Pediatric Disaster Preparedness in the Wake of Katrina: Lessons to be Learned

Primary Care Medical Practices: Are Community Health Care Providers Ready for Disasters?

OBJECTIVE

This study seeks to determine the capacity of community primary care practices to meet the needs of patients during public health emergencies and to identify the barriers and resources necessary to participate in a coordinated response with public safety agencies.

METHODS

The self-administered web-based survey was distributed in January 2014 via e-mail to primary care providers in Pennsylvania using the listservs of several professional societies.

RESULTS

A total of 179 primary care providers participated in the survey. In total, 38% had practice continuity of operations plan in place and 26% reported that they had a plan for patient surge in the outpatient setting. Thirty percent reported that they were registered on the state Health Alert Network and 41% said they were able to communicate with patients during disasters. Only 8% of providers reported that they believed that their patients with special health care needs were prepared for a disaster, although over two-thirds of responding practices felt they could assist these patients with disaster preparedness. Providers indicated that more information regarding government agency plans and community resources, patient education materials, and more time to devote to counseling during patient encounters would improve their ability to prepare their patients with special health care needs for disasters. Providers also reported that they would benefit from partnerships to help the practice during emergencies and communications technology to reach large numbers of patients quickly.

CONCLUSIONS

Community-based primary care practices can be useful partners during public health emergencies. Efforts to promote continuity of operations planning, improved coordination with government and community partners, as well as preparedness for patients with special health care needs, would augment their capabilities and contribute to community resilience. (Disaster Med Public Health Preparedness. 2019;13:128-132).

The Disaster Information Needs of Families of Children with Special Healthcare Needs: A Scoping Review

Families with children who have access and mobility challenges, chronic illness, or intellectual or developmental disabilities require targeted messages before, during, and after disasters to ensure that they understand risks to their children's health and can take measures to avoid harm and build resilience. A scoping review was conducted to assess current evidence for optimal ways to address the disaster information needs and communication preferences of families with children and youth with special healthcare needs. The disaster information needs of such families remain understudied, with few published evidence-based practices. Much of the relevant research focuses on information content, specifically the preparedness needs of these families; disaster recovery information for them remains a major gap. The few studies that have been performed suggest that parents with children and youth with special healthcare needs require additional information, education, and training to develop an effective disaster preparedness plan for their children. They are also largely unaware of schools' disaster plans, and schools are often unable to meet parents' expectations for timely, accurate information during a disaster. Several guidance documents highlighted the importance of completing an emergency information form before an event. Several studies suggested that one-on-one education or counseling was a strategy for encouraging preparedness planning; others highlighted potential value in incorporating families directly into disaster risk reduction planning. Evidence about channel preferences and their effectiveness in this population was generally lacking. Future studies should expand the evidence basis for optimal communication during all disaster phases both with parents of children and youth with special healthcare needs and with children directly.

Evaluation and Gap Analysis of Pediatric Disaster Preparedness Resources

The goal of this research was to identify, summarize, and evaluate pediatric disaster preparedness resources in the United States and to identify areas that need improvement or further development. Using standard literature, gray literature and website reviews, relevant resources were identified and the 50 most relevant resources were studied in depth. Each resource was given a grade of A, B, or C based on content, format, quality, and thoroughness. These resources were divided into 3 categories: (1) hospital resources, (2) school resources, and (3) training/education resources. Half of the 50 resources (25) were given a grade of A, indicating the highest level of quality and thoroughness, with pertinent information presented in a clear format. Sixteen of the resources were given a rating of B, while 9 of the resources were given a rating of C. Over 60% of the resources did not contain culturally sensitive information and more than 60% of the resources did not contain preparedness information for children with disabilities. Resources specific to hospitals and schools were limited in number and quality available, while training/education resources were widely available. In addition, 60% of resources were not specific to schools, children's hospitals, or to certain occupations (ie, nurses, doctors, teachers, principals). Based on these results, gaps in cultural sensitivity were identified and limitations in resources for children with disabilities and for schools and hospitals currently exist. All these areas require further development in the field of pediatric disaster preparedness (Disaster Med Public Health Preparedness. 2019;13:330-337).

Assessing Disaster Preparedness Among Select Children's Summer Camps in the United States and Canada

OBJECTIVE

Children's summer camps are at risk for multiple pediatric casualties during a disaster. The degree to which summer camps have instituted disaster preparedness is unknown. We assessed disaster preparedness among selected camps nationally for a range of disasters.

METHODS

We partnered with a national, web-based electronic health records system to send camp leadership of 315 camp organizations a 14-question online survey of disaster preparedness. One response from each camp was selected in the following order of importance: owner, director, physician, nurse, medical technician, office staff, and other. The results were analyzed using descriptive statistics.

