Last month, I shared an up-close look at Puerto Rico and the challenges facing their health care system following two major hurricanes. Officials were working hard to put emergency protocols into place and restore regular delivery of care. As a follow-up this month, I’d like to focus on how every hospital can evaluate and prepare for disasters and emergencies.
Large-scale catastrophic events and infectious disease outbreaks require disaster planning at all community levels well in advance. An updated Committee Opinion, released last week, outlines the key components to preparation and communication for the successful management of obstetrical care during emergencies.
From the outset, preparing for disaster and emergency situations may feel overwhelming. Within the obstetrics unit alone, hospitals see many patients with health care needs that span a vast spectrum. In order to make planning more accessible and successful in application, collaboration across departments, hospitals and health care systems is vital.
A first step toward preparation is to form a standing committee, incorporating representatives from obstetrics, pediatrics and anesthesia, as well as any other departments deemed necessary. This committee can help the hospital to develop specific strategies for managing obstetrical issues that are likely to arise during an emergency, like stabilizing and transporting obstetric patients, managing surge capacity, limited resources, power outages, sheltering-in-place and incorporating regional facilities that do not provide maternity services.
While many hospitals may have already considered immediate concerns like those listed above, the Committee Opinion introduces two new recommendations to expand and improve preparation: adherence to ACOG and Society for Maternal-Fetal Medicine’s Levels of Maternal Care designations; and communication using a common terminology, like Obstetric Triage by Resource Allocation for Inpatient (OB-TRAIN). During an emergency, both systems enable quick categorization of patient needs and transport of obstetric patients to appropriate facilities, guaranteeing the right care at the right time for every woman.
As discussed last month, hospitals and health care systems must also consider how to reach women who are unable to access care facilities during or following a catastrophic event. When able, hospitals should consider using any existing telemedicine capabilities, including “distance prenatal care” or telephone triage, to reach patients remotely. Telemedicine can also facilitate consultation between smaller regional facilities and larger tertiary care facilities to share expertise, medical files and reach the maximum number of patients. Being flexible and creative with these resources is essential to making sure every woman receives the care she needs.
Of course, most importantly, hospitals must ensure that staff at every level are familiar with and understand when and how to implement disaster plans. Adequate review and training facilitates a safer and more efficient delivery of care during emergencies.
As years practicing obstetrics has taught me, even a hurricane won’t stop a baby from coming. It’s our job to be prepared, no matter the circumstances. ACOG colleagues in Texas, Florida and Puerto Rico know this all too well, and we commend them for their leadership, preparation and response at the local level during these most recent disasters. These efforts have no doubt saved the lives of many women and babies.
The full disaster preparedness guidelines are available here.