and Gynecology Co-Director of Disaster Planning at the Johnson Center for Pregnancy and Newborns Stanford University School of Medicine Learning Objectives Disaster Planning 1) Recognize the unique needs of obstetric units during a disaster 2) Recognize the specific needs for evacuation, shelter in place, surge and active shooter. 3) Describe OB specific tools used for disasters 4) Discuss future vision of disaster preparedness on a regional, statewide and national level 1
6/8/2018 Mass Casualty Disaster The Hospital as “the injured” Joplin Regional Medical Center, Joplin, MO 2011 8 Earthquake Risk in Next 20 Years? • The chance of a 6.7 magnitude temblor, equal to the 1994 Northridge Quake, is: • 97% in southern CA • 93% in northern CA • The likelihood of a 7.5 magnitude quake, 16X more intense, is: “As I hurtled through space, one thought kept crossing my mind • 37% in southern CA - every part of this rocket* was supplied by the lowest bidder” • 15% in northern CA John Glenn (*think…your hospital) https://i.ytimg.com/vi/-si7R9KRJOY/maxresdefault.jpg http://www.iii.org/issue-update/earthquakes-risk-and-insurance-issues 2
6/8/2018 Why Moms and their Babies are at Video from Oklahoma Risk in Disasters? • >97% of all births in the US occur in a hospital or clinical setting…which may not be accessible or may be severely damaged during a disaster event Why Moms and their Babies are at Learning Objectives Risk in Disasters? 1) Understand the unique needs of obstetric units during a disaster • Pregnant women are subject to the usual risks of injury at a disaster, but with more complicated care 2) Recognize the specific needs for evacuation, shelter in place, surge and active shooter. 3) Describe OB specific tools used for disasters 4) Discuss future vision of disaster preparedness on a regional, statewide and national level 3
6/8/2018 OB is Unique Why is OB unique? One size ≠ all in a disaster setting for OB We always have 2 patients Within the same footprint of any OB unit there exists a • Antepartum = mom + fetus large variety of patient acuity and needs Postpartum = mom + newborn • • Laboring women Intra op and post operative patients • Healthy postpartum patients with their newborns • thavibe.com Learning Objectives Keeping Mom and Baby Together… 1) Recognize the unique needs of obstetric units • In the days after Hurricane Katrina struck Louisiana, during a disaster 125 critically ill newborn babies and 154 pregnant women 2) Recognize the specific needs for evacuation, were evacuated to Woman's Hospital in Baton Rouge shelter in place, surge and active shooter. It was at least 10 days before some of the infants and mothers were reunited 3) Describe OB specific tools used for disasters Washington Post 2006 4) Discuss future vision of disaster preparedness on a regional, statewide and national level www.neworleans.va.gov/images/evacuate2_lg.jpg 4
6/8/2018 Concepts: Hospital Response Evacuation Evacuation Shelter in Place Surge Active shooter Being Prepared to Evacuate L&D Because when you got to go….. You have got to go!! 5
6/8/2018 We need a universal common language Disaster Planning for OB: for evacuation A Triage Algorithm • Disaster triage tool designed for hospitalized OB patient movement OB TRAIN * = • Based on the needs of patient to Triage by R esource determine appropriate level of transport for evacuation A llocation for IN patient • Created by expert opinion and aligned *Based on the triage system created by Dr. Ron Cohen for the NICU at with local EMS protocols for transport LPCH and adapted for OB OB TRAIN for AP + L&D Basis of Triage for OB TRAIN for L&D/AP Blue = Car Green = BLS Yellow = ALS Red = Specialized (S) Specialized = must be accompanied by MD or Transport RN * Able to rise from a standing squat ** Epidural catheter capped off http://www.parsippany.net/Departments/Ambulance-Squads/images/IT.jpg 6
6/8/2018 OB TRAIN Triage - Example Basis of Triage System for OB TRAIN 32 yr @ 31 weeks with severe preeclampsia undergoing induction of labor Labor status • Early labor: 2 cm • Non-ambulatory Mobility • Epidural in place < 1 hr • Cat 1 FHR Anesthesia status • Intermittent IV labetalol for BP control Maternal risk factors/fetal risk factors • On 2 g of IV magnesium sulfate http://sd.keepcalm-o-matic.co.uk/i/keep-calm-and-triage.png Levels of Maternity Care Specialized ACOG Consensus Feb 2015 1. Levels: Birthing Centers Basic Care (Level l) Specialty Care (Level ll) Subspecialty Care (Level lll) Regional Perinatal Health Care Centers (Level lV) 2. Capabilities 3. Types of providers SEND THE RIGHT PATIENT TO THE RIGHT HOSPITAL Obstet Gynecol 2015:125:502-15 7
