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Steps Toward a National Disaster Plan for Obstetrics

Daniels, Kay MD; Oakeson, Ann Marie MSN, RDMS; Hilton, Gillian MBChB, FRCA

doi: 10.1097/AOG.0000000000000326
Contents: Current Commentary

Hospitals play a central role in disasters by receiving an influx of casualties and coordinating medical efforts to manage resources. However, plans have not been fully developed in the event the hospital itself is severely damaged, either from natural disasters like earthquakes or tornados or manmade events such as a massive electrical failure or terrorist attacks. Of particular concern is the limited awareness of the obstetric units' specialized needs in the world of disaster planning. Within the same footprint of any obstetric unit, there exists a large variety of patient acuity and needs including laboring women, postoperative patients, and healthy postpartum patients with their newborns. An obstetric-specific triage method is paramount to accurately assess and rapidly triage patients during a disaster. An example is presented here called OB TRAIN (Obstetric Triage by Resource Allocation for Inpatient). To accomplish a comprehensive obstetric disaster plan, there must be 1) national adoption of a common triage and evacuation language including an effective patient tracking system to avoid maternal–neonatal separation; 2) a stratification of maternity hospital levels of care; and 3) a collaborative network of obstetric hospitals, both regionally and nationally. However, obstetric disaster planning goes beyond evacuation and must include plans for shelter-in-place and surge capacity, all uniquely designed for the obstetric patient. Disasters, manmade or natural, are neither predictable nor preventable, but we can and should prepare for them.

Obstetric disaster planning requires a triage tool, a national stratification of maternity hospital levels of care, and a collaborative network of hospitals.

Departments of Obstetrics and Gynecology and Anesthesia, Stanford University School of Medicine, and the Lucile Packard Children's Hospital at Stanford, Stanford, California.

Corresponding author: Kay Daniels, MD, Department of Obstetrics and Gynecology, Stanford University School of Medicine, H3330, 300 Pasteur Dr., Stanford, CA 94305; e-mail:

Supported by the Department of Obstetrics and Gynecology, the Department of Anesthesia, Lucile Packard Children's Hospital at Stanford University School of Medicine.

The authors thank the Disaster Committee at Lucile Packard Children's Hospital: Fran Schlaefer, Nancy Peterson, Barbara Petree, Susan Lee, Mariamne Sulayma, Ana Clark, Camille Anacabe, Laura Harwood, Brandon Bond, Ronald Cohen, and Anna Linn for their contributions to the development of disaster planning tools; and Jane Chueh for editorial assistance.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.