scholarly journals (P1-103) Utilization of a Pediatric Disaster Coalition as a Model for Regional Pediatric Disaster Planning

2011 ◽  
Vol 26 (S1) ◽  
pp. s132-s132
Author(s):  
G. Foltin ◽  
A. Flamm ◽  
A. Cooper ◽  
M. Sagy ◽  
B.M. Greenwald ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Preparedness ◽  
Large Scale ◽  
Pediatric Emergency ◽  
Mass Casualty ◽  
Metropolitan Region ◽  
Pediatric Care ◽  
Preparedness Planning ◽  
Field Triage ◽  
Care Surgery

PurposeThere remains a lack of comprehensive pediatric emergency preparedness planning worldwide. A disaster or mass-casualty incident (MCI) involving pediatric patients could overwhelm existing pediatric resources within the New York City (NYC) metropolitan region. The NYC Department of Health and Mental Hygiene (DOHMH) recognizing the importance to plan for a MCI with a large number of pediatric victims, implemented a project (the Pediatric Disaster Coalition; PDC), to address gaps in the healthcare system to provide effective and timely pediatric care during a MCI.MethodsThe PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from the NYC pediatric/children's hospitals, DOHMH, Office of Emergency Management, and Fire Department (FDNY). Two committees addressed pediatric prehospital triage, transport, and pediatric critical care (PCC) surge capacities. They developed guidelines and recommendations for pediatric field triage and transport, matching patients' needs to resources, and increasing PCC Surge Capacities.ResultsSurge recommendations were formulated. The algorithm developed provides specific pediatric triage criteria that identify severity of illness using the traditional Red, Yellow, and Green categories plus an Orange designation for continual reassessments that has been adopted by FDNY that has trained > 3,000 FDNY EMS personnel in its use. Triaged patients can be transported to appropriate resources based on a tiered system that defines pediatric hospital capabilities. The Surge Committee has created PCC Surge Capacity Guideline that can be used by hospitals to create their individual PCC surge plans. 15 of 25 NYC hospitals with PCC capabilities are participating with PDC planning; 5 have completed surge plans, 3 are nea completion, and 7 are in development. The completed plans add 92 surge beds to 244 regularly available PICU beds. The goal is to increase the PCC surge bed capacity by 200 + beds.ConclusionsThe project is an effective, multidisciplinary group approach to planning for a regional, large-scale pediatric MCI. Regional lead agencies must emphasize pediatric emergency preparedness in their disaster plans.

Utilizing a Pediatric Disaster Coalition Model to Increase Pediatric Critical Care Surge Capacity in New York City

2017 ◽  
Vol 11 (4) ◽  
pp. 473-478 ◽  
Author(s):  
Michael Frogel ◽  
Avram Flamm ◽  
Mayer Sagy ◽  
Katharine Uraneck ◽  
Edward Conway ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Critical Care ◽  
York City ◽  
Emergency Preparedness ◽  
Mass Casualty ◽  
Surge Capacity ◽  
Pediatric Critical Care ◽  
Mass Casualty Event ◽  
Care Surgery

AbstractA mass casualty event can result in an overwhelming number of critically injured pediatric victims that exceeds the available capacity of pediatric critical care (PCC) units, both locally and regionally. To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) was established. The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from 18 of 25 major NYC PCC-capable hospitals. A PCC surge committee created recommendations for making additional PCC beds available with an emphasis on space, staff, stuff (equipment), and systems. The PDC assisted 15 hospitals in creating PCC surge plans by utilizing template plans and site visits. These plans created an additional 153 potential PCC surge beds. Seven hospitals tested their plans through drills. The purpose of this article was to demonstrate the need for planning for disasters involving children and to provide a stepwise, replicable model for establishing a PDC, with one of its primary goals focused on facilitating PCC surge planning. The process we describe for developing a PDC can be replicated to communities of any size, setting, or location. We offer our model as an example for other cities. (Disaster Med Public Health Preparedness. 2017;11:473–478)

Emergency drills and exercises in healthcare organizations: Assessment of pediatric population involvement using after-action reports

2009 ◽  
Vol 4 (1) ◽  
pp. 23-32 ◽  
Author(s):  
Rizaldy R. Ferrer, PhD ◽  
Marizen Ramirez, PhD, MPH ◽  
Kori Sauser, MD ◽  
Ellen Iverson, MPH ◽  
Jeffrey S. Upperman, MD, FACS, FAAP
Keyword(s):  
Emergency Preparedness ◽  
Disaster Preparedness ◽  
Qualitative Content Analysis ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
Pediatric Care ◽  
Healthcare Organizations ◽  
Bed Capacity ◽  
Reporting Tool ◽  
Using Data

