Hospitals need updated emergency plans in place for maternity care before a natural disaster or a new outbreak of infectious disease strikes, the American College of Obstetricians and Gynecologists (ACOG) said in a new opinion statement.
Of note, hospitals should attempt to adhere to the Levels of Maternal Care designationsdeveloped by ACOG and the Society for Maternal-Fetal Medicine, and use a common terminology like Obstetric Triage by Resource Allocation for Inpatient (OB-TRAIN), reported the authors, from ACOG’s Committee on Obstetric Practice.
In addition, hospitals should consider using telemedicine to help with prenatal care, the authors wrote in the document, published online in Obstetrics and Gynecology.
“It’s vital that hospitals dedicate staff and resources to establishing plans and communicating about emergencies in advance, ensuring every element of obstetric and neonatal care is considered and partnerships are well established,” the document’s lead author, Nathaniel DeNicola, MD, of George Washington School of Medicine & Health Sciences, said in a statement. “As this latest hurricane season demonstrated, waiting until a catastrophic event is imminent or underway is too late for hospitals to adequately respond or guarantee patients’ safety and security.”
These Levels of Maternal Care designations call for “an integrated, regionalized network to identify when transfer of patients may be necessary to provide risk-appropriate maternal care,” and are defined as follows:
- Basic (I)
- Specialty (II)
- Subspecialty (III)
- Regional (IV)
In unexpected disasters, the authors said, level III and IV centers may be forced to stop accepting new patients, but hospitals should have plans in place to have consultants available to provide remote assistance about obstetric care.
“An established, flexible network that incorporates coordination during an emergency response would enhance the entire region’s disaster response and reduce neonatal morbidity and mortality,” the document states.
OB-TRAIN is built on the existing neonatal TRAIN system for pediatric patients in the event of an evacuation, and can help facilitate transport and care for mothers and infants based on the acuity of their situation. This model uses a composite score of specific factors using common terminology across obstetric and pediatric units and can be used to characterize a patient’s acuity, DeNicola and coauthors explained.
As part of this system, obstetric units should make special plans for laboring patients who cannot be transported, including planning for alternate sites of delivery and a way to make sure equipment can be transported there. Hospitals should also ensure that women can be transported with their infants — a “vital element” of disaster planning.
In the case of infectious disease outbreaks, the committee members cite “logistic barriers” for critically ill pregnant women due to adult intensive care units being distant from labor and delivery units, meaning that extra coordination with critical care clinicians is critical. The authors recommend coordinating with infectious disease specialists when infectious disease outbreaks make familial involvement in the birthing process and the importance of lactation and early parental bonding especially challenging.
But in the case of environmental disaster, the authors say that “distance prenatal care” through telemedicine may be of great value if patients cannot access care locally. They cite such examples as “conducting virtual visits and remote delivery of routine testing, such as antenatal testing.” The authors also highlighted the potential value of social media, particularly Twitter, to “announce safe havens or allow electronic communication from remote areas.” It is also important to have hard copies of a patient’s medical record, because electronic medical records may not be available during a disaster, the authors noted.
In addition, they recommend that clinicians and hospitals should implement a standing perinatal committee in charge of disaster preparedness, which can mobilize quickly.