Public Health Emergency Preparedness

Strategies and Tools for Meeting the Needs of Children

Agency for Healthcare Research and Quality Advancing Excellence in Health Care • www.ahrq.gov AHRQAHRQ’’ss ObjectivesObjectives toto AddressAddress EmergencyEmergency PreparednessPreparedness

DevelopDevelop andand Assess:Assess: „„ AlternativeAlternative approachesapproaches toto ensuringensuring healthhealth carecare surgesurge capacitycapacity „„ ModelsModels thatthat addressaddress trainingtraining andand informationinformation needsneeds „„ AlternativeAlternative usesuses ofof informationinformation technologytechnology andand electronicelectronic communicationcommunication networksnetworks „„ ProtocolsProtocols andand technologiestechnologies toto enhanceenhance interoperabilityinteroperability amongamong healthhealth carecare systemssystems Strategies and Tools for Meeting the Needs of Children Wednesday, JanJanuaryuary 11, 2006, 1:00 – 2:30 p.m. Eastern Standard Time

Panelists: Irwin Redlener, M.D., F.A.A.P. Michael Shannon, M.D., M.P.H. Director Director National Center for Disaster Preparedness The Center for Biopreparedness Professor and Chair Mailman School of Public Health Division of Emergency Medicine , NY Children's Hospital, Harvard Medical School Boston, MA

George L. Foltin, M.D., F.A.A.P., F.A.C.E.P. David S. Markenson, M.D. Director Chief Center for Pediatric Emergency Medicine Pediatric Emergency Medicine Bellevue Hospital Maria Fareri Children’s Hospital New York, NY Westchester Medical Center Valhalla, NY Moderator: Cindy DiBiasi DecontaminationDecontamination VideoVideo

AA clipclip fromfrom "The"The DecontaminationDecontamination ofof Children"Children" cancan bebe foundfound onlineonline atat http://www.ahrq.gov/research/decontam.htmhttp://www.ahrq.gov/research/decontam.htm

AA free,free, singlesingle copycopy ofof thethe videovideo——availableavailable inin DVDDVD oror VHSVHS formatformat——maymay bebe orderedordered byby callingcalling 11--800800--358358--92959295 oror byby sendingsending anan EE-- mailmail toto [email protected]@ahrq.gov.. ResourcesResources andand ToolsTools

ForFor aa selectedselected listlist ofof resourcesresources andand toolstools toto helphelp communitiescommunities respondrespond toto bioterrorismbioterrorism oror otherother publicpublic healthhealth emergencies,emergencies, sponsoredsponsored byby thethe AgencyAgency forfor HealthcareHealthcare ResearchResearch andand QualityQuality underunder itsits BioterrorismBioterrorism andand EmergencyEmergency PreparednessPreparedness ProgramProgram,, gogo to:to:

http://http://www.ahrq.gov/path/biotrspn.htmwww.ahrq.gov/path/biotrspn.htm AboutAbout OurOur SponsorsSponsors

The mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.

The User Liaison and Research Translation Program (ULRT) attempts to accelerate the rate at which research and promising practices are incorporated into policy and practice by health system administrators, providers, corporate purchasers of health care, and State officials. ULRT does this through the use of web and audio conferences, workshops, technical assistance, and through the support of learning networks and communities of practice. PublicPublic HealthHealth EmergencyEmergency PreparednessPreparedness A Free Web Conference for Regional, State, and Local Health Care Decisionmakers

Sally Phillips, R.N., Ph.D. Director, Bioterrorism Preparedness Research Program Center for Primary Care, Prevention, and Clinical Partnerships Agency for Healthcare Research and Quality U.S. Department of Health and Human Services E-Mail: [email protected] 20042004--20052005 SeriesSeries onon SurgeSurge CapacityCapacity andand HealthHealth SystemSystem PreparednessPreparedness

Surge Capacity: Education and Training for a Qualified Workforce―March 2, 2004 Surge Capacity: Facilities and Equipment― July 13, 2004 Addressing Surge Capacity in a Mass Casualty Event― October 26, 2004 Mass Casualty Care: Overlooked Community Resources―May 17, 2005

To view archives of these events, go to:

http://www.ahrq.gov/news/ulp/biotconf.htm Strategies and Tools for Meeting the Needs of Children

InterestedInterested inin freefree accessaccess toto materialsmaterials andand productsproducts fromfrom thisthis event?event?

