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Obstetric units should have a designated safe location for laboring patients who cannot be transported because of imminent delivery. This plan should include an identified alternative site for delivery if the labor and delivery unit is damaged and a system to ensure the necessary equipment can be transported quickly to an alternative site.
Postpartum triage for the neonate is another important consideration. Ensuring that the woman and her infant are transported together is a vital element of disaster planning. This situation may require additional coordination in the event that the woman or her infant needs care at a specialized facility and may be initially transported separately. Few obstetricians are trained in critical care, yet obstetric patients can be affected severely by some infectious disease outbreaks and may require disproportionate critical care resource allocation 7— In many facilities, adult intensive care units are distant from labor and delivery units.
Physical separation may pose logistic barriers to the delivery of optimal intensive care for critically ill pregnant women. These barriers may be exacerbated during times of overwhelming patient volume. These trends warrant thoughtful consideration and extra coordination with critical care clinicians before and during disaster mitigation. These considerations may be true especially when focusing specifically on influenza pandemics.
Data from influenza pandemics demonstrate heightened rates of hospitalization and preterm birth associated with maternal influenza infection 8—11, The increased number of newborns born at preterm gestations during an influenza epidemic has clear implications for neonatal intensive care capacity and resource allocation that parallels increased maternal resource needs. Two special considerations presented by the obstetric population related to infection control practices are 1 the desire for familial involvement in the birthing process, and 2 the importance of lactation and early parental bonding with the neonate.
Infectious disease outbreaks often require tight restrictions on visitation procedures while the nature of the epidemic is being investigated. Isolation often is a difficult hospital practice to implement in general and is especially challenging to enforce in the obstetric population given the need women have for support during labor, delivery, and the postpartum period. Likewise, the importance of lactation and early parent—newborn bonding introduces infection control considerations that are not relevant to other patient populations and, therefore, warrant additional advance planning.
Maternity services should coordinate with infectious disease specialists for guidance in this challenging clinical scenario. Obstetricians and other obstetric care providers should consider the option of altering obstetric services to function with less resource use. Examples include early hospital discharge after delivery and enhanced use of telephone and telemedicine triage, with attention to documentation requirements. Such alterations often are necessary and beneficial when the volume of patients in a health care facility is unusually high.
This concept has received considerable legal and medical attention 20 , The goal of these efforts is to give facilities and health care providers guidance on temporary flexibility in care standards as well as who is permitted to provide care. Equally important is planning by the hospital leadership for the potential need to rapidly credential temporary obstetric care providers in the face of a health care provider shortage that can occur with a variety of disaster scenarios. Facility preparedness committees are encouraged to consult with their local legal colleagues to assist in interpreting state and federal guidance on this issue.
In the case of an environmental disaster, pregnant and postpartum women in need of care may be cut off from a hospital facility, medical records, and health care providers. The Health and Medicine Division of the National Academy of Sciences, Engineering, and Medicine formerly the Institute of Medicine has recently considered remote and distance care 22 and has reported on one example of the successful use of telephone triage in obstetric care If feasible, creative use of evolving telemedicine capabilities could enable facilities to maintain adequate patient care in the face of increased local resource demands and provide a mechanism for consultation between smaller regional facilities and larger tertiary care facilities.
Some examples may include conducting virtual visits and remote delivery of routine testing, such as antenatal testing Conversely, in emergency scenarios it often is necessary to provide medical care without the benefit of standard technology eg, lack of electronic medical records during a power outage , thus reliance on paper records to facilitate communication during transport may be necessary The use of social media, particularly Twitter, has provided a valuable emergency system to announce safe havens or allow electronic communication from remote areas.
Even during a disaster, documentation of all patient—health care provider interactions in the prenatal record remains important, as is the ability to access those records. Communication strategies should include back-up broadcast systems—in the event of loss of telephone communication—that take advantage of new technology, such as telemedicine, that can function over the internet and still may be accessible when other lines of communication have been cut off. Hospitals should prepare for power outages and lack of access to electronic medical records.
The possibility that access to the electronic medical record will be limited needs to be considered in advance, and mechanisms for providing patients with copies of their own medical records are recommended. The disaster recovery phase also should be considered in advance as should the establishment of local mechanisms, or triggers, or both, for transitioning back to the usual standards of care.
Once a hospital has determined its capacity to provide adequate maternity services, the next step is efficient and appropriate triage of obstetric patients. Birth is difficult to predict and obstetric units are vulnerable to a patient volume surge and unpredictable resource use. Ensuring that the woman and her infant are transported together is a vital element of disaster planning. Catholic Church as they and their local agencies respond to immediate emergency needs and the United States Conference of Catholic Bishops for pastoral and reconstruction needs of the Church. The possibility that access to the electronic medical record will be limited needs to be considered in advance, and mechanisms for providing patients with copies of their own medical records are recommended. Total damage has yet to be assessed completely.
The goal is to enable a smooth recovery that optimizes care and resource use that parallels that of baseline facility function once the acute phase has resolved. The discipline of hospital disaster preparedness has undergone significant advances in recent years, largely driven by the need to respond to an increase in natural and human-influenced crises.
