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de la Fontaine N, Silberg T, Fegert JM, Tsafrir S, Weisman H, Rubin N, Ashkenazi M, Nacasch N, Polliack ML, Chen W, Herman-Raz M, Wachsberg-Lachmanovich R, Pessach-Gelblum L, Ziv A, Moshkovitz A, Shilo N, Frenkel-Nir Y, Gothelf D, Pessach IM. Acute response to the October 7th hostage release: rapid development and evaluation of the novel ReSPOND protocol implementation within a children's hospital. Child Adolesc Psychiatry Ment Health 2024; 18:76. [PMID: 38902765 PMCID: PMC11191208 DOI: 10.1186/s13034-024-00767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The decision to allocate hospitals for the initial reception of hostages abducted on the October 7th Hamas attack introduced an array of unprecedented challenges. These challenges stemmed from a paucity of existing literature and protocols, lack of information regarding captivity conditions, and variability in hostage characteristics and circumstances. OBJECTIVE To describe the rapid development, implementation and evaluation of the Hostage-ReSPOND protocol, a comprehensive trauma-informed procedure for the care of hostages, including young children, their caregivers and families, immediately following their release from prolonged captivity. METHODS A multidisciplinary expert focus group conducted a comprehensive literature review to develop the ReSPOND protocol, consisting of: Readiness of teams via multifaceted trainings, utilizing live simulations and video debriefings; Specialized professional teams experienced in providing holistic trauma-informed care; Personalized care tailored to individualized and developmentally-informed needs; Optimal safety rooted in creating a secure environment and trauma-informed response to young children, adolescents, caregivers and families; and Navigating Discharge, through coordination with community-based care systems. RESULTS A designated facility at the Children's hospital was carefully prepared for receiving 29 hostages, aged 3.9-80 years, 28% under the age of 18. Implementation of the ReSPOND protocol, which prioritized holistic psychosocial interventions above urgent medical care, proved feasible and effective in managing the diverse and complex needs of returnees as per provider report. Finally, systemic assessment of returnee's immediate and long-term mental health needs proved highly challenging. CONCLUSIONS There is currently no literature addressing the response to released hostages, especially those involving infants, young children and families within a children's hospital facility. This study has the potential to fill a crucial gap in knowledge by introducing a novel protocol which could offer valuable insights for public health organizations tasked with providing acute care to diverse individuals and families experiencing extreme, multi-layered mass traumatization.
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Affiliation(s)
- Naama de la Fontaine
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel.
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
| | - Tamar Silberg
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Jörg M Fegert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center, Competence Domain Mental Health Prevention, Ulm, Germany
| | - Shlomit Tsafrir
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Hana Weisman
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
| | - Noa Rubin
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
| | - Moshe Ashkenazi
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Nitsa Nacasch
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Michael L Polliack
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Wendy Chen
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- Department of Social Services, Sheba Medical Center, Ramat Gan, Israel
| | - Meirav Herman-Raz
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- Department of Social Services, Sheba Medical Center, Ramat Gan, Israel
| | | | - Liat Pessach-Gelblum
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
| | - Amitai Ziv
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
| | - Anat Moshkovitz
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
| | - Noya Shilo
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Yael Frenkel-Nir
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Doron Gothelf
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- Sagol School of Neuroscience, The Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Itai M Pessach
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
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Validation of the Pediatric Physiological and Anatomical Triage Score in Injured Pediatric Patients. Prehosp Disaster Med 2019; 34:363-369. [DOI: 10.1017/s1049023x19004552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:Triaging plays an important role in providing suitable care to a large number of casualties in a disaster setting. A Pediatric Physiological and Anatomical Triage Score (PPATS) was developed as a new secondary triage method. This study aimed to validate the accuracy of the PPATS in identifying injured pediatric patients who are admitted at a high frequency and require immediate treatment in a disaster setting. The PPATS method was also compared with the current triage methods, such as the Triage Revised Trauma Score (TRTS).Methods:A retrospective review of pediatric patients aged ≤15 years, registered in the Japan Trauma Data Bank (JTDB) from 2012 through 2016, was conducted and PPATS was performed. The PPATS method graded patients from zero to 22, and was calculated based on vital signs, anatomical abnormalities, and the need for life-saving interventions. It categorized patients based on their priority, and the intensive care unit (ICU)-indicated patients were assigned a PPATS ≥six. The accuracy of PPATS and TRTS in predicting the outcome of ICU-indicated patients was compared.Results:Of 2,005 pediatric patients, 1,002 (50%) were admitted to the ICU. The median age of the patients was nine years (interquartile range [IQR]: 6-13 years). The sensitivity and specificity of PPATS were 78.6% and 43.7%, respectively. The area under the receiver-operating characteristic (ROC) curve (AUC) was larger for PPATS (0.61; 95% confidence interval [CI], 0.59-0.63) than for TRTS (0.57; 95% CI, 0.56-0.59; P <.01). Regression analysis showed a significant correlation between PPATS and the Injury Severity Score (ISS; r2 = 0.353; P <.001), predicted survival rate (r2 = 0.396; P <.001), and duration of hospital stay (r2 = 0.252; P <.001).Conclusion:The accuracy of PPATS for injured pediatric patients was superior to that of current secondary triage methods. The PPATS method is useful not only for identifying high-priority patients, but also for determining the priority ranking for medical treatments and evacuation.