OnOn thethe Internet,Internet, visitvisit thethe followingfollowing WebWeb site:site: www.hsrnet.net/ahrq/www.hsrnet.net/ahrq/care4kidscare4kids AHRQAHRQ WebWeb ConferencesConferences onon PublicPublic HealthHealth EmergencyEmergency PreparednessPreparedness

IfIf youyou wouldwould likelike toto receivereceive informationinformation onon futurefuture AHRQAHRQ--sponsoredsponsored events,events, gogo to:to:

www.hsrnet.net/ahrq/swww.hsrnet.net/ahrq/surgecapacityurgecapacity Public Health Emergency Preparedness and the Needs of Children

Irwin Redlener, M.D., F.A.A.P. Professor of Clinical Public Health and Pediatrics Director, The National Center for Disaster Preparedness Columbia University Mailman School of Public Health and President, The Children’s Health Fund Special Vulnerabilities of Children to Chemical, Biological, Radioactive, and Nuclear Agents (CBRNE)

Not just “little adults”

„ Lower “breathing zones” and more rapid respiratory rates

„ Greater skin surface and permeability

„ Greater propensity to dehydration, shock

„ Need special treatment, management protocols

„ “Dependent”

„ Suffer varying mental health effects

I. Redlener, M.D. How Are Children Exposed to Chemical, Biological, Radioactive, and Nuclear Agents (CBRNE) Materials?

„ Unintentionally „ Industrial accidents (e.g., chemical leaks, nuclear reactor accidents) „ Natural disasters „ Airplane crashes

„ Inadvertently „ As collateral victims of terrorism (e.g. Oklahoma City, Madrid)

„ Indirectly „ Posttraumatic stress (PTSD) and other psychological effects „ Through media (e.g., Oklahoma City, WTC)

„ Intentionally Targeted „ As victims of terrorist attacks (e.g., Ma’lot, Beslan)

I. Redlener, M.D. MedicalMedical CareCare forfor ChildrenChildren

BeslanBeslan,, 20042004 StaffStaff andand MedicalMedical EquipmentEquipment ofof ChildrenChildren’’ss FieldField HospitalHospital

Doctors & Nurses - 20 Technical staff - 16

Specialists of Russian Center for Disaster Medicine and staff of Airmobile Hospital of Emergencies Ministry How Can Parents and Professionals Speak to Children About Terrorism and the Potential for Major Disasters?

„ Be available

„ Give age-appropriate messages

„ Encourage questions

„ Seek professional assistance when stress symptoms increase Caring for Children: Observations from Hurricane Katrina Pediatric Terrorism and Disaster Preparedness Resource (PTDPR)

George L. Foltin, M.D., F.A.A.P., F.A.C.E.P. Director Center for Pediatric Emergency Medicine NYU School of Medicine/Bellevue Hospital , NY What Is the Pediatric Terrorism and Disaster Preparedness Resource (PTDPR)? z American Academy of Pediatrics Project funded by AHRQ z AAP in partnership with the Center for Pediatric Emergency Medicine at NYU School of Medicine z Lead Editors: George Foltin, MD, David Schonfeld, MD and Michael Shannon, MD z Delivered to AHRQ on November 30 z Plans for Distribution ongoing What Is the Pediatric Terrorism and Disaster Preparedness Resource (PTDPR)? z Comprehensive pediatric reference on preparedness for acts of terrorism: includes slides, handouts, and lecture outlines z Content experts from around the country were recruited to develop training materials z Covers clinical and policy issues z Designed to allow access of critical and essential background information z save time while facilitating planning efforts Why Was the PTDPR Created? z Lack of available pediatric-specific resources or clinical guidelines z Unavailability of pediatric resources in the community or on the Internet z Save time for those facilitating pediatric planning efforts Pediatric Terrorism and Disaster Preparedness Resource (PTDPR)