Background: Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires healthcare organizations to demonstrate disaster preparedness through the use of disaster exercises, the evaluation of pediatric preparations is often lacking. Our investigation identified, described, and assessed pediatric victim involvement in healthcare organizations’ disaster drills and exercises using data from after-action reports.Methods: Following the IRB approval, the authors reviewed the after-action reports generated by healthcare organizations after a disaster drill and exercise, as a self-assessed reporting tool for JCAHO regulations. Forty-nine of these reports that were voluntarily supplied to the emergency medical services agency were collected. The authors analyzed the data using quantitative and qualitative analytic approaches.Results: Only nine reports suggested pediatric involvement. Hospitals with large bed capacity (M = 465.6) tended to include children in exercises compared with smaller facilities (M = 350.8). Qualitative content analysis revealed themes such as lack of parent–child identification and family reunification systems, ineffective communication strategies, lack of pediatric resources and specific training, and unfamiliarity with altering standards of pediatric care during a disaster.Conclusions: Although many organizations are performing disaster exercises, most are not including pediatric concerns. Further work is needed to understand the basis for this gap in emergency preparedness. Overall, pediatric emergency planning should be a high priority for this vulnerable population.

scholarly journals (P1-106) Scarce Resources Planning Summit for Pediatric Critical Care and Transport Stakeholders

2011 ◽  
Vol 26 (S1) ◽  
pp. s133-s133
Author(s):  
S. Reynolds ◽  
E.K. Weber ◽  
P.J. Severin
Keyword(s):  
Critical Care ◽  
Emergency Preparedness ◽  
Ethical Issues ◽  
Community Integration ◽  
Pediatric Emergency ◽  
Standards Of Care ◽  
Pediatric Critical Care ◽  
Scarce Resources ◽  
Incident Command ◽  
Key Issues

There are six children's hospitals in Chicago, Illinois and the surrounding region. These hospitals often have bed limitations due to high censuses in daily operations. The Pediatric Committee of the Chicago Healthcare System Coalition for Preparedness and Response had provided two conferences in pediatric emergency preparedness in Spring 2010 that identified a need to examine scarce critical care resources in the region. A “Pediatric Critical Care and Transport Stakeholder's Summit” was convened in April 2010. This meeting brought together the Pediatric Critical Care Medical and Nursing Directors along with Transport Team representatives from major hospitals to identify the key issues related to pediatric emergency preparedness and scarce resources. The four-hour Summit, was held in a Conference Center, away from any hospital or clinical setting, was organized into seven sections: (1) Welcome & Introductions; (2) Issues Identification; (3) Scenario Introduction; (4) Specific Issues Indentification; (5) Prioritization of Specific Issues; (6) Development of Action Steps; and (7) Moving Forward. A Facilitator with specific knowledge of hospital-based preparedness led the Summit process. He utilized a pediatric scenario to engage the participants in discussion, interaction, and planning. Action steps, with statements of need and specific action items were developed, based on the following prioritized issues: (1) lack of pediatric training and experience for front line personnel; (2) alternate care sites/bed capacity/surge planning; (3) ethical issues; (4) transport; (5) credentialing/pediatric specialist availability; (6) incident command/community integration; (7) pediatric supplies and equipment; (8) patient indentification; (9) financial tracking/reimbursement; and (10) Crisis Standards of Care/Crisis Operation Standards Moving forward, the participants of the Summit will reconvene into small workgroups to develop plans and training for the areas specified above. In May, 2011 a statewide exercise utilizing the special population of children will occur to test these plans.

scholarly journals Medical Coordination Rescue Members’ and Ambulance Nurses’ Perspectives on Emergency Mass Casualty and Terrorism Preparedness in the Netherlands - A Qualitative Study

2019 ◽  
Vol 34 (s1) ◽  
pp. s79-s80
Author(s):  
Johan De Cock ◽  
Sivera Berben ◽  
Lilian Vloet
Keyword(s):  
The Netherlands ◽  
Emergency Preparedness ◽  
Large Scale ◽  
Terrorist Attack ◽  
Structured Interview ◽  
Mass Casualty ◽  
Terrorist Attacks ◽  
Mass Casualties ◽  
List Type ◽  
New Model