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Breuer F, Beckers SK, Poloczek S. [Mass casualty incidents and attacks involving a multitude of children and adolescents-Overview of policy recommendations and challenges]. Anaesthesist 2019; 68:476-482. [PMID: 31297543 DOI: 10.1007/s00101-019-0626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Fortunately, mass casualty incidents involving a large number of children and adolescents are rare and the experience in this field, both in terms of medical as well as psychosocial emergency care is comparatively low. Children represent a vulnerable group and have a particularly high risk of developing posttraumatic stress disorder in the aftermath of experiencing disasters. A selective literature search was carried out in Medline. The peculiarity of damaging events with a large number of children and adolescents affected is that in addition to emergency medical care, an early approach to psychosocial emergency care must be provided. Accordingly, it makes sense to integrate such structures into the respective deployment concepts. A specific screening algorithm for children could so far not prevail but due to the physiological and anatomical characteristics appropriate emergency medical care concepts should be provided. Furthermore, hospitals must adapt to this patient group in a suitable manner.
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Affiliation(s)
- F Breuer
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland.
| | - S K Beckers
- Ärztliche Leitung Rettungsdienst Stadt Aachen, Berufsfeuerwehr Aachen, Aachen, Deutschland.,Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - S Poloczek
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland
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Altman RL, Santucci KA, Anderson MR, McDonnell WM, Fanaroff JM, Bondi SA, Narang SK, Oken RL, Rusher JW, Scibilia JP, Scott SM, Sigman LJ. Understanding Liability Risks and Protections for Pediatric Providers During Disasters. Pediatrics 2019; 143:peds.2018-3893. [PMID: 30804075 DOI: 10.1542/peds.2018-3893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although most health care providers will go through their careers without experiencing a major disaster in their local communities, if one does occur, it can be life and career altering. The American Academy of Pediatrics has been in the forefront of providing education and advocacy on the critical importance of disaster preparedness. From experiences over the past decade, new evidence and analysis have broadened our understanding that the concept of preparedness is also applicable to addressing the unique professional liability risks that can occur when caring for patients and families during a disaster. Concepts explored in this technical report will help to inform pediatric health care providers, advocates, and policy makers about the complexities of how providers are currently protected, with a focus on areas of unappreciated liability. The timeliness of this technical report is emphasized by the fact that during the time of its development (ie, late summer and early fall of 2017), the United States went through an extraordinary period of multiple, successive, and overlapping disasters within a concentrated period of time of both natural and man-made causes. In a companion policy statement (www.pediatrics.org/cgi/doi/10.1542/peds.2018-3892), recommendations are offered on how individuals, institutions, and governments can work together to strengthen the system of liability protections during disasters so that appropriate and timely care can be delivered with minimal fear of legal reprisal or confusion.
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Affiliation(s)
- Robin L. Altman
- Department of Pediatrics, New York Medical College of Touro University and Maria Fareri Children's Hospital of Westchester Medical Center Health Network, Valhalla, New York
| | - Karen A. Santucci
- Department of Pediatrics, School of Medicine, Yale University and Children’s Emergency Department, Yale-New Haven Hospital, New Haven, Connecticut
| | | | - William M. McDonnell
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
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