Table of Contents z How Children Are Different z System Issues: Preparedness Primer For The Pediatrician z Biological Terrorism z Chemical Weapons & Terrorism z Nuclear Terrorism z Blast Terrorism z Mental Health Issues z Integrating This Resource Into Your Practice Pediatric Terrorism and Disaster Preparedness Resource (PTDPR) APPENDICES z Glossary: definitions of key words z Formulary: list of critical medications z Key points of each section z Critical Web Links: Web sites related to chapter/section z Illustrations and pictures z Articles: key references z AAP statements: full text or Web-linked z Parent EMS handouts; home emergency prep plan or kit z Materials for non pediatrician practitioners: tables covering vital signs, developmental differences, equipment differences z TIPS: Algorithms, treatment/triage task analyses (based on critical chapter content) z Hurricane Katrina: Lessons Learned Pediatric Terrorism and Disaster Preparedness Resource (PTDPR)

Figure 9. PTDPR Decon Shower- Child

Figure 10. PTDPR Decon Shower- Infant Pediatric Disaster Tool Kit

NYC Department of Health and Mental Hygiene HRSA Funding Pediatric Disaster Advisory Group

Hospital Guidelines for Pediatrics in Disasters “Resources for General Hospitals” Pediatric Disaster Tool Kit

Sections z Transportation z Introduction z Staffing z Security z Decontamination z Dietary z Pharmacy z Space and Equipment z Psychosocial/Ethical z Training For Further Information z Email George Foltin at [email protected] z Visit CPEM website at www.cpem.org z Visit AAP at www.aap.org z Visit AHRQ at www.ahrq.gov z Visit HRSA at www.hrsa.gov EmergencyEmergency Preparedness:Preparedness: EducationEducation andand TrainingTraining forfor TreatingTreating thethe PediatricPediatric PopulationPopulation

Michael Shannon, M.D., M.P.H. Director The Center for Biopreparedness Professor and Chair Division of Emergency Medicine Children's Hospital, Harvard Medical School Boston, MA UnmetUnmet NeedsNeeds inin PediatricPediatric EmergencyEmergency PreparednessPreparedness

„ Comprehensive,Comprehensive, schoolschool--basedbased emergencyemergency preparednesspreparedness protocolsprotocols

„ PediatricPediatric protocolsprotocols inin everyevery hospitalhospital

„ PediatricPediatric surgesurge capacitycapacity plansplans

„ Education/trainingEducation/training onon uniqueunique issuesissues

„ CommunityCommunity involvementinvolvement

„ IdentificationIdentification andand reunificationreunification ofof childrenchildren andand parentsparents KeyKey IssuesIssues inin EducationEducation && TrainingTraining

„ ManyMany firstfirst respondersresponders remainremain inadequatelyinadequately trainedtrained inin pediatricpediatric aspectsaspects ofof disasterdisaster responseresponse

„ TrainingTraining programsprograms areare failingfailing toto provideprovide specificspecific pediatricpediatric trainingtraining

„ ThereThere hashas beenbeen littlelittle developmentdevelopment ofof DVDs/videosDVDs/videos asas trainingtraining toolstools DecontaminationDecontamination ofof Children:Children: PreparednessPreparedness andand ResponseResponse forfor HospitalHospital EmergencyEmergency DepartmentsDepartments

„ VideoVideo providesprovides stepstep--byby--stepstep demonstrationdemonstration ofof decontaminationdecontamination processprocess inin realreal timetime

„ TrainingTraining tooltool forfor emergencyemergency respondersresponders andand hospitalhospital emergencyemergency departmentdepartment staffstaff VideoVideo--basedbased TrainingTraining TopicsTopics

„ RespondingResponding toto mentalmental healthhealth needsneeds ofof childrenchildren afterafter disasterdisaster „ DevelopmentDevelopment ofof comprehensive,comprehensive, schoolschool--basedbased disasterdisaster planplan „ SpecificSpecific toto children:children: •• ManagementManagement ofof massmass casualtycasualty incidentsincidents •• ManagementManagement ofof bioterrorismbioterrorism andand otherother infectiousinfectious emergenciesemergencies •• ManagementManagement ofof radiologicradiologic emergenciesemergencies IdentificationIdentification andand ReunificationReunification ofof ChildrenChildren AfterAfter aa MassMass CasualtyCasualty IncidentIncident

„ RequiresRequires meansmeans ofof rapidlyrapidly collectingcollecting informationinformation onon arrivingarriving casualtiescasualties (e.g.,(e.g., digitaldigital photos)photos)

„ PhotoPhoto indexingindexing

„ SiteSite wherewhere arrivingarriving parentsparents cancan reviewreview photosphotos

