The NICU Silent Angels Project. Nationwide Children s Hospital NICU Conference May 15,

Transcription

1 The NICU Silent Angels Project Nationwide Children s Hospital NICU Conference May 15,

2 Operation Silent Angels By JJ Burke MS EMT-I Gregory Bond MS EMT-P May 15, 2014

3 Simulation exercise designed to test the capabilities of both inhospital and prehospital personnel and equipment in the event of a partial or full evacuation of Neonatal Intensive Care Unit (NICU) patients. Intro/Overview

4 Silent Angels 1 The first evolution was conducted in 2012 as a partial NICU Evacuation Drill Two test NICU patients were evacuated to awaiting ambulances, which were used as temporary NICU beds

5 Silent Angels 2 Simulated evacuation of the entire NICU patient census of babies Streamline both security and tracking of NICU patients by moving them all into a single transport asset

6 Two Phases 1. In-hospital preparation of patients for transport 2. Out-of-hospital loading and preparation of patients for continuous monitoring/treatment throughout duration of transport

7 NICU

8 Preparing Patients for Safe Transport Safe Mode of Transport Thermoregulation Oxygen Delivery/Ventilation Medication Delivery Monitoring Hand-carried by nurse Warming packs/swaddling Portable Neopuff Devices or Ambu-bag with O2 tank Portable IV pumps and monitors

9 Evacuation How to vertically transport critically ill infants without elevators? Precluded use of transport Isolets

10 Elements of an Effective and Speedy NICU Evacuation 1. Familiarity with an evacuation plan, including triage strategies 2. Awareness of and (advance) determination of appropriate receiving hospitals 3. (Advance) Determination of transportation resources 4. Medical record transfer and patient tracking 5. Communication with Parents

11 EMS

12 Goals/Objectives Equipment Familiarization MAB Crew makeup & responsibilities Stocking proper equipment Evaluating capacities/capabilities of MAB Identifying gaps/deficiencies

13 Special Equipment Evacuation offers little time to stop and collect items Use check lists Preemie-specific medical supplies Patient records Breast milk/formula Medications Portable O2 Prepackaged Go-Bags

14 Prepackaged Durable Equipment Resuscitation Equipment Bulb Syringe/Suction Extra NG tubes Thermometers Lip Balm Extra Binkies Diapers Baby Wipes Mylar Blankets Cyalume light sticks Headlamps/Flashlights Extra Batteries Blankets/Swaddlers Extra Linen/Towels Accommodations for parents/staff?

15 Unique Strategies Altered but realistic/workable Nurse-to-Patient ratio Altered Standards of Care Increased level of parental involvement Ambulances as ACS Electrical conversion devices Oxygen concentrators

16 Assigned Tasks Patient Triage Parameters Order of Evacuation Additional Equipment/Resources needed Methods of Evacuation Modes of Transport Destination(s) Patient Tracking/Accountability Safety/Security for all Patients/Staff

17 On-scene Actions Developing the loading plan Loading procedures & factors Exploring methods of securing patients Transport Considerations Unloading procedures & factors

18 Driver Designate Patient Transfer Area Using available shelter (tent, awning), stage patients until moved onto bus Patients ready for transfer and loading should be assembled near the REAR of the MAB MAB Cots & Equipment Assembly near Transfer Area Coordination of Patient Exchange

19 Prepare MAB for loading/unloading. Supervising, directing and assisting litter bearers in the proper loading and unloading of patients Loadmaster

20 Bus is Loaded from FRONT to REAR and from TOP to BOTTOM Loaded from Rear Door Load Least Critical First Allows Most Critical Patients to be loaded last and unloaded first at the receiving facility (load in middle position if possible) Loading Order

21 Side A - Driver s Side (Street Side) Stretcher Labeling: Driver s Side/Street Side Stretchers are numbered A -# Top stretcher is # 1, middle is #2 and bottom is #3 continues top to bottom and front of bus to rear of bus Total of 9 stretchers on Side A

22 Side B Officer s Side (Curb Side) Stretcher Labeling: Officer s side/curb Side stretchers are numbered B -# Top stretcher is # 1 and middle is #2 continues top to bottom and front of bus to rear of bus Total of 11 stretchers on Side B

23 Loading from ramps or platforms Two litter teams are required to load the bus. One litter team enters rear of the bus with a patient, loads the patient onto the berth, and exits through the front as the second team enters through the rear with a litter patient. The second team loads its patient and exits through the front as the first team enters the rear with its second patient. Only one of the teams is in the bus at a time, thereby avoiding interference.

24 References Bernard M and Mathews PR. Evacuation of a maternal-newborn area during Hurricane Katrina.. MCN Am J Maternal Child Nursing. 2008; 333(4): Downey EL, et al. External factors impacting hospital evacuations caused by Hurricane Rita: the role of situational awareness. Prehosp Disaster Med. 2013; 28(3): 1-8

25 Contact Information John J. Burke, M.S., EMT-I Associate Director / Instructor Boston University School of Medicine s Health Care Emergency Management Program jjemt8@bu.edu