Introduction:Mass casualty incidents, specifically incidents with chemical, biological, radiological, and nuclear agents (CBRN) or terrorist attacks, challenge medical coordination, rescue, and ambulance care. Recently in the Netherlands, a new model for emergency preparedness for large-scale mass casualties and a specific approach dealing with terrorist attacks was introduced (2016).Aim:To provide insight into the first experiences with this approach in order to identify strengths and pitfalls.Methods:The study had a qualitative design and was performed between January 2017 and June 2018. A semi-structured interview included topics that were selected based on available literature. All interviews were typed out verbatim and were analyzed using a structured approach of labeling and clustering of the response.Results:The main issues raised by the respondents included the following: The interpretation of definitions introduced in the new model for the mass casualty preparedness model and the terrorist attack approach differed among respondents.All respondents supported the six points of departure in the CRBN and terrorist attack approach.Awareness of optimal personal safety (‘safety first principle’) specific for CBRN and terrorism is lacking.Respondents reported that several rescue workers did not feel competent to perform specific newly introduced tasks, such as the command and control of the first ambulance arriving at the scene and the coordination task of emergency transport by the dispatch nurse.Current regional differences in preparedness may complicate interregional collaboration.Discussion:As the approach is new and experience is primarily based on the outcome of exercises, the systematic planning and evaluation of exercises, and sharing of opinions and knowledge, as a result, is important to ensure an unambiguous approach in a real situation.

Ready for Our Children? Results From a Survey of Upstate New York Hospitals' Utilization of Pediatric Emergency Preparedness Toolkit Guidance

2012 ◽  
Vol 6 (2) ◽  
pp. 138-145 ◽  
Author(s):  
Kathleen A. Clancy ◽  
Marilyn A. Kacica
Keyword(s):  
New York ◽  
Emergency Preparedness ◽  
Pediatric Patients ◽  
Management Plan ◽  
Pediatric Emergency ◽  
Clinical Expertise ◽  
Emergency Plan ◽  
Hospital Size ◽  
Preparedness Planning ◽  
Clinical Coordinator

ABSTRACTObjective: This project evaluated New York (NY) hospitals outside of New York City (upstate) for their awareness and utilization of the NY State Department of Health Pediatric and Obstetric Emergency Preparedness Toolkit (toolkit) and presence of pediatric emergency preparedness planning elements.Methods: A survey assessing toolkit awareness and utilization was distributed to all 145 upstate NY hospitals. Quantitative survey data were analyzed using summary statistics, χ2 analysis, and odds ratios (OR) in aggregate, by hospital size, and by presence of pediatric medicine/surgery, pediatric intensive care unit (PICU), and/or neonatal ICU (NICU) beds (pediatric beds).Results: Of the 145 hospitals, 116 (80%) completed the survey; 86% of these had reviewed the toolkit. Most had staff clinicians with pediatric expertise, but fewer had appointed pediatric clinical (physician or nurse) coordinators. Hospitals with at least one pediatric bed were more than 2.5 times more likely to have an emergency management plan (EMP) for pediatric patients (P =. 0223) and nearly 8 times more likely to have appointed a pediatric physician coordinator (P <. 0001) than were hospitals without pediatric beds. Appointment of a pediatric clinical coordinator was significantly associated (P <. 001) with presence of various pediatric emergency plan elements (OR range: 3.06-15.13), while staff pediatric clinical expertise or toolkit review were not.Conclusions: Appointment of at least one pediatric clinical coordinator and the presence of one or more pediatric beds were significantly associated with having developed key EMP pediatric elements. Further research should examine barriers to pediatric clinical coordinator appointment and explore the awareness that pediatric patients may arrive at nonpediatric hospitals during a disaster with no option for transfer.(Disaster Med Public Health Preparedness. 2012;6:138–145)

Triage During Mass Gatherings

2012 ◽  
Vol 27 (6) ◽  
pp. 531-535 ◽  
Author(s):  
Sheila A. Turris ◽  
Adam Lund
Keyword(s):  
Large Scale ◽  
Scoring Systems ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Limited Resources ◽  
Mass Gathering ◽  
Publication Type ◽  
Mass Gatherings ◽  
Field Triage