RESULTS

A total of 181 camps responses were received, 169 of which were complete. Camp types were overnight (60%), day (21%), special/medical needs (14%), and other (5%). Survey respondents were directors (52%), nurses (14%), office staff (10%), physicians (5%), owners (5%), emergency medical technicians (2%), and other (12%). Almost 18% of camps were located >20 mi from a major medical center, and 36% were >5 mi from police/fire departments. Many camps were missing emergency supplies: car/booster seats for evacuation (68%), shelter (35%), vehicles for evacuation (26%), quarantine isolation areas (21%), or emergency supplies of extra water (20%) or food (17%). Plans were unavailable for the following: power outages (23%); lockdowns (15%); illness outbreaks (15%); tornadoes (11%); evacuation for fire, flood, or chemical spill (9%); and other severe weather (8%). Many camps did not have online emergency plans (53%), plans for children with special/medical needs (38%), methods to rapidly communicate information to parents (25%), or methods to identify children for evacuation/reunification with parents (40%). Respondents reported that staff participation in disaster drills varied for weather (58%), evacuations (46%), and lockdowns (36%). The majority (75%) of respondents had not collaborated with medical organizations for planning.

CONCLUSIONS

A substantial proportion of camps were missing critical components of disaster planning. Future interventions must focus on developing summer camp-specific disaster plans, increasing partnerships, and reassessing national disaster plans to include summer camp settings.

Evaluation and Treatment of Minors

Many patients under the age of majority present to emergency departments (EDs) without parents or guardians. This may create concern in regard to evaluation of these patients without formal consent to treat. The Emergency Medical Treatment and Labor Act mandates that all patients presenting to EDs receive a medical screening examination and does not exclude these minors. Standards for who can provide consent for a patient vary from state to state and address important issues such as consent by parent surrogates, as well as adolescent emancipation, reproductive health, mental health, and substance use. This document addresses current federal and state legal implications of providing emergency care to minors, as well as guidance in obtaining consent, maintaining confidentiality, and addressing refusal of care.

Rebuilding sustainable communities for children and families after disaster: recommendations from symposium participants in response to the April 27th, 2011 tornadoes

Tuscaloosa, Alabama experienced a significant disaster, an EF4 tornado with 190 mile an hour winds on April 27, 2011. Fifty-two people were killed and more than 5,000 homes were severely damaged. Twelve percent of the city was destroyed and 7,000 people were immediately unemployed. This was a disaster of significant proportion and impacted everyone in the community of over 80,000. In an effort to address the needs of the community after this disaster a symposium was organized with a focus on helping children and families. More than 40 professionals and community members attended the symposium which was led by an international expert on disaster. Recommendations were established and distributed to the community and governmental organizations. The process for planning and implementing the symposium also may serve as a model for addressing future disasters.

Pediatrics in disasters: evaluation of a global training program

The findings of this evaluation document partial success for the PEDS training program to achieve its 3 aims. It will take several years for the dissemination of this program to reach a critical mass of pediatricians and other physicians in many LMICs. Obtaining stronger support from MOHs and other governmental agencies is necessary to achieve this goal. Another additional approach would be to integrate the training into medical school and residency programs.

Uniting multi-adult households during emergency evacuation planning

When a no-notice emergency prompts an evacuation, family members in different locations throughout a city may unite so that they can evacuate as a group. This paper draws on data from more than 300 interviews conducted in the metropolitan area of Chicago, Illinois, United States. The study uses discrete choice models to analyse the expectations of respondents regarding whether their likely plans for evacuation involve gathering spouses, parents, adult-age children, and/or non-family members. In addition, it addresses the matter of whether respondents plan to reunite with family members at home. Individuals' access to a personal car is the dominating factor in predicting whether respondents plan to gather a spouse. Being the parent of a child under the age of 18 years increases the tendency to report planning to reunite with family members at home. Both commute mode and car availability are not significantly associated with plans to reunite at home.

Disaster preparedness and families of children with special needs: a geographic comparison

Over eleven million children in the United States have special health care needs. These unique needs can burden community and emergency responders after a disaster, complicating rescue and recovery efforts and generating reunification needs. Family disaster preparedness can help to moderate the extent that community resources are utilized by preparing families to be self-sustaining after a disaster and streamline access to medical care when needed. This study explored differences in two populations of families of children with special health care needs to determine if geographic differences exist in preparedness levels and whether a brief education intervention would prove successful in increasing baseline preparedness levels across both populations. A brief education intervention was delivered by trained community health educators to 210 families of children with special health care needs. A quasiexperimental pre-posttest design was used to compare baseline preparedness levels and 1 month follow-up levels. Although there was no difference in preparedness levels based on geographic location, both populations demonstrated a statistically significant increase in preparedness levels post-intervention. This study provides additional evidence that a brief education intervention helps to increase preparedness levels among families of children with special health care needs.

