Evacuation of a Tertiary Neonatal Centre: Lessons from the 2016 Kumamoto Earthquakes

Abstract

Background: Newborn infants hospitalised in the neonatal intensive care unit (NICU) are vulnerable to natural disasters. However, publications on evacuation from NICUs are sparse. The 2016 Kumamoto Earthquakes caused serious damage to Kumamoto City Hospital and its level III regional core NICU. Local/neighbour NICU teams and the disaster-communication team of a neonatal academic society cooperated to evacuate 38 newborn infants from the ward.

Objective: The aim of this paper was to highlight potential key factors to improve emergency NICU evacuation and coordination of hospital transportation following natural disasters.

Methods: Background variables including clinical risk scores and timing/destination of transportation were compared between infants, who subsequently were transferred to destinations outside of Kumamoto Prefecture, and their peers.

Results: All but 1 of the infants were successfully evacuated from their NICU within 8 h. One very-low-birth-weight infant developed moderate hypothermia following transportation. Fourteen infants were transferred to NICUs outside of Kumamoto Prefecture, which was associated with the diagnosis of congenital heart disease, dependence on respiratory support, higher risk scores, and longer elapsed time from the decision to departure. There was difficulty in arranging helicopter transportation because the coordination office of the Disaster Medical Assistance Team had requisitioned most air/ground ambulances and only helped arrange ground transportations for 13 low-risk infants. Transportation for all 10 high-risk infants (risk scores greater than or equal to the upper quartile) was arranged by local/neighbour NICUs.

Conclusions: Although the overall evacuation process was satisfactory, potential risks of relying on the adult-based emergency transportation system were highlighted. A better system needs to be developed urgently to put appropriate priority on vulnerable infants.

Keywords: Hospital evacuation; Natural disaster; Newborn infant; Transportation.

Fig. 1

Transportation risk and subsequent evacuation of 38 infants. a Histogram of the composite risk scores for the transportation of 38 infants. Open bars, infants transferred by the DMAT coordination office. Shaded-bars, infants transferred by the NICU network (i.e., independent of the DMAT coordination office). Note that transportation of infants requiring high-dependency care with the composite scores of equal to or greater than the upper quartile (indicated as “high-risk” quartile) were exclusively arranged by the NICU network. b Timing of evacuation from Kumamoto City Hospital plotted along the clock time on the x-axis for “all patients,” the “high-risk” subgroup, and their “low-risk” peers. The pace of evacuation was similar between the 2 subgroups, highlighting the difficulty in putting a priority on the transportation of high-risk infants. DMAT, Disaster Medical Assistance Team; NICU, neonatal intensive care unit.