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Created by the New York City Pediatric Disaster Coalition in collaboration with city experts and hospitals, the template supports site-specific customization and recommends alignment with an institution’s emergency operations plan. It includes placeholders for facility name and revision date, guidance on when to reference emergency operations policies, and a structured table of contents covering plan objectives, NICU details, staff roles, triage space, fire/smoke and oxygen considerations, activation steps, notifications, command center activities, and senior management.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/neonatal-intensive-care-unit-surge-and-evacuation-plan-template-use-guidance/351106/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/neonatal-intensive-care-unit-surge-and-evacuation-plan-template-use-guidance/351106.png","ImageObject",442,249,{"name":88,"@type":89},"Mary Man","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-09-22",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",13,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"Who created this NICU surge and evacuation plan template?","Question",{"text":109,"@type":110},"It was created by the New York City Pediatric Disaster Coalition (PDC) with collaboration from New York City subject matter experts and New York City hospitals.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How should the template be used by healthcare facilities?",{"text":114,"@type":110},"Facilities should use it alongside PDC’s Pediatric Surge and Evacuation Plan Guidelines and modify it as needed to fit their existing disaster plan.",{"name":116,"@type":107,"acceptedAnswer":117},"What guidance does the template provide for referencing the emergency operations plan?",{"text":118,"@type":110},"When creating a surge plan, it recommends providing references (for example, page numbers) to the facility’s emergency operations plan where necessary, and following current policies and procedures.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},351106,1791047546,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":142},7421720224475,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Neonatal Intensive Care Unit Surge and Evacuation Plan  \n[Insert Institution Name Here]  \n[Insert Date Created / Revised Here]  \nCreated by:  \n[New York City Pediatric Disaster Coalition]  \n[New York City Department of Health and Mental Hygiene]  \nHow to Use This Template:  \nThe Neonatal Intensive Care Unit (NICU) Surge and Evacuation Plan Template was created by the New York City Pediatric Disaster Coalition (PDC) to help health care facilities create site-specific pediatric surge and evacuation plans to be incorporated into their overall disaster plans. PDC reviewed existing literature and research and collaborated with New York City subject matter experts and New York City hospitals to develop this template.  \nPlease use this template in conjunction with PDC’s Pediatric Surge and Evacuation Plan Guidelines.  \nWhen necessary, please modify the template to adapt to your existing disaster plan.  \nPDC recommends referring to your institution’s emergency operations plan for guidance on current policies and procedures. When creating your surge plan, provide references (e.g., see page number) to your facility’s emergency operations plan where necessary.  \nFor questions or more information about using this template, please contact PDC.  \nThank you,  \nNew York City Pediatric Disaster Coalition  \nNew York City Department of Health and Mental Hygiene  \nDr. George Foltin  \nPrincipal Investigator  \nNew York City Pediatric Disaster Coalition [gfoltin@maimonidesmed.org](gfoltin@maimonidesmed.org)  \nDr. Michael Frogel  \nCo-Principal Investigator  \nNew York City Pediatric Disaster Coalition [mfrogel@maimonidesmed.org](mfrogel@maimonidesmed.org)  \nLuAnn Gibson, LMSW, MPA  \nProgram Manager  \nNew York City Pediatric Disaster Coalition [lugibson@maimonidesmed.org](lugibson@maimonidesmed.org)  \nJohn Jermyn  \nProject Coordinator  \nNew York City Pediatric Disaster Coalition [jjermyn@maimonidesmed.org](jjermyn@maimonidesmed.org)  \nWanda I. Medina  \nSenior Program Manager, Healthcare and Medically Vulnerable Populations New York City Department of Health and Mental Hygiene  \nBureau of Healthcare System Readiness  \nOffice of Emergency Preparedness and Response [wmedina2@health. nyc.gov](wmedina2@health. nyc.gov)  \nWebsite: [pediatricdisastercoalition.org](pediatricdisastercoalition.org) General Email: [info@pediatricdisastercoalition.org](info@pediatricdisastercoalition.org)  \nTable of Contents  \nTable of Contents  \n____________________________________________________________________________  \nEme_rgency Operations  Plan_: Pediatric Addendum ............................................................. 1_  \nPlan Objectives.................................................................................................................. 1_  \nPlan Revision ..................................................................................................................... 1  \n____________________________________________________________________________  \nNICU_Details and Contacts ................................................................................................. 1_  \nSurge Triage Space............................................................................................................. 2_  \nStaff Roles and Schedules .................................................................................................. 2  \nClinical Staff....................................................................................................................... 3  \nNon-Clinical Staff .............................................................................................................. 3  \n____________________________________________________________________________  \nSpecific Considerations ...................................................................................................... 4  \nSmoke/Fire........................................................................................................................ 4  \n___ Oxygen ","cbCainVuyHJJj84E","https://ap.wps.com/l/cbCainVuyHJJj84E","pdf",747537,28,"English","# Emergency Operations Plan - Pediatric Addendum\n## Plan Objectives\n## Plan Revision\n# NICU Details and Contacts\n## Surge Triage Space\n## Staff Roles and Schedules\n## Clinical Staff\n## Non-Clinical Staff\n# Specific Considerations\n## Smoke/Fire\n## Oxygen Considerations in Case of Fire\n## Pre-Activation\n## Impending Threat or Condition\n## Plan Activation\n## Immediate Threat\n## Notifications and Communication\n## Hospital Command Center\n## Staffing and Activities\n## Staffing\n## Hospital Command Center Activities\n## Senior Management\n## Internal Staff Notification\n## Internal Staff Response\n## Off-Duty Staff Notification\n## Off-Duty Staff Response\n## External Notifications","[{\"question\":\"Who created this NICU surge and evacuation plan template?\",\"answer\":\"It was created by the New York City Pediatric Disaster Coalition (PDC) with collaboration from New York City subject matter experts and New York City hospitals.\"},{\"question\":\"How should the template be used by healthcare facilities?\",\"answer\":\"Facilities should use it alongside PDC’s Pediatric Surge and Evacuation Plan Guidelines and modify it as needed to fit their existing disaster plan.\"},{\"question\":\"What guidance does the template provide for referencing the emergency operations plan?\",\"answer\":\"When creating a surge plan, it recommends providing references (for example, page numbers) to the facility’s emergency operations plan where necessary, and following current policies and procedures.\"}]","Neonatal Intensive Care Unit Surge and Evacuation Plan - Template - Use Guidance | PDF",1790092648,10]