Emergency Preparedness: Are You Ready?
By Ashley Richardson, MSN RNC-NIC CNML
An integral part of the healthcare system, emergency preparedness is much more than completing annual mandatory modules and knowing where the evacuation aprons are (even though those are VERY important). Whole teams are dedicated to preparing hospitals for emergencies, from natural disasters to cyberattacks. As disasters steadily increase in the world around us, comprehensive emergency response plans must adapt to the environment inside and outside the hospital. Systems must be in place for alternative methods of delivering care before normal care flow is interrupted.
But do those plans ever make it to the bedside team who will need to carry them out? It is imperative to pull out those emergency care binders, hand them to the bedside care team, and ask, “What are you supposed to do if you had to pack up your patients and go?” We are well versed at practicing and preparing for emergencies with patients through code simulations, but is your unit ready for a disaster, whether a natural event, such as a hurricane or earthquake, or a system failure, like a cyberattack?
The neonatal intensive care unit (NICU) cares for the most vulnerable populations in the entire healthcare system, posing a significant challenge when creating emergency plans specific to this specialty population. Complicating this further is the fact that neonates and other pediatric populations are solely dependent on their caregivers and technology for their survival during a disaster, unlike adults who could potentially participate in the evacuation process (Ghazanfari et al., 2022).
Disaster drills most often are tabletop exercises—facilitated discussions about scenarios, rather than comprehensive simulations—and often focus on adult populations (Oo et al., 2021). Even if there are comprehensive emergency plans in place, satisfying mandates from accrediting agencies like The Joint Commission, the facility often hasn’t completed enough simulations to be impactful and improve the comfort level of the bedside teams to execute seamlessly in the event of a disaster (Eskandar-Afshari et al., 2020). Most written NICU-specific evacuation information has come from lessons learned during hurricane evacuations, such as those experienced with Hurricanes Katrina, Ike and Sandy. Those storms and their aftermath highlighted the priorities of having battery-operated equipment, proper patient identification, alternate water sources and methods of thermoregulation, back-up medical records, and clear command structures (Tullius et al., 2023). Although types of disasters may be region- and site-specific, the responses to devastation require similar skills and actions (Eskandar-Afshari et al., 2020).
To establish or refine a NICU-specific emergency preparedness plan, leaders should look at institutions or agencies that have created toolkits. The California Perinatal Quality Care Collaborative (CPQCC) released their updated toolkit, 10-Step Guide for Neonatal Disaster Preparedness, in September 2025 with the help of the California Association of Neonatology and Loma Linda University Children’s Hospital (Lefrak et al., 2025). This guide includes steps such as establishing a disaster plan, completing risk assessments, establishing neonatal evacuation protocols, training staff, and conducting regular drills. These actions increase the likelihood that the care team can continue to provide high-quality care during emergencies (Lefrak et al., 2025).
One specific call-out in the CPQCC guide highlighted the need to strengthen partnerships with community and emergency agencies, a concept echoed in many other publications (Lefrak et al., 2025). An article published by Tullius et al. (2023) outlined an evacuation simulation coordinated with multiple NICUs within El Paso, Texas, which included first responders, many of whom had never seen a premature infant, much less had to evacuate one.
CPQCC’s comprehensive disaster toolkit details the six elements of disaster response, discusses how to conduct hazard vulnerability analyses, and provides important and useful checklists, such as required forms and job action sheets that the multidisciplinary team needs to successfully handle any emergency (Lefrak et al., 2025).
A study found that in every scenario published about the evacuation of neonates from their home unit to another unit in the hospital or to another facility, simulations increased providers’ comfort level with the plan more than reviewing the emergency plans with tabletop discussions (Ghazanfari et al., 2022). This is a reminder to continue the work of practicing the plans that are put together for disaster response.
Another integral part of creating emergency preparedness plans is to include staff nurses in the development of the emergency plans and observe the operations performed by the hospital incident command center to better understand the workflows and the significant role bedside clinicians play in those plans (Tussing et al., 2022).
Emergency preparedness in the NICU requires a deeper level of proactiveness in creating and distributing highly specialized and multidisciplinary disaster plans to provide uncompromised care to patients and their families. Lessons learned through lived emergencies and simulations stress the importance of practicing drafted plans through simulation. This is the only way to improve the comfort level of the providers caring for the most vulnerable populations in the healthcare system and leads to positive outcomes for neonatal patients during crisis. It’s time to open that disaster manual to make sure the team is ready for any disaster!
References
Eskandar-Afshari, F., Carbine, D. N., Cohen, R. S., Cui, X., Dueñas, G. V., & Lee, H. C. (2020). California NICU disaster preparedness. Journal of Perinatology, 40(8), 1262-1266. https://doi.org/10.1038/s41372-020-0676-3
Ghazanfari, M. J., Karkhah, S., & Yaghoubi, T. (2022). Emergency evacuation related challenges in specialized hospitals for children and neonates: a narrative review. Journal of Pediatrics Review. 10(2):111-120.
Lefrak, L., Cohen, R., & Breault, C. (2025). Neonatal disaster preparedness toolkit. California Perinatal Quality Care Collaborative and California Association of Neonatologists. https://www.cpqcc.org/content/can-neonatal-disaster-preparedness-toolkit
Oo, M. K., Siswoyo, B. E., Thit, W. M., & Thajeen, J. (2021, February). A guideline for innovative tabletop & simulation exercise: Lesson learned from MBDS experiences. Mekong Basin Disease Surveillance (MBDS) Foundation. https://mbdsnet.org/wp-content/uploads/2023/02/Guideline-for-Innovative-Tabletop-Simulation.pdf
Tullius, Z., Helgesen, W., Mulla, Z. D., & Chheda, S. (2023). An evacuation simulation in multiple neonatal intensive care units across a single city: Lessons learned. Disaster Medicine and Public Health Preparedness, 17, e244. https://doi.org/10.1017/dmp.2022.158
Tussing, T. E., Chesnick, H., & Jackson, A. (2022). Disaster preparedness: keeping nursing staff and students at the ready. Nursing Clinics of North America, 57(4), 599-611. https://doi.org/10.1016/j.cnur.2022.06.008