Pandemic planning and response in academic pediatric emergency departments during the 2009 H1N1 influenza pandemic

OBJECTIVES

The terrorist attacks of September 11, 2001, initiated a shift toward a comprehensive, or "all-hazards," framework of emergency preparedness in the United States. Since then, the threat of H5N1 avian influenza, the severe acute respiratory syndrome epidemic, and the 2009 H1N1 influenza pandemic have underscored the importance of considering infectious events within such a framework. Pediatric emergency departments (EDs) were disproportionately burdened by the 2009 H1N1 influenza pandemic and therefore serve as a robust context for evaluation of pandemic preparedness. The objective of this study was to explore pediatric ED leaders' experiences with preparedness, response, and postincident actions related to the H1N1 pandemic to inform future pandemic and all-hazards planning and policy for EDs.

METHODS

The authors selected a qualitative design, well suited for exploring complex, multifaceted organizational processes such as planning for and responding to a pandemic and learning from institutional experiences. Purposeful sampling was used to recruit medical directors or their designated physician respondents from pediatric emergency medicine training institutions representing a range of geographic regions across the United States, hospital types, and annual ED volumes; snowball sampling identified additional information-rich respondents. Recruitment began in May 2011 and continued until thematic saturation was reached in January 2012 (n = 20). Data were collected through in-depth individual phone interviews that were recorded and professionally transcribed. Using a standard interview guide, respondents were asked open-ended questions about pandemic planning, response, and institutional learning related to the H1N1 pandemic. Data analysis was performed by a multidisciplinary team using a grounded theory approach to generate themes inductively from respondents' expressed perspectives. The constant comparative method was used to identify emerging themes.

RESULTS

Five common themes characterized respondents' experiences with pandemic planning and response: 1) national pandemic influenza preparedness guidance has not fully penetrated to the level of pediatric emergency physician (EP) leaders, leading to variable states of preparedness; 2) pediatric EDs that maintained strong relationships with local public health and other health care entities found those relationships to be beneficial to pandemic response; 3) pediatric EP leaders reported difficulty reconciling public health guidance with the reality of ED practice; 4) although many anticipated obstacles did not materialize, in some cases pediatric EP leaders experienced unexpected institutional challenges; and 5) pediatric EP leaders described varied experiences with organizational learning following the H1N1 pandemic experience.

CONCLUSIONS

Despite a decade of investment in hospital preparedness, gaps in pediatric ED pandemic preparedness remain. This work suggests that raising awareness of pandemic planning standards and promoting strategies to overcome barriers to their adoption could enhance ED and hospital preparedness. Helping hospitals better prepare for pandemic events may lead to strengthened all-hazards preparedness.

Preparing families of children with special health care needs for disasters: an education intervention

Children with special health care needs pose a special challenge in post-disaster response. Current research suggests that the general population is not adequately prepared for a major disaster event, with members of vulnerable populations even less prepared. The purpose of this study was to determine the short-term effectiveness of a brief patient education intervention aimed at increasing levels of disaster preparedness among families of special health care needs children. One hundred twenty-one families were randomly assigned to either intervention or intervention plus incentive group. Families were surveyed prior to the intervention using a previously published instrument on family preparedness, and at 30-45 days post-intervention. A Preparedness Score was assigned to each family based on the number of items completed on the preparedness instrument. Significant differences were found between pre- and posttest scores for families that received the intervention, regardless of whether or not an incentive item was provided. Posttest scores were significantly higher than pretest scores, suggesting that the intervention was successful in increasing short-term overall levels of family preparedness in this population.

Legal considerations during pediatric emergency mass critical care events

INTRODUCTION

Recent public health emergencies, such as the 2009 Influenza A/H1N1 Pandemic and Hurricane Katrina, underscore the importance of developing healthcare response plans and protocols for disasters impacting large populations. Significant research and scholarship, including the 2009 Institute of Medicine report on crisis standards of care and the 2008 Task Force for Mass Critical Care recommendations, provide guidance for healthcare responses to catastrophic emergencies. Most of these efforts recognize but do not focus on the unique needs of pediatric populations. In 2008, the Centers for Disease Control and Prevention supported the formation of a task force to address pediatric emergency mass critical care response issues, including legal issues. Liability is a significant concern for healthcare practitioners and facilities during pediatric emergency mass critical care that necessitates a shift to crisis standards of care. This article describes the legal considerations inherent in planning for and responding to catastrophic health emergencies and makes recommendations for pediatric emergency mass critical care legal preparedness.

