When Disaster Strikes, Planning and Collaboration are Essential

Washington, DC—Large-scale catastrophic events and infectious disease outbreaks require disaster planning at all community levels. Today, in an updated Committee Opinion, “Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care,” the American College of Obstetricians and Gynecologists (ACOG) outlined the key components to preparation and communication for the successful management of obstetrical care during emergencies. 

The Committee Opinion recommends hospitals develop specific strategies for managing 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 of these challenges may already be known to hospitals, the Committee Opinion includes two new components of planning and coordination to integrate into existing strategies: 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).

“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,” said Nathaniel DeNicola, M.D., lead author of the new Committee Opinion. “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 Levels of Maternal Care assign clear designations to maternal care facilities’ capabilities and require the formation of a regional network incorporating hospitals with maternity services, allowing patients and providers to plan for the appropriate care setting to address their obstetrical needs. Likewise, OB-TRAIN creates a composite score of specific factors with common terminology that can be used across obstetric and pediatric units to categorize an obstetric patient’s needs. 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.

“While many hospitals may already be familiar with expected challenges during catastrophic events,” DeNicola said, “Previously, we didn’t have the necessary shared language and networks to address challenges and implement responses with minimal disruption to obstetric and neonatal care. Levels of Maternal Care and OB-TRAIN will connect the dots to maintain a consistent delivery of care across a community during emergencies.”

The Committee Opinion also identifies strategies to assist women who are unable to access hospital facilities during or following a catastrophic event. Hospitals should consider using any existing telemedicine capabilities, including “distance prenatal care,” or telephone triage to maintain adequate patient care. Telemedicine approaches can also facilitate consultation between smaller regional facilities and larger tertiary care facilities. Being flexible and creative with these resources is essential to making sure every woman receives the care she needs.

Committee Opinion #726, “Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care,” will appear in the December issue of Obstetrics & Gynecology.

Other Recommendations in the December Issue of Obstetrics & Gynecology

Practice Bulletin #187, Neural Tube Defects 

Neural tube defects (NTDs) are congenital structural abnormalities of the central nervous system and vertebral column. Neural tube defects may occur as an isolated malformation, in combination with other malformations, as part of a genetic syndrome, or as a result of teratogenic exposure. Neural tube defects are the second-most common major congenital anomaly after cardiac malformations, and their prevalence varies by geographic region, race and environmental factors. Outcomes and disabilities depend on level and extent of lesion; for instance, anencephaly is incompatible with life, but most infants with spina bifida will survive after surgical repair. Importantly, and in contrast to many other congenital abnormalities, primary prevention of NTDs is possible with folic acid. In addition, prenatal screening and diagnosis are widely available, and fetal surgery has improved outcomes for some newborns. The purpose of this document is to provide information about NTDs and make management recommendations for the pregnancy complicated by a fetal NTD.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org