Many of the advancements provide new, specific guidance to obstetricians and other obstetric care providers at the individual and institution levels. Although emergencies may be unexpected, hospitals and obstetric delivery units can prepare to implement plans that will best serve maternal and pediatric care needs when disaster occurs. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
Hospital disaster preparedness for obstetricians and facilities provi-ding maternity care. American College of Obstetricians and Gynecologists. Women's Health Care Physicians. Hospitals providing care for maternal and neonatal patients should communicate using a common terminology, such as OB-TRAIN Obstetric Triage by Resource Allocation for Inpatient , to facilitate and prioritize transport based on acuity of care.
This plan should include an identified alternative site for delivery if the labor and delivery unit is damaged and a system to ensure the necessary equipment can be transported quickly to the alternative site. Background Large-scale catastrophic events and infectious disease outbreaks—including the terrorist attacks of September 11, , the bombing at the Boston Marathon, the — H1N1 influenza pandemic, and the — Ebola outbreak—highlight the need for disaster planning at all community levels. The Role of Health Care Institutions in Disaster Preparedness Given that health care institutions play an important role in responding to disasters, the discipline of hospital preparedness now occupies a central role in effective disaster mitigation planning 5 , 6.
Considerations for Obstetric Care Facilities Features unique to the obstetric population—including antepartum, intrapartum, postpartum and neonatal care—warrant special consideration in the event of a disaster. Planning for Obstetric Surge Capacity The potential surge in maternal and neonatal patient volume due to mass-casualty events, transfer of high-acuity patients, or redirection of patients because of geographic barriers presents unique challenges for obstetric care facilities. Triage of the Obstetric Patient in Disaster Response Once a hospital has determined its capacity to provide adequate maternity services, the next step is efficient and appropriate triage of obstetric patients.
Special Considerations for Infectious Disease Outbreaks Few obstetricians are trained in critical care, yet obstetric patients can be affected severely by some infectious disease outbreaks and may require disproportionate critical care resource allocation 7— Temporary Modifications in Standard of Care Obstetricians and other obstetric care providers should consider the option of altering obstetric services to function with less resource use.
Remote and Distance Care With Telemedicine In the case of an environmental disaster, pregnant and postpartum women in need of care may be cut off from a hospital facility, medical records, and health care providers. Conclusion The discipline of hospital disaster preparedness has undergone significant advances in recent years, largely driven by the need to respond to an increase in natural and human-influenced crises. Council on Environmental Health. Prehosp Disaster Med ; Emergency preparedness in obstetrics. What hospitals should do to prepare for an influenza pandemic.
Pandemic influenza and pregnancy: Influenza occurring in pregnant women: Clin Infect Dis ; Crit Care Med ; Clin Obstet Gynecol ; Steps toward a national disaster plan for obstetrics. Development of a triage protocol for critical care during an influenza pandemic. Obstetric Care Consensus No. The role of obstetrics and gynecology national societies during natural disasters. Int J Gynaecol Obstet ; Retrieved September 15, Magee-Womens Hospital Ethics Committee. Guidance for establishing crisis standards of care for use in disaster situations: National Academies Press; Standard of care in sickness and in health and in emergencies.
These funds will be used to support the efforts of Catholic Relief Services and Catholic Charities USA as they reach out to provide humanitarian aid in the form of water, food, shelter, and medical care, as well as to their long term efforts to restore communities after widespread destruction, and to the United States Conference of Catholic Bishops for the pastoral and reconstruction needs of the Church in the Caribbean and the US. Funds collected will support the humanitarian efforts of Catholic Charities USA and will provide pastoral and rebuilding support to the impacted dioceses.
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On January 5, Archbishop Joseph E. Kurtz, President of the USCCB asked dioceses throughout the United States to consider taking up a special collection for the severe storms that occurred in December and January These storms have impacted states in the South and Midwest regions of the country.
Archbishop Kurtz requested this special collection take place on the weekend of January or , The funds collected in this one-time special appeal will be used to support the relief efforts of Catholic Charities USA, the official domestic relief agency of the U. Catholic Charities USA, with their member agencies, respond to immediate emergency needs like water, food, shelter, and medical care. They will also continue to provide support throughout the recovery and rebuilding.
This collection will also be used to provide relief from potential future domestic calamities in Send proceeds to diocesan finance office Diocese: In light of the devastation caused by the earthquakes in Mexico, you can support the humanitarian and recovery assistance as well as the long-term rebuilding efforts of communities and the local Church.
These earthquakes devastated some of the poorest dioceses in the country and your support is a sign of solidarity with our brothers and sisters as they recover.
On April 16, , a 7. About people have been killed, over 5, injured, and there is widespread damage to buildings, roads, and other infrastructure. Total damage has yet to be assessed completely. Catholic Relief Services is responding with water, food, and temporary shelter. For more information on relief efforts for Ecuador, please visit www.
The Collection for the Church in Latin America is also assessing the impact to church structures including parishes, schools, and diocesan offices. The Subcommittee on the Church in Latin America intends to make emergency grants for church reconstruction in Ecuador. For more information on giving to the Collection for the Church in Latin America, please visit our How to Give section.
The Subcommittee makes annual grants to the Church in Latin America and the Caribbean from the annual collection. While the Subcommittee cannot earmark individual contributions for specific countries or programs, including for the earthquake in Ecuador, its emergency grants are made from the same funding source, the collection, so any donations made in response to this disaster will increase the overall funds available. USCCB is still taking donations for this important effort. Following the earthquake, Archbishop Joseph E.
Kurtz, President of the USCCB, asked his brother bishops to take up a second collection for our affected brothers and sisters in Nepal.