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An Assessment of Pediatric Resident Disaster Preparedness for the Neonatal Intensive Care Unit

Published online by Cambridge University Press:  18 November 2021

Nitin Kuppanda
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
Joelle Simpson
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA Department of Emergency Medicine, Children’s National Hospital, Washington, DC, USA
Lamia Soghier*
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA Center for Translational Science, Children’s Research Institute, Children’s National Hospital, Washington, DC, USA Department of Neonatology, Children’s National Hospital, Washington, DC, USA
Corresponding author: Lamia Soghier, Email:



To assess the level of neonatal intensive care unit (NICU) disaster preparedness among pediatric residents.


A mixed-methods study including qualitative interviews and quantitative surveys was used. Interviews guided survey development. Surveys were distributed to residents who rotated through Children’s National NICU. Questions assessed residents’ background in disaster preparedness, disaster protocol knowledge, NICU preparedness, roles during surge and evacuation, and views on training and education.


Survey response was 62.5% (n = 80) with 51.3% of invited residents completing it. Pediatric residents (PGY-2 and PGY-3) (n = 41) had low levels of individual disaster preparedness, particularly evacuations (86%). None were aware of specific NICU disaster protocols. Patient acuity, role ambiguity, knowledge, and training deficits were major contributors to unpreparedness. Residents viewed their role as system facilitators (eg, performing duties assigned, recruiting other residents, and clerical work like documentation). Resident training requests included disaster preparedness training every NICU rotation (48%) using multidisciplinary simulations (66%), role definition (56%), and written protocols (50%). Despite their unpreparedness, residents (84%) were willing to respond.


Pediatric residents lacked knowledge of NICU disaster response but were willing to respond to disasters. Training should include multi-disciplinary simulations that can be refined iteratively to clarify roles, and residents should be involved in planning and execution.

Original Research
© The Author(s), 2021. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