METHODS

The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010, to review the pediatric emergency mass critical care recommendations developed by a 17-member steering committee. During the meeting, experts determined that the recommendations would be strengthened by a manuscript addressing legal issues. Authors drafted the manuscript through consensus-based study of peer-reviewed research, literature reviews, and expert opinion. The manuscript was reviewed by Pediatric Emergency Mass Critical Care Steering Committee members and additional legal counsel and revised.

TASK FORCE RECOMMENDATIONS

While the legal issues associated with providing pediatric emergency mass critical care are not unique within the overall context of disaster healthcare, the scope of the parens patriae power of states, informed consent principles, and security should be considered in pediatric emergency mass critical care planning and response efforts because parents and legal guardians may be unavailable to participate in healthcare decision making during disasters. In addition, practitioners who follow properly vetted and accepted pediatric emergency mass critical care disaster protocols in good faith should be protected from civil liability, and healthcare facilities that provide pediatric care should incorporate informed consent and security protocols into their disaster plans.

The Impact of Child-Related Stressors on the Psychological Functioning of Lower-Income Mothers After Hurricane Katrina

In the present study, the authors examined the role of child-related stressors in the psychological adjustment of lower-income, primarily unmarried and African American, mothers (N = 386). All participants lived in areas affected by Hurricane Katrina, and about a third were also exposed to Hurricane Rita (30.3%, n = 117). Lacking knowledge of a child's safety during the hurricanes was a significant predictor of heightened postdisaster psychological distress and posttraumatic stress, even after controlling for demographic variables, predisaster psychological distress, evacuation timing, and bereavement. From interviews with a subset of the participants (n = 57), we found that mothers consistently put their own needs behind those of their children. The authors recommend policies that promptly reunite mothers with missing children and support lower-income mothers in caring for their children during natural disasters and the aftermath.

Disaster preparedness for children with special healthcare needs and disabilities

Ask the Expert provides research-based answers to practice questions submitted by JSPN readers.

A multiple additive regression tree analysis of three exposure measures during Hurricane Katrina

This paper analyses structural and personal exposure to Hurricane Katrina. Structural exposure is measured by flood height and building damage; personal exposure is measured by the locations of 911 calls made during the response. Using these variables, this paper characterises the geography of exposure and also demonstrates the utility of a robust analytical approach in understanding health-related challenges to disadvantaged populations during recovery. Analysis is conducted using a contemporary statistical approach, a multiple additive regression tree (MART), which displays considerable improvement over traditional regression analysis. By using MART, the percentage of improvement in R-squares over standard multiple linear regression ranges from about 62 to more than 100 per cent. The most revealing finding is the modelled verification that African Americans experienced disproportionate exposure in both structural and personal contexts. Given the impact of exposure to health outcomes, this finding has implications for understanding the long-term health challenges facing this population.

Policy statement--emergency information forms and emergency preparedness for children with special health care needs

Children with chronic medical conditions rely on complex management plans for problems that cause them to be at increased risk for suboptimal outcomes in emergency situations. The emergency information form (EIF) is a medical summary that describes medical condition(s), medications, and special health care needs to inform health care providers of a child's special health conditions and needs so that optimal emergency medical care can be provided. This statement describes updates to EIFs, including computerization of the EIF, expanding the potential benefits of the EIF, quality-improvement programs using the EIF, the EIF as a central repository, and facilitating emergency preparedness in disaster management and drills by using the EIF.

Pediatric emergency preparedness training: are we on a path toward national dissemination?

BACKGROUND

Emergency preparedness training is crucial for all health professionals, but the physiologic, anatomic, and psychologic differences between children and adults necessitates that health professionals receive training specific to pediatric emergencies. Before a standardized, nationally disseminated pediatric curriculum can be developed or endorsed, evidence-based evaluations of short- and long-term outcomes need to be conducted.

METHODS

A review of literature was conducted to identify developed courses and any evaluation of these courses.

RESULTS

Much has been published that supports the need for pediatric emergency preparedness, and many resources have been developed. However, very little literature presents evaluations of training courses.

DISCUSSION

To achieve evidence-based pediatric emergency preparedness training, existing training programs must be evaluated, standardized training guidelines need to be developed, and critical components of pediatric disaster response need to be captured in the academic literature.

Pediatric issues in disaster preparedness: meeting the educational needs of nurses-are we there yet?

Children have unique physical, emotional, and developmental needs making them particularly vulnerable during disasters. Most existing disaster preparedness courses lack a pediatric perspective. This article describes a pediatric disaster preparedness program presented to pediatric nurses in an urban, Level 1 trauma center. Survey results from the participants prior to the program revealed a lack of awareness of pediatric issues. Although the program resulted in an immediate improvement in awareness, retention fell back to precourse levels 2 years later. We conclude that pediatric disaster preparedness training should be integrated into hospital nursing curriculum on a regular basis.