A strategy for disaster preparedness in obstetrics





obstetric disaster planning, preexisting regional coalitions, COVID-19


Background: Many hospital units, including obstetric (OB) units, were unprepared when the novel coronavirus began sweeping through communities. National and international bodies, including the World Health Organization, Centers for Disease Control Prevention, and the American College of Obstetricians and Gynecologists, directed enormous efforts to present the latest evidence-based practices to healthcare institutions and communities. The first hospitals that were affected in China and the United States (US) did heroic work in assisting their colleagues with best practices they had acquired. Despite these resources, many US hospitals struggled with how to best incorporate and implement this new information into disaster plans, and many protocol changes had to be established de novo. In general, disaster planning for OB units lagged behind other disaster planning performed by specialties such as emergency medicine, trauma, and pediatrics.

Participants: Fortunately, two pre-existing collaborative disaster groups, the OB Disaster Planning Workgroup and the Western Regional Alliance for Pediatric Emergency Management, were able to rapidly deploy during the pandemic due to their pre-established networks and shared goals.

Main outcome: These groups were able to share best practices, identify and address knowledge gaps, and disseminate information on a broad scale. The case will be made that the OB community needs to establish more such regional and national disaster committees that meet year-round. This will ensure that in times of urgency, these groups can increase the cadence of their meetings, and thus rapidly disperse time-sensitive policies and procedures for OB units nationwide.

Conclusion: Given the unique patient population, it is imperative that OB units establish regional coalitions to facilitate a coordinated response to local and national disasters.

Author Biographies

Kay Daniels, MD

Clinical Professor, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California

Manju Monga, MD

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas

Saloni Gupta

Medical Student, David Geffen School of Medicine, UCLA, Los Angeles, California

Gillian Abir, MBChB, FRCA

Clinical Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California

M. Chanisse

Western Regional Alliance for Pediatric Emergency Management (WRAPEM), UCSF School of Medicine, San Francisco, California

Christopher Newton, MD, FACS, FAAP

Pediatric and Trauma Surgeon, Medical Director, Trauma Care Center and Pediatric Surgery Department, UCSF Benioff Children’s Hospitals, Oakland, California


Chen H, Guo J, Wang C, et al.: Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet. 2020; 395: 809-815.

Breslin N, Baptiste C, Miller R, et al.: Coronavirus disaster 2019 in pregnancy: Early lessons. Am J Obstet Gynecol MFM. 2020; 2: 100-111.

Breslin N, Baptiste C, Gyamfi-Bannerman C, et al.: Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020; 2: 10018.

Gawande A: Why Boston’s hospitals were ready. The New Yorker, April 17, 2017.

Gates J, Arabian S, Biddinger P, et al.: The initial response to the Boston marathon bombing: Lessons learned to prepare for the next disaster. Ann Surg. 2014; 260: 960-966.

Martin JA, Hamilton BE, Osterman MJK, et al.: Births: Final data for 2018. National Vital Statistics Reports. Vol. 68, No. 13. Hyattsville, MD: National Center for Health Statistics, 2019.

American College of Obstetricians and Gynecologists: Preparing for disasters: Perspectives on women. Committee opinion no. 457. Obstet Gynecol. 2010; 115: 1339-1342.

The Pandemic and All-Hazards Preparedness Act (P.L. 109-417): Provisions and changes to preexisting law. 109th Congress. 2006. Available at https://www.govinfo.gov/content/pkg/PLAW-109publ417/pdf/PLAW-109publ417.pdf. Accessed May 29, 2021.

Coccolini F, Sartelli M, Kluger Y, et al.: COVID-19 the showdown for mass casualty preparedness and management: The Cassandra syndrome. World J Emerg Surg. 2020; 15: 26. DOI: 10.1186/s13017-020-00304-5.

Beigi RH, Davis G, Hodges J, et al.: Preparedness planning for pandemic influenza among large US maternity hospitals. Emerg Health Threats J. 2009; 2: E2.

Daniels K, Oakeson AM, Hilton G: Steps toward a national disaster plan for obstetrics. Obstet Gynecol. 2014; 124: 154-158.

American College of Obstetricians and Gynecologists: Hospital disaster preparedness for obstetricians and facilities providing maternity care. Committee opinion no. 726. Obstet Gynecol. 2017; 130: E291-E297.

American College of Obstetricians and Gynecologists: Levels of maternal care. Obstetric care consensus no. 9. Obstet Gynecol. 2019; 134: E41-E55.

Vladutiu CJ, Minnaert JJ, Sosa S, et al.: Levels of maternal care in the United States: An assessment of publicly available state guidelines. J Womens Health (Larchmt). 2020; 29: 353-361.

MacKenzie E, Rivara F, Jurkovish G, et al.: A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006; 354: 366-378.

Champion HR, Mabee MS, Meredith JW: The state of US trauma systems: Public perceptions versus reality—Implications for US response to terrorism and mass casualty events. J Am Coll Surg. 2006; 203: 951-961.

Carr BG, Walsh L, Williams JC, et al.: A geographic simulation model for the treatment of trauma patients in disasters. Prehosp Disaster Med. 2016; 31: 413-421.

Klima DA, Seiler SH, Peterson JB, et al.: Full-scale regional exercises: Closing the gaps in disaster preparedness. J Trauma Acute Care Surg. 2012; 73: 592-597.

Claridge J, Allen D, Paterons B, et al.: Regional collaboration across hospitals systems to develop and implement trauma protocols saves lives within 2 years. Surgery. 2013; 154: 875-882.

Mattox K: Hurricanes Katrina and Rita: Role of individuals and collaborative networks in mobilizing/coordinating societal and professional resources for major disasters. Crit Care. 2006; 10: 205.

National Pediatric Disaster Coalition: Available at http://npdcoalition.org. Accessed May 2020.

Western Regional Alliance for Pediatric Emergency Management: Available at http://wrap-em.org. Accessed May 2020.



How to Cite

Daniels, MD, K., M. Monga, MD, S. Gupta, G. Abir, MBChB, FRCA, M. Chanisse, and C. Newton, MD, FACS, FAAP. “A Strategy for Disaster Preparedness in Obstetrics”. American Journal of Disaster Medicine, vol. 16, no. 3, Sept. 2021, pp. 207-13, doi:10.5055/ajdm.2021.0403.