AbstractTriage is a complex process and is one means for determining which patients most need access to limited resources. Triage has been studied extensively, particularly in relation to triage in overcrowded emergency departments, where individuals presenting for treatment often are competing for the available stretchers. Research also has been done in relation to the use of prehospital and field triage during mass-casualty incidents and disasters.In contrast, scant research has been done to develop and test an effective triage approach for use in mass-gathering and mass-participation events, although there is a growing body of knowledge regarding the health needs of persons attending large events. Existing triage and acuity scoring systems are suboptimal for this unique population, as these events can involve high patient presentation rates (PPR) and, occasionally, critically ill patients. Mass-gathering events are dangerous; a higher incidence of injury occurs than would be expected from general population statistics.The need for an effective triage and acuity scoring system for use during mass gatherings is clear, as these events not only create multiple patient encounters, but also have the potential to become mass-casualty incidents. Furthermore, triage during a large-scale disaster or mass-casualty incident requires that multiple, local agencies work together, necessitating a common language for triage and acuity scoring.In reviewing existing literature with regard to triage systems that might be employed for this population, it is noted that existing systems are biased toward traumatic injuries, usually ignoring mitigating factors such as alcohol and drug use and environmental exposures. Moreover, there is a substantial amount of over-triage that occurs with existing prehospital triage systems, which may lead to misallocation of limited resources. This manuscript presents a review of the available literature and proposes a triage system for use during mass gatherings that also may be used in the setting of mass-casualty incidents or disaster responses.TurrisSA, LundA. Triage during mass gatherings. Prehosp Disaster Med. 2012;27(6):1-5.

scholarly journals (A283) Hospital Security Planning for Patient Surge Incidents: A Comparison of Three National Systems in China, India, and Japan

2011 ◽  
Vol 26 (S1) ◽  
pp. s78-s79
Author(s):  
E. Downey ◽  
A. Hebert, Chpa ◽  
D. Kim
Keyword(s):  
Emergency Preparedness ◽  
Mass Casualty ◽  
Hospital Environment ◽  
Extensive Literature ◽  
Security Measures ◽  
Patient Identification ◽  
Security Systems ◽  
Preparedness Planning ◽  
National Healthcare ◽  
Security Planning

IntroductionAs the number of disasters caused by natural and non-natural hazards increase, so does the emphasis placed on healthcare security planning for the influx of patients that often accompany such events. This presentation expands on a previously published examination of national healthcare security systems and emphasizes the role of security in the hospital environment during disasters in China, India, and Japan. National emergency preparedness planning systems and disaster type are examined. Elements of planning for a mass-casualty incident (MCI) that most directly impact security planning include mass-notification alert systems, patient routing processes to hospitals (from an MCI scene) and within hospitals (emergency department flow), staffing, disaster triage, patient identification, tracking and discharge, volunteer tracking, and the adaptability and flexibility of space and processes.MethodsResearchers conducted extensive literature reviews of country-specific health care and physical security elements of patient surge. The comparative analysis was augmented by communication with national healthcare security experts.ConclusionsPositive associations exist between increased disasters and the level of priority and funding given to healthcare security measures in disaster planning. National characteristics of governance, landmass, disaster history, and population influenced the development of healthcare security systems and planning for patient surge incidents. Planning for the mental health impact of terrorism victims, and its subsequent impact to patient surge into hospitals was more relevant in the literature for both India and Japan.

scholarly journals (P1-78) Utilizing New York City Pediatric Disaster Coalition Site Visits to Create Hospital Pediatric Critical Care Surge Plans

2011 ◽  
Vol 26 (S1) ◽  
pp. s124-s124
Author(s):  
A. Flamm ◽  
G. Foltin ◽  
K. Uraneck ◽  
A. Cooper ◽  
B.M. Greenwald ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Critical Care ◽  
York City ◽  
Emergency Preparedness ◽  
Capacity Planning ◽  
Mass Casualty ◽  
Federal Grant ◽  
Surge Capacity ◽  
Pediatric Critical Care

PurposeThe New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has supported a federal grant establishing a Pediatric Disaster Coalition (PDC) comprised of pediatric critical care (PCC) and emergency preparedness consultants from major city hospitals and health agencies. One of the PDC's goals was to develop recommendation for hospital-based PCC surge plans.MethodsMembers of the PDC convened bi-weekly and among other projects, developed guidelines for creating PCC surge capacity plans. The PDC members, acting as consultants, conducted scheduled visits to hospitals in NYC and actively assisted in drafting PCC surge plans as annexes to existing hospital disaster plans. The support ranged from facilitating meetings to providing draft language and content, based on each institutions request.ResultsNew York City has 25 hospitals with PCC services with a total of 244 beds. Five major hospitals have completed plans, thereby adding 92 PCC beds to surge capacity. Thirteen additional hospitals are in the process of developing a plan. The PDC consultants participated in meetings at 11 of the planning hospitals, and drafted language for 10 institutions. The PDC continues to reach out to all hospitals with the goal of initiating plans at all 25 PCC hospitals.ConclusionsProviding surge guidelines and the utilization of on-site PDC consultants was a successful model for the development and implementation of citywide PCC surge capacity planning. Visiting hospitals and actively assisting them in creating their plans was an effective, efficient and well received, method to create increased PCC surge capacity. By first planning with major hospitals, a significant increase of surge beds (92 or 38%) was created, from a minimal number of hospitals. Once hospitals complete plans, it is anticipated that there will be the addition of at least 200 PCC surge beds that can be incorporated in to regional city-wide response to pediatric mass-casualty incident.