„ SystemSystem forfor presentingpresenting selectselect photosphotos ConsiderationsConsiderations inin EmergencyEmergency Preparedness:Preparedness: AA TwoTwo--tracktrack ConferenceConference

David Markenson, M.D. Director, Center for Disaster Medicine New York Medical College School of Public Health Chief, Pediatric Emergency Medicine Maria Fareri Children’s Hospital

Center for Disaster Medicine New York Medical College School of Public Health ObjectivesObjectives ofof ConferenceConference

„ ReviewReview newnew pediatricpediatric literatureliterature „ UpdateUpdate pediatricpediatric guidelinesguidelines „ ExpandExpand guidelinesguidelines inin selectedselected areasareas „ ReviewReview literatureliterature ofof personspersons withwith disabilitiesdisabilities „ DraftDraft guidelinesguidelines onon emergencyemergency preparednesspreparedness forfor personspersons withwith disabilitiesdisabilities ChangesChanges inin TerrorismTerrorism GuidelinesGuidelines

„ RoleRole ofof fluoroquinolonesfluoroquinolones „ RoleRole „ InclusionInclusion ofof onesones otherother thanthan ciprofloxacinciprofloxacin „ NerveNerve agentagent autoauto--injectorinjector „ PediatricPediatric equivalentequivalent „ AnticonvulsantAnticonvulsant „ CidofavirCidofavir AddedAdded andand ExpandedExpanded TopicsTopics

„ SchoolSchool PreparednessPreparedness „ ChildChild CongregateCongregate FacilityFacility PreparednessPreparedness „ ShelteringSheltering NeedsNeeds ofof ChildrenChildren „ PediatricPediatric NeedsNeeds forfor PublicPublic HealthHealth EmergencyEmergency PreparednessPreparedness „ ChildrenChildren withwith SpecialSpecial HealthHealth CareCare NeedsNeeds andand TechnologicallyTechnologically AssistedAssisted ChildrenChildren „ DecontaminationDecontamination ofof ChildrenChildren „ BiologicalBiological TerrorismTerrorism ProphylaxisProphylaxis andand TreatmentTreatment ofof EmergingEmerging AgentsAgents „ FamilyFamily CenteredCentered PreparednessPreparedness RecommendationsRecommendations forfor SchoolsSchools andand ChildChild CongregateCongregate FacilitiesFacilities

„ DevelopDevelop safetysafety plansplans thatthat identifyidentify uniqueunique threatsthreats oror hazardshazards thatthat schoolsschools maymay faceface „ ShareShare safetysafety plansplans withwith communitycommunity toto ensureensure thatthat allall communitycommunity resourcesresources willwill bebe utilizedutilized inin emergenciesemergencies „ HaveHave schoolsschools practicepractice firefire andand evacuationevacuation drillsdrills regularly,regularly, atat leastleast twicetwice perper academicacademic yearyear „ HaveHave locallocal plansplans reflectreflect majormajor rolerole ofof schoolsschools inin communitycommunity planningplanning andand asas emergencyemergency resourcesresources RecommendationsRecommendations forfor DecontaminationDecontamination

„ DecontaminationDecontamination ofof youngyoung childrenchildren mustmust bebe donedone withwith highhigh--volume,volume, lowlow--pressure,pressure, heatedheated waterwater systemssystems „ SystemsSystems mustmust bebe designeddesigned forfor decontaminationdecontamination ofof allall agesages andand typestypes ofof childrenchildren „ AllAll protocolsprotocols andand guidanceguidance mustmust address:address: „ Water temperature and pressure „ Nonambulatory child „ Child with special health care needs „ Clothing for after decontamination RecommendationsRecommendations forfor HospitalsHospitals

„ 7272 hourshours ofof pediatricpediatric suppliessupplies andand pharmaceuticalspharmaceuticals onon handhand forfor averageaverage dailydaily censuscensus plusplus minimumminimum surgesurge ofof 5%5% adjustedadjusted forfor riskrisk assessmentassessment „ EngageEngage inin specificspecific pediatricpediatric disasterdisaster riskrisk assessmentassessment withwith communitycommunity toto includeinclude schoolschool districts,districts, emergencyemergency services,services, policepolice dept.,dept., firefire dept.,dept., childchild welfare,welfare, privateprivate practitioners,practitioners, childchild care,care, publicpublic health,health, andand mentalmental healthhealth