Hostname: page-component-6b989bf9dc-vmcqm Total loading time: 0 Render date: 2024-04-13T19:39:31.321Z Has data issue: false hasContentIssue false

An Evacuation Simulation in Multiple Neonatal Intensive Care Units Across a Single City: Lessons Learned

Published online by Cambridge University Press:  03 August 2022

Zoe Tullius*
Paul L Foster School of Medicine, Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA El Paso Children’s Hospital, El Paso, TX, USA
Wanda Helgesen
Border Regional Advisory Council, El Paso, TX, USA
Zuber D Mulla
Paul L. Foster School of Medicine, Department of Obstetrics and Gynecology and Office of Faculty Development, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA Julia Jones Matthews Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
Sadhana Chheda
Paul L Foster School of Medicine, Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA El Paso Children’s Hospital, El Paso, TX, USA
Corresponding author: Zoe Tullius, Emails:,



Evacuations of neonatal intensive care units (NICUs) in emergency situations pose specialized challenges given their population of critically-ill neonates. Most of the literature on this topic describes planned evacuations and simulations due to natural disasters, usually involving only NICU staff. This study examines a unique emergent NICU evacuation simulation involving multiple responders occurring on a citywide scale.


A simulated evacuation in response to a fire was conducted in 6 different NICUs in El Paso, Texas. The exercise utilized response from NICU staff and first responders. A standardized tool, by independent evaluators, was used to evaluate staff competencies while reactions were assessed using post-exercise surveys.


This city-wide multidisciplinary simulation improved NICU personnel skills in evacuation and also introduced first responders to this specialized patient population. Areas of strength across all NICUs included teamwork, knowledge of evacuation equipment, and patient tracking. Areas for improvement included lack of adequate equipment for post-evacuation care, understanding implications of smoke exposure, alternative evacuation routes, incident command structure, and unified communication.


This successful, citywide NICU evacuation simulation improved knowledge among participants, introduced first responders to a specialized patient population, and provided valuable lessons on neonate-specific themes that can be incorporated to improve citywide emergency preparedness.

