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

Abstract Objective: 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. Methods: 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. Results: 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. Conclusions: 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.