Disaster Series: The Use of Information for Wildland Fire and the NICU: Combined Evacuation and Sheltering

NICU preparation for a hurricane includes evacuating or sheltering neonates, agreements to transfer neonates, communication, and emergency transport systems to move neonates to safer ground. Under-represented are identifying the skills and capabilities to support a neonate for hours, if not days, in an austere and adverse environment. The successful operations that sheltered and evacuated 235 neonates with only two deaths and no adverse events recorded are under-recognized. Such accomplishments came about from the actions and improvisations of local Neonatologists and NICU staff who extended an ordinary workday into the consequences of major hurricanes.

Section: Hurricane Operationsmentioning

confidence: 99%

Section: The Decision To Evacuatementioning

confidence: 99%

Disaster Series: Prolonged Improvisation during Hurricanes – High Reliability Organizing in the NICU

Stralen¹,

McKay²,

Mercer³

2022

Disaster Series: The Abrupt NICU Evacuation – Disasters without a Plan

Stralen¹,

McKay²,

Mercer³

2021

An abrupt disaster brings the environment physically into the NICU. We describe immediate evacuation measures taken because of a ruptured water pipe, hospital fire, unexploded WWII bomb, and two earthquakes. These abrupt changes thrust the Neonatologist into an environment with new structures, rules, and threats. The intruding environment dictates actions at first as the Neonatologist addresses safety for the neonates and staff while continuing medical care for the infants. The environment has just become the pathology, a new comorbidity. Operations during abrupt change mean the Neonatologist must hand off direct minute-to-minute care for the neonates, trust staff, then begin the more demanding work of figuring out next and future steps. Personal stress and fear responses must be modulated while supporting staff during the uncertainty. While these events at first appear disparate, they share the common problem of rapid movement of neonates to safety, ensuring the safety of infants and staff while solving problems embedded in a threatening environment. Faced with an abrupt environmental threat, we must maintain awareness that disaster and medical professionals will not appreciate the unique responses of the neonate to the raw environment. We must accept and rely on our colleagues' strength, fortitude, and creativity in the NICU to resolve problems embedded in the environment.

High Reliability Organizing for (HRO) Disasters – Disaster Ecology and the Color of Noise

Stralen¹,

McKay²,

RAdm³

2021

The frequencies of stochastic noise inherent to the environment can be described as colors. The various colors of noise refer to the disruptive potential of stochastic energy within the environment and its characteristics. The meaning of the type of noise lies in the unpredictability of events and the 'forcing functions' of energy. That is the strength of the environment to force a system or population to respond. For human activity, the color types correlate to problem characteristics such as leadership-line authority coupling, well-structured, ill-structured, and embedded problems. When the noise color changes, forcing functions and the types of problems also change, increasing characteristics necessary for adaptation or altering characteristics in unexpected ways through relaxed selection. The noise process applies equally to nursing homes, NICUs, and public safety and is independent of timescale or magnitude. We need not characterize normal environmental variation differently from catastrophes.