Original Research
© The Author(s), 2022. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Barfield, WD, Krug, SE, Committee on Fetus and Newborn, Disaster Preparedness Advisory Council. Disaster Preparedness in Neonatal Intensive Care Units. Pediatrics. 2017;139(5):e20170507. doi: 10.1542/peds.2017-0507 CrossRefGoogle ScholarPubMed
Chung, S, Foltin, G, Schonfeld, D. Pediatric disaster preparedness and response topical collection. In: Pediatrics AAP, ed. Itasca, IL: American Academy of Pediatrics; 2019.Google Scholar
Centers for Medicare and Medicaid Services. Emergency Preparedness Rule. Accessed January 2, 2021. Google Scholar
The Joint Commission. Plans - Emergency management event recovery/continuity. Accessed January 2, 2022. Google Scholar
Bernard, M, Mathews, PR. Evacuation of a maternal-newborn area during Hurricane Katrina. MCN Am J Matern Child Nurs. 2008;33(4):213-23. doi: 10.1097/01.NMC.0000326075.03999.11 CrossRefGoogle ScholarPubMed
Orlando, S, Bernard, ML, Mathews, P. Neonatal nursing care issues following a natural disaster: lessons learned from the Katrina experience. J Perinat Neonatal Nurs. 2008;22(2):147-153. doi: 10.1097/01.JPN.0000319102.20593.12 CrossRefGoogle ScholarPubMed
Mitchell, L, Anderle, D, Nastally, K, et al. Lessons learned from Hurricane Ike. AORN J. 2009;89(6):1073-1078. doi: 10.1016/j.aorn.2009.03.002 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):e1662-1669. doi: 10.1542/peds.2014-0936 CrossRefGoogle Scholar
Iwata, O, Kawase, A, Iwai, M, Wada, K. Evacuation of a tertiary neonatal centre: lessons from the 2016 Kumamoto Earthquakes. Neonatology. 2017;112(1):92-96. doi: 10.1159/000466681 CrossRefGoogle ScholarPubMed
Ma, AL, Cohen, RS, Lee, HC. Learning from wildfire disaster experience in California NICUs. Children (Basel). 2020;7(10):155. doi: 10.3390/children7100155 Google ScholarPubMed
Farra, S, Miller, ET, Gneuhs, M, et al. Evacuation performance evaluation tool. Am J Disaster Med. 2016;11(2):131-136. doi: 10.5055/ajdm.2016.0232 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 Google ScholarPubMed
Eskandar-Afshari, F, Carbine, DN, Cohen, RS, Cui, X, Dueñas, GV, Lee, HC. California NICU disaster preparedness. J Perinatol. 2020;40(8):1262-1266. doi: 10.1038/s41372-020-0676-3 CrossRefGoogle ScholarPubMed
Lin, A, Taylor, K, Cohen, RS. Triage by resource allocation for INpatients: a novel disaster triage tool for hospitalized pediatric patients. Disaster Med Public Health Prep. 2018;12(6):692-696. doi: 10.1017/dmp.2017.139 CrossRefGoogle ScholarPubMed
Lynch, TF, Kugler, L, Niedziela, J. Saving our smallest patients. J Healthc Prot Manage. 2014;30(2):72-82.Google ScholarPubMed
Farra, S, Hodgson, E, Miller, ET, et al. Effects of Virtual reality simulation on worker emergency evacuation of neonates. Disaster Med Public Health Prep. 2019;13(2):301-308. doi: 10.1017/dmp.2018.58 CrossRefGoogle ScholarPubMed
Femino, M, Young, S, Smith, VC. Hospital-based emergency preparedness: evacuation of the neonatal intensive care unit-the smallest and most vulnerable population. Pediatr Emerg Care. 2013;29(1):107-113. doi: 10.1097/PEC.0b013e31827b8bc5 CrossRefGoogle ScholarPubMed
Gray, MM, Thomas, AA, Burns, B, Umoren, RA. Evacuation of vulnerable and critical patients: multimodal simulation for nurse-led patient evacuation. Simul Healthc. 2020;15(6):382-387. doi: 10.1097/SIH.0000000000000451 CrossRefGoogle ScholarPubMed
Border RAC. Border RAC Regional Advisory Council: about us. Accessed January 2, 2022. Scholar
US Census Bureau. QuickFacts: El Paso County, Texas. Accessed January 2, 2022.,elpasocountytexas/PST045221.Google Scholar
Response OotASfPa. 2017-2022 Health Care Preparedness and Response Capabilities. In:2016:40-41. Accessed January 2, 2022. Google Scholar
HomeLand Security. Homeland Security Exercise and Evaluation Program (HSEEP). 2020:5-1-5-10. Accessed January 2, 2021. Google Scholar
FEMA. Exercise Evaluation Guides (EEGs): public health, healthcare, and emergency medical services. HSEEP Resources;2020.Google Scholar
Gray, MM, Thomas, AA, Burns, B, Umoren, RA. Identifying crucial equipment and skills needed to evacuate critically ill infants during disasters: using nursing expertise to guide training targets. Prehosp Disaster Med. 2019;34(4):370-375. doi: 10.1017/S1049023X19004473 CrossRefGoogle ScholarPubMed
Thomas, A, Gray, MM, Burns, B, Umoren, RA. EVAC: Evacuation of vulnerable and critical pediatric patients for nurses. Cureus. 2020;12(5):e8302. doi: 10.7759/cureus.8302.Google ScholarPubMed
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
Cocanour, CS, Allen, SJ, Mazabob, J, et al. Lessons learned from the evacuation of an urban teaching hospital. Arch Surg. 2002;137(10):1141-1145. doi: 10.1001/archsurg.137.10.1141 CrossRefGoogle ScholarPubMed
Soto, L, Chheda, S, Soto, J. Reducing fatalities in mass attacks and the related matter of gun control policy following the El Paso August 2019 Shooting. THJ. 2020;26:85.Google Scholar
Epley, E. Responses from the ground. Texas EMS Trauma News. 2017;4:3-4.Google Scholar
Flynn, SE. Higher ground: the sophisticated healthcare response of the SouthEast Texas Regional Advisory Council to Hurricane Harvey. Northeastern University. 2018:1-18.Google Scholar
Supplementary material: File

Tullius et al. supplementary material

Tullius et al. supplementary material

Download Tullius et al. supplementary material(File)
File 24.7 KB