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Esfandyari, M, Vaghef-Mehrabany, E, Ebrahimi-Mameghani, M. Varzaghan earthquake affected mothers’ and their newborns’ health more severely, in socioeconomically vulnerable area. Disaster Med Public Health Prep. 2019;13(3):511-518. doi: 10.1017/dmp.2018.96 CrossRefGoogle ScholarPubMed
Frey, MT, Meaney-Delman, D, Bowen, V, et al. Surveillance for emerging threats to pregnant women and infants. J Women Health. 2019;28(8):1031-1036. doi: 10.1089/jwh.2019.7943 CrossRefGoogle ScholarPubMed
Barfield, WD, Krug, SE. Disaster preparedness in neonatal intensive care units. Pediatrics. 2017;139(5):e20170507. doi: 10.1542/peds.2017-0507 CrossRefGoogle ScholarPubMed
Clancy, KA, Kacica, MA. Ready for our children? Results from a survey of Upstate New York hospitals’ utilization of pediatric emergency preparedness toolkit guidance. Disaster Med Public Health Prep. 2012;6(2):138-145. doi: 10.1001/dmp.2012.20 CrossRefGoogle ScholarPubMed
Phillips, P, Niedergesaess, Y, Powers, R, Brandt, R. Disaster preparedness: emergency planning in the NICU. Neonatal Netw J Neonatal Nurs. 2012;31(1):5-15. doi: 10.1891/0730-0832.31.1.5 CrossRefGoogle ScholarPubMed
Espiritu, M, Patil, U, Cruz, H, et al. Evacuation of a neonatal intensive care unit in a disaster: lessons from Hurricane Sandy. Pediatrics. 2014;134(6):e1662-9. doi: 10.1542/peds.2014-0936 CrossRefGoogle Scholar
Carbine, D, Cohen, R, Hopper, A, et al. Neonatal Disaster Preparedness Toolkit. Published 2015. Accessed July 26, 2018. Google Scholar
Neonatal Intensive Care Unit (NICU) Evacuation Guidelines. A guide to assist NICU professionals and Emergency Planners in their planning and preparation for evacuations; Lurie Childrenʼs Hospital; 2009. Google Scholar
Powell, T, Hanfling, D, Gostin, LO. Emergency preparedness and public health: the lessons from Hurricane Sandy. JAMA. 2012;308(24):2569-2570. doi: 10.1001/jama.2012.108940 CrossRefGoogle ScholarPubMed
Hayanga, HK, Barnett, DJ, Shallow, NR, et al. Anesthesiologists and disaster medicine: a needs assessment for education and training and reported willingness to respond. Anesth Analg. 2017;124(5):1662-1669. doi: 10.1213/ANE.0000000000002002 CrossRefGoogle ScholarPubMed
Martin, SD, Bush, AC, Lynch, JA. A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs. Pediatrics. 2006;118(3):e620-626. doi: 10.1542/peds.105.3.662 CrossRefGoogle ScholarPubMed
Summerhill, EM, Mathew, MC, Stipho, S, et al. A simulation-based biodefense and disaster preparedness curriculum for internal medicine residents. Med Teach. 2008;30(6):e145-e151. doi: 10.1080/01421590802047257 CrossRefGoogle ScholarPubMed
Farra, SL, Miller, ET, Gneuhs, M, et al. Disaster management. Nurs Manag (Springhouse). 2017;48(7):51-54. doi: 10.1097/01.NUMA.0000520720.78549.e4 CrossRefGoogle ScholarPubMed
Schultz, R, Pouletsos, C, Combs, A. Considerations for emergencies & disasters in the neonatal intensive care unit. MCN Am J Matern Child Nurs. 2008;33(4):204-210. doi: 10.1097/01.NMC.0000326073.19246.4c CrossRefGoogle ScholarPubMed
Policy Priorities to Improve the Nation’s Health from America’s Medical Schools and Teaching Hospitals. Colleges A of AM. 2021. March 11, 2021.Google Scholar
Burke, LG, Frakt, AB, Khullar, D, et al. Association between teaching status and mortality in US Hospitals. JAMA. 2017;317(20):2105-2113. doi: 10.1001/jama.2017.5702 CrossRefGoogle ScholarPubMed
ACGME. ACGME Program Requirements for Graduate Medical Education in Pediatrics.; 7/1/2021. Google Scholar
Mani, S. Five years of thoughts on Hurricane Katrina from a resident on duty. Pediatrics. 2011;128(Suppl 1). doi: 10.1542/peds.2010-3724D CrossRefGoogle ScholarPubMed
Barkemeyer, BM. Practicing neonatology in a blackout: The University Hospital NICU in the midst of Hurricane Katrina: caring for children without power or water. Pediatrics. 2006;117(Suppl 4):S369-S374. doi: 10.1542/peds.2006-0099F CrossRefGoogle ScholarPubMed
Newman, B, Gallion, C. Hurricane Harvey: first-hand perspectives for disaster preparedness in graduate medical education. Acad Med. 2019;94(9):1267-1269.10.1097/ACM.0000000000002696CrossRefGoogle Scholar
Zell, L, Blake, C, Brittingham, D, et al. Simulation prepares an interprofessional team to evacuate a 60-bed level 4 neonatal intensive care unit. J Perinat Neonatal Nurs. 2019;33(3):253-259. doi: 10.1097/jpn.0000000000000430 CrossRefGoogle Scholar
Stroud, MH, Trautman, MS, Meyer, K, et al. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics. 2013;132(2):359-366. doi: 10.1542/peds.2013-0529 CrossRefGoogle Scholar
Tegtmeyer, K, Conway, EE, Upperman, JS, Kissoon, N. Education in a pediatric emergency mass critical care setting. Pediatr Crit Care Med. 2011;12(6 Suppl). doi: 10.1097/PCC.0b013e318234a764 CrossRefGoogle Scholar
Christian, MD, Toltzis, P, Kanter, RK, et al. Treatment and triage recommendations for pediatric emergency mass critical care. Pediatr Crit Care Med. 2011;12(6 Suppl). doi: 10.1097/PCC.0b013e318234a656 CrossRefGoogle ScholarPubMed
Passmore, C, Dobbie, AE, Parchman, M, Tysinger, J. Guidelines for constructing a survey. Fam Med. 2002;34(4):281-286.Google ScholarPubMed
Monzani, A, Ragazzoni, L, della Corte F, et al. COVID-19 pandemic: perspective from Italian pediatric emergency physicians. Disaster Med Public Health Prep. 2020;14(5):648-651. doi: 10.1017/DMP.2020.198 CrossRefGoogle ScholarPubMed
Streeton, R, Cooke, M, Campbell, J. Researching the researchers: using a snowballing technique. Nurs Res. 2004;12(1):35-46. doi: 10.7748/nr2004. CrossRefGoogle Scholar
Merriam, SB, Tisdell, EJ. Qualitative research: a guide to design and implementation. 4th ed. John Wiley & Sons; 2015.Google Scholar
Simon, NJ, Atkins, A, Miller, B, et al. The value of cognitive pretesting: improving validity and revealing blind spots through the development of a newborn screening parent experiences survey. Int J Neonatal Screen. 2021;7(3). doi: 10.3390/IJNS7030041 CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. doi: 10.1016/j.jbi.2008.08.010 CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Minor, BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95. doi: 10.1016/j.jbi.2019.103208 CrossRefGoogle ScholarPubMed
Schlosser, KR, Creedon, JK, Michelson, KA, et al. Lessons from the 2013 Boston Marathon: incorporating residents into institutional emergency plans. Pediatrics. 2017;139(6):20170688.10.1542/peds.2017-0688CrossRefGoogle ScholarPubMed
Murphy, B. COVID-19: States Call on Early Medical School Grads to Bolster Workforce. American Medical Association. Published 2019. Accessed June 21, 2020. Google Scholar
Ragazzoni, L, Barco, A, Echeverri, L, et al. Just-in-time training in a tertiary referral hospital during the COVID-19 pandemic in Italy. Acad Med. 2021;96(3):336-339. doi: 10.1097/ACM.0000000000003575 CrossRefGoogle Scholar
Smith, EC, Burkle, FM, Aitken, P, Leggatt, P. Seven decades of disasters: a systematic review of the literature. Prehosp Disaster Med. 2018;33(4):418-423. doi: 10.1017/S1049023X18000638 CrossRefGoogle ScholarPubMed
Cohen, R, Murphy, B, Ahern, T, Hackel, A. Regional disaster planning for neonatology. J Perinatol. 2010;30(11):709-711. doi: 10.1038/jp.2010.76 CrossRefGoogle ScholarPubMed
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