scholarly journals (P1-102) Developing Methodologies to Assess Resource Needs and Ability to Provide Interventions and Care for Children in Disasters, Terrorism and Public Health Emergencies

2011 ◽  
Vol 26 (S1) ◽  
pp. s132-s132
Author(s):  
D. Markenson ◽  
M. Reilly
Keyword(s):  
Emergency Preparedness ◽  
Central Venous Access ◽  
Vital Signs ◽  
Venous Access ◽  
The United States ◽  
Pediatric Care ◽  
Standards Of Care ◽  
Published Data ◽  
Preparedness Planning ◽  
Number Of Patients

IntroductionIn emergency preparedness there is the need to prospectively develop an approach to which interventions can be provided with available resources and the maximal amount of clinical effectiveness which can be attained by staff.MethodsA panel of pediatric emergency preparedness experts employed our previously validated evidence based consensus process with a modified Delphi process for topic selection and approval. Interventions were chosen such that resources and staff efficiency would not exceed previously published data for non-disaster emergency care but allowing for standard emergency preparedness planning alterations in standards of care such as the assumption that usual numbers of staff would care for a disaster surge of four times the usual number of patients.ResultsUsing standard emergency preparedness assumptions of limited resources and staff efficiency, the panel agreed upon both methodologies for resource allocation and feasible interventions. A number of standard interventions would not be feasible and included detailed recording of vital signs, administration of vasoactive agents, prolonged resuscitation and central venous access.ConclusionBy employing this approach to resource utilization described combined with the unique aspects of pediatric care, we can improve our planning and responses. This can be accomplished by understanding the needs of the population being served, learning how to focus on both pediatric needs and the expectations of the community with regard to care of children, adopting what has been learned in prior events in the United States and abroad, and developing prospective recommendations regarding essential interventions which can be performed in a disaster.

scholarly journals (P1-12) Had the Times Square Bomb Exploded: What about the Injured Children?

2011 ◽  
Vol 26 (S1) ◽  
pp. s102-s102
Author(s):  
E. Conway ◽  
A. Flamm ◽  
G. Foltin ◽  
A. Cooper ◽  
B.M. Greenwald ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Critical Care ◽  
York City ◽  
Emergency Preparedness ◽  
Time Of Day ◽  
Federal Grant ◽  
Pediatric Critical Care ◽  
Times Square ◽  
Preparedness Planning

IntroductionChildren frequently are the victims of disasters due to natural hazards or terrorist attacks. However, there is a lack of specific pediatric emergency preparedness planning worldwide. To address these gaps, the federal grant-funded New York City Pediatric Disaster Coalition (PDC) established guidelines for creating Pediatric Critical care (PCC) surge plans and assisted hospitals in creating their plans. To date, five hospitals completed plans, thereby adding 92 beds to surge capacity. On 01 May 2010, 18:00h, there was an attempt to detonate a car bomb in Times Square, a large urban attraction in the heart of New York City. The perpetrator was later convicted of the attempted use of a weapon of mass destruction. Had the bomb exploded, given the location and time of day, it is possible that many critically injured victims would have been children.MethodsThe unit director or a senior attending of nine major hospitals in the NYC area (five in close proximity and four at secondary sites) were surveyed for the number of their vacant pediatric critical care beds at the time of the event before activation of surge plans.ResultsAt the time the car bomb was discovered, the nine hospitals, which have a total of 141 PCC beds, had only 29 vacant approved pediatric critical care beds.ConclusionsHad the event resulted in many pediatric casualties, the existing PCC vacant beds at these hospitals may not have satisfied the need. Activating surge plans at five of these hospitals would have added 92 to the 29 available PCC beds for a total of 121. In order to provide PCC to a large number of victims, it is crucial that hospitals prepare PCC surge plans.

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