6/8/2018 Hospital Levels of Care and Distance List Distance Hospital Hospital City Neonatal Maternal (mi) Phone number (650) 497-8000 Reality testing 0.0 LPCH Palo Alto 4 4 Santa Clara (408) 885-5000 18.4 Valley Medical San Jose 3 3 Center (415) 476-9000 34.6 UCSF SF 4 4 (415) 600-6000 36.0 CPMC SF 3 3 (510) 752-1000 38.6 Kaiser Oakland Oakland 3 3 Kaiser: Santa (408) 851-1000 17.0 Santa Clara 3 4 Clara (408) 559-2011 19.8 Good Samaritan San Jose 3 3 Kaiser: San San (415) 833-6353 36.4 4 Francisco Francisco Walnut (925) 939-3000 53.0 John Muir 3 3 Creek Mountain (650) 940-7000 9.0 El Camino 3 2 View (415) 206-8000 32.3 SF General SF 2 2 (510) 204-4444 42.7 Alta Bates Berkeley 2 3 (831) 462-7700 45.5 Dominican Santa Cruz 2 2 Natividad (831) 647-7611 78.5 Salinas 3 2 Medical Center Salinas Valley (831) 757-4333 81.2 Salinas 2 2 Memorial Sierra Vista (805) 546-7600 San Luis 205 Regional 2 2 Obispo Medical Center Redwood (650) 369-5811 8.2 Sequoia 2 2 City (510) 797-1111 17.9 Washington Fremont 2 1 (408) 947-2500 19.9 O’Connor San Jose 2 1 Regional (408) 259-5000 22.7 San Jose 2 1 Medical Center (831) 724-4741 Fox news 57.0 Watsonville Watsonville 2 1 Kaiser: (650) 299-2015 Redwood 6.8 Redwood 1 1 City City 31 Hospitals’ Best-Laid Plans Upended By Disaster • Within three hours, staffers evacuated 122 patients to other facilities — something they’d • The Tubbs Fire roars through never come close to doing before. Ambulances neighborhoods Oct. 9 in Santa Rosa, Calif. sped off with some of the sickest patients; city buses picked up many of the rest . • It was 3:35 a.m. and flames from a massive Northern California wildfire licked at the back of a Santa Rosa hospital. From Richard O Johnson MD California Pediatric Surge Project 2018 8
6/8/2018 Shelter in Place/Evacuation: Shelter in Place Grab & Go Bags Surge COMMUNICATION: Peds OB How will peds know where OB is evacuating to? • Is there a system in place for notification? Who from peds has been designated to go with OB? • To care for ‘ shelter in place’ in deliveries 9
6/8/2018 Definition : Surge Specifics for Surge : Types A Surge Event is a significant event or circumstances that 1. Conventional/crowding capacity : Spaces, staff, impact the healthcare delivery system resulting in excess and supplies used are consistent with daily practices within the institution demand over capacity and/or capability 2. Contingency capacity : Spaces, staff, and supplies used are not consistent with daily practices but maintain or have minimal effect on usual patient care practices 3. Crisis capacity : Adaptive spaces, staff, and supplies are not consistent with usual standards of care but provides sufficiency of care in the setting of a catastrophic disaster CNN 2013 Surge Type : Conventional/crowding • Because some one dared to say “It sure is quiet tonight” • Your hospital is intact • You are receiving a large influx of patients (We have all been here!!) • Because there is a full moon 10
6/8/2018 Conventional/Crowding surge Surge Type : Contingency Influx above usual census and resources are • You have the ability to flex up to accommodate influx inadequate • No gubernatorial waiver of existing • Any hospital can internally declare a disaster regulations • You are expected to: • Follow the rules outlined in the pre-approved Emergency Operations Plan (EOP) Surge Type : Crisis Governor’s Suspension: Influx with simultaneous severe damage to Government code section 8571 the hospital • Catastrophic disaster • The Governor can suspend any regulatory statue if • Damage to the entire area and your hospital is he/she determines that compliance would prevent/delay the mitigation of the effects of a state emergency severely damaged yet you are receiving a surge of patients • State has declared a disaster • Gubernatorial Waiver of existing regulations California Department of Public Health Standards and Guidelines for HealthCare Surge during an Emergency 11
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