1. James, Dotti C. PhD, RNC, Guest Columnist

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This special issue of MCN contains many articles about nurses' need to better prepare for disasters. The words disaster preparedness probably make you think of terrorist attacks or hurricanes, but these are not the only emergencies to which perinatal nurses need to respond with uncommon skills. Other more common events triggered by weather often paralyze healthcare systems and threaten the health and safety of mothers and babies. For example, in one 12-month period, four federally declared disasters occurred in the Midwest related to excessive heat and cold. Heat waves with thunderstorms and tornados disrupt electrical power and air conditioning. Ice storms repeat the cycle of power outages, except cold becomes the hazard. Power outages force hospitals to discover the unanticipated weaknesses in their emergency systems and should cause perinatal nurses to consider how they would cope if a weather emergency resulted in all electrical power being lost.

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The problems facing perinatal nurses during such disasters are many, and preparation is key. Most nurses have been taught that during storms or tornados, patients should be moved to central corridors without windows and well babies should be taken to their mothers, but what can be done about maternal-fetal monitoring during labor? When fetal monitors and central surveillance systems aren't functioning, we are still responsible for ongoing assessment. Intermittent auscultation and uterine palpation may be the only methods available, requiring 1:1 nursing care. If the call light system fails, communication between patients and the perinatal team is challenging. IV pumps are another issue. They function only as long as the battery charge lasts, so nurses must be skilled in IV rate calculation. Computerized medication dispensing systems may become unavailable; alternative plans must be made to access medications. Effective warming for newborns might require skin-to-skin kangaroo care because blanket warmers might not work. Stress from weather dangers, power outages, and family disruption may cause women to present in preterm labor or with weather-related injuries. Water departments may experience failure of backup generators, and hospital backup generators may be unable to fully support water delivery or air conditioning to upper floors. If the water supply becomes contaminated, plans to obtain bottled water and food may be necessary.


All of these circumstances would seem to require additional nurses, but they may not be readily available. With power outages at home and children and aged parents to care for, nurses may be unable to work all assigned shifts. Nurses from neighboring areas may help, but transportation may be difficult if roadways are blocked with downed power lines, snow, ice, or motor vehicle accidents.


If mothers and babies are discharged during periods of extended power outages, it may be necessary to send them to shelters to protect new babies from extremes of heat, humidity, or cold. Perinatal nurses should know their Memoranda of Agreement ahead of need to facilitate the transfer of patients to other institutions.


It is more dramatic to think about the once-in-a-century event or the mass casualty event caused by terrorism, but the more likely event starts with the ordinary-a summer storm or a winter snow or ice storm. Being able to provide continuous, quality care for laboring women during these times is a heroic response, even if it does not receive the same level of media coverage or accolades.


Preparing the Labor and Birth Unit for Emergencies


* Get preapproval for 1:1 nurse staffing for intermittent auscultation of the fetal heart rate and palpation of uterine activity


* Create protocols for delaying elective procedures


* Create an emergency call list to facilitate meeting staffing needs


* Generate backup paper medical record forms if computerized documentation systems aren't functional


* Stock nonelectric neonatal warming pads


* Ensure pharmacist coverage for medication dispensing


* Stock flashlights and battery lanterns (with extra batteries on hand)


* Have walkie-talkies or other nonelectric communication devices


* Create plans for effective, limited use of electricity


* Create plans to obtain delivery of bottled water