MAY 2006 • VOLUME 117 • NUMBER 5 PEDIATRICS௡ OFFICIAL JOURNAL OF THE AMERICAN ACADEMY OF PEDIATRICS www.pediatrics.org A SUPPLEMENT TO PEDIATRICS Hurricane Katrina, Children, and Pediatric Heroes HANDS-ON STORIES BY AND OF OUR COLLEAGUES HELPING FAMILIES DURING THE MOST COSTLY NATURAL DISASTER IN US HISTORY This supplement was made possible by grants from Baton Rouge Neonatal Associates, Children’s Health Corporation, Children’s Hospital of Alabama, Texas Children’s Hospital, the Children’s Health Fund, National Association of Children’s Hospitals and Related Institutions, and the Michael and Helen Metrock Charitable Foundation PEDIATRICS OFFICIAL JOURNAL OF THE AMERICAN ACADEMY OF PEDIATRICS MAY 2006 • VOLUME 117 • NUMBER 5 A SUPPLEMENT TO PEDIATRICS Hurricane Katrina, Children, and Pediatric Heroes HANDS-ON STORIES BY AND OF OUR COLLEAGUES HELPING FAMILIES DURING THE MOST COSTLY NATURAL DISASTER IN US HISTORY Carden Johnston, MD, FAAP, FRCP, Supplement Editor; Irwin Redlener, MD, FAAP, Supplement Co-editor This supplement was made possible by grants from Baton Rouge Neonatal Associates, Children’s Health Corporation, Children’s Hospital of Alabama, Texas Children’s Hospital, the Children’s Health Fund, National Association of Children’s Hospitals and Related Institutions, and the Michael and Helen Metrock Charitable Foundation PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2006 by the American Academy of Pediatrics The content of the journal is Editor Richard E. Besser, Atlanta, GA Jerold F. Lucey, Burlington, VT Susan L. Bratton, Salt Lake City, UT intended to encompass the James F. Casella, Baltimore, MD Associate Editor needs of the whole child in his Barbara Cromer, Cleveland, OH Ralph D. Feigin, Houston, TX Gail J. Demmler, Houston, TX physiologic, mental, emotional, Consulting Editors Phyllis A. Dennery, Philadelphia, PA Steve Berman, Denver, CO Francis J. DiMario, Jr, Hartford, CT and social structure. Russell W. Chesney, Memphis, TN Howard Dubowitz, Chevy Chase, MD Lewis First, Burlington, VT David C. Goodman, Hanover, NH The single word, PEDIATRICS, Frank Greer, Madison, WI Consulting Editor, Tamison Jewett, Winston-Salem, NC has been chosen to indicate this Pediatrics Electronic Pages Zeev N. Kain, New Haven, CT Jeffrey D. Horbar, Burlington, VT catholic intent. Lawrence C. Kleinman, Allentown, PA Assistant Editor Neal LeLeiko, Providence, RI Joseph D. Dickerman, Burlington, VT M. Jeffrey Maisels, Royal Oak, MI Hugh McCulloch Ross E. McKinney, Jr, Durham, NC PEDIATRICS, January 1948 International Advisor Jordan Metzl, New York, NY Jose Ramet, Antwerp, Belgium Virginia Moyer, Houston, TX Executive Editor Michael E. Msall, Chicago, IL Michael T. Clarke, Elk Grove Village, IL Gary Smith, Columbus, OH Dennis W. Vane, Burlington, VT Managing Editor Consultant Bridget Donohue, Elk Grove Village, IL Carol D. Berkowitz, Torrance, CA Editorial Associates Ex Officio Karri Benoit, Burlington, VT Eileen M. Ouellette, President Nancy Brown, Burlington, VT Errol R. Alden, Executive Director Diana Edwards, Burlington, VT Gia Gustilo, Houston, TX Publisher Mark Meyer, Houston, TX American Academy of Pediatrics Robert Perelman, Director, Department of Education Journal Production Manager Kristin Wye-Rodney, Columbia, MD Editorial Board Myles B. Abbott, Berkeley, CA Richard Bachur, Boston, MA PEDIATRICS (ISSN 0031 4005) is owned and controlled by the American Academy of Pediatrics. It is published monthly by the American Academy of Pediatrics, Elk Grove Village, IL 60007-1098. Copyright © 2006 by the American Academy of Pediatrics. All Rights Reserved. Printed in USA. Authorization to photocopy items for internal or personal use, or for the internal or personal use of specific clients, is granted by PEDIATRICS, provided that the base fee of $10.00 per article, per copy is paid directly to the Copyright Clearance Center Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400. PEDIATRICS is a registered trademark of the American Academy of Pediatrics. The publication of an advertisement neither constitutes nor implies a guarantee or endorsement by PEDIATRICS or the American Academy of Pediatrics of the product or service advertised or of the claims made for the product or service by the advertiser. Subscriptions to PEDIATRICS are provided to AAP Members as part of annual membership dues. All others please contact our Customer Service Center at (866) 843-2271 (7:00 am–5:30 pm Central Time, Monday–Friday) for pricing and information. Periodicals postage paid at ARLINGTON HEIGHTS, ILLINOIS, and at additional mailing offices. Printed in USA. Postmaster: Send address changes to: THE AMERICAN ACADEMY OF PEDIATRICS, Attn: Customer Service Center, 141 Northwest Point Blvd, Elk Grove Village, IL 60007-1098. Printed on recycled paper. A2 SUPPLEMENT TO PEDIATRICS CONTENTS EDITORS’ COMMENTS S355 Introduction: Pediatricians Providing Sophisticated Care Under Extreme Conditions Carden Johnston, Irwin Redlener COMMENTARY S357 Children’s Hospitals Meeting the Challenge Together Lawrence A. McAndrews CHAOS, CRISES, AND QUICKLY IMPLEMENTED IMPROVISED SOLUTIONS Life-Changing Experiences of a Private Practicing Pediatrician S359 Perspectives From a Private Pediatric Practice Mitchell Gruich, Jr Escaping With VLBW Neonates S365 Caring for and Transporting Very Low Birth Weight Infants During a Disaster Juan J. Gershanik Practicing Neonatology in a Blackout S369 The University Hospital NICU in the Midst of Hurricane Katrina: Caring for Children Without Power or Water Brian M. Barkemeyer Sweating It out in a Level III Regional NICU S375 Disaster Preparation and Lessons Learned at the Ochsner Foundation Hospital Harley G. Ginsberg A First for This Century S381 Closing and Reopening of a Children’s Hospital During a Disaster Keith Perrin On Call for the Duration S386 Code Gray: A Resident’s Personal Account From Children’s Hospital of New Orleans Sandhya D. Mani CREATIVE, CARING SOLUTIONS FOR SICK CHILDREN DISPLACED BY A HURRICANE AND FLOOD Opening Our Doors for All Newborns S389 Caring for Displaced Neonates: Intrastate Steven B. Spedale Pediatricians’ Experiences 80 Miles up the River S396 Baton Rouge Pediatricians’ Experiences Meeting the Health Needs of Evacuated Children David E. Thomas et al What Happened to Children in Detention? S402 Caring for Children in a Juvenile Justice System After a Disaster Ronald A. www.pediatrics.org Feinstein A3 SUPPLEMENT TO PEDIATRICS CONTENTS FEMA’s Organized Response With a Pediatric Subspecialty Team S405 The National Disaster Medical System Response: A Pediatric Perspective Debra L. Weiner et al Chronicles From Out-of-State Professionals S412 Providing Primary Care to Underserved Children After a Disaster: A National Organization Response Alan Shapiro et al OVERCOMING BARRIERS TO EMERGENCY TRANSPORTING AND CARING FOR CHILDREN IN ANOTHER STATE Moving Hospitalized Children All Over the Southeast S416 Interstate Transfer of Pediatric Patients During Hurricane Katrina Steve Baldwin et al Getting Kids From the Big Easy Hospitals to Our Place (Not Easy) S421 Preparing, Improvising, and Caring for Children During Mass Transport After a Disaster Susan M. Distefano et al Caring for Evacuated Children Housed in the Astrodome S428 Creation and Implementation of a Mobile Pediatric Emergency Response Team: Regionalized Caring for Displaced Children After a Disaster Paul E. Sirbaugh et al Using International Practice Techniques in Texas S439 Hurricane Katrina Experiences: Receiving Patients in Longview, Texas, 350 Miles From Ground Zero O.W. “Skip” Brown CARING FOR DISRUPTED FAMILIES AND HIGHLY STRESSED PROFESSIONALS Getting 5000 Families Back Together S442 Reuniting Fractured Families After a Disaster: The Role of the National Center for Missing & Exploited Children Daniel D. Broughton et al Responding Creatively to Family Needs of Hospital Staff S446 Caring for Children of Caretakers During a Disaster Susan Buttross Challenges in Meeting Immediate Emotional Needs S448 Short-term Impact of a Major Disaster on Children’s Mental Health: Building Resiliency in the Aftermath of Hurricane Katrina Paula A. Madrid et al A4 SUPPLEMENT TO PEDIATRICS CONTENTS A Critical Concern S454 Pediatrician Self-care After Disasters Paula A. Madrid, Stephanie J. Schacher LESSONS LEARNED Critical Concepts for Children in Disasters Identified by Hands-on Professionals S458 Summary of Issues Demanding Solutions Before the Next One Carden Johnston, Irwin Redlener ACKNOWLEDGMENTS We extend gratitude to Ben K. Silverman, MD, FAAP, and William O. Robertson, MD, FAAP, for supportive comments and critiques. A5 INTRODUCTION Pediatricians Providing Sophisticated Care Under Extreme Conditions Carden Johnston, MD, FAAP, FRCPa, Irwin Redlener, MD, FAAPb,c aDepartment of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; bThe Children’s Health Fund, New York, New York; c Mailman School of Public Health, Columbia University, New York, New York The authors have indicated they have no financial relationships relevant to this article to disclose. ATRINA. THE WORD now brings up images of news onates, their stories too have huge omissions. So, the Kreports of the disaster caused by the flooding after reader will want to know, where are the other stories? the hurricane. The news was bad, with people stranded What about the transport teams relating what happened in their homes or hospitals, not being able to eat, bathe, in their vehicles? What about the hematologists who or drink water, and a slower-than-desirable