Pediatric emergency mass critical care: the role of community preparedness in conserving critical care resources

The Role of Clinic Preparedness to Support Patients and Strengthen the Medical System During and After a Pandemic

Pediatric clinic preparedness is essential to improve the care and health outcomes for children during a pandemic and to decrease the burden on hospital systems. Clinic preparedness is a process that involves a well thought out plan that includes coordination with staff, open communication between the clinic and patient families, and collaboration with community partners. Planning for disasters can decrease some of the risks for our most vulnerable patients, including children and youth with special health care needs. There are plans, coalitions, and community partners that can help clinics in their preparedness journey.

Non-Pediatric Nurses' Willingness to Provide Care to Pediatric Patients during a Disaster: An Assessment of Pediatric Surge Capacity in Four Midwestern Hospitals

OBJECTIVE

To assess non-pediatric nurses' willingness to provide care to pediatric patients during a mass casualty event (MCE).

METHODS

Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses' willingness to provide MCE pediatric care.

RESULTS

In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital.

CONCLUSION

Pediatric surge capacity is lacking among nurses. Increasing nurses' pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.

[Mass casualty incidents and attacks involving a multitude of children and adolescents-Overview of policy recommendations and challenges]

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.

A Productive Proposed Search Syntax for Health Disaster Preparedness Research

Objective:

To find a proper search strategy to do a systematic review related to preparedness for disasters.

Methods:

MeSH and Emtree terms were searched to detect synonyms for two main search terms “disaster” and “preparedness”. Expert opinion on the synonyms was examined applying a Google form. The adopted syntax was searched in PubMed and results were sifted. Hand searching in two top key journals was done and sensitivity was calculated.

Results:

Out of 1120 articles, 122 were included. In PDM journal, 10 articles were included by hand searching, out of which 5 were not spotted in PubMed search with the proposed syntax. In DMPHP journal, 13 publications were included, with 5 not found in PubMed search. Because of human error in hand searching 2 articles were added.

Conclusion:

The proposed syntax in this study achieves a sensitivity of search of 0.6 in PubMed which could be quite applicable for researchers. Moreover, in case only MeSH or Emtree terms were applied in search strategy or where hand searching was not performed, there were a number of articles missed.

A Productive Proposed Search Syntax for Health Disaster Preparedness Research

Objective

To find a proper search strategy to do a systematic review related to preparedness for disasters.

Methods

MeSH and Emtree terms were searched to detect synonyms for two main search terms "disaster" and "preparedness". Expert opinion on the synonyms was examined applying a Google form. The adopted syntax was searched in PubMed and results were sifted. Hand searching in two top key journals was done and sensitivity was calculated.

Results

Out of 1120 articles, 122 were included. In PDM journal, 10 articles were included by hand searching, out of which 5 were not spotted in PubMed search with the proposed syntax. In DMPHP journal, 13 publications were included, with 5 not found in PubMed search. Because of human error in hand searching 2 articles were added.

Conclusion

The proposed syntax in this study achieves a sensitivity of search of 0.6 in PubMed which could be quite applicable for researchers. Moreover, in case only MeSH or Emtree terms were applied in search strategy or where hand searching was not performed, there were a number of articles missed.

Understanding Liability Risks and Protections for Pediatric Providers During Disasters

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.

Development of an Evacuation Tool to Facilitate Disaster Preparedness: Use in a Planned Evacuation to Support a Hospital Move

OBJECTIVES

Our institution relocated to a new facility 3.5 miles from our original location in Chicago on June 9, 2012. We describe the tools we developed to prepare, execute, and manage our evacuation and relocation.

METHODS

Tools developed for the planned evacuation included the following: level of acuity and team composition classification, patient departure checklist, evacuation handoff tool, and a patient tracking system within the electronic health record. Incident Command structure was utilized.

RESULTS

Monthly census tracking exercises were held beginning 12 months before the evacuation. Simulation drills began 6 months before the evacuation. The entire evacuation took less than 14 hours and there were no safety issues. A total of 127 patients were transported to the new facility: 45 patients were moved via the Neonatal/Pediatric Critical Care Transport Team, and the rest were moved with various team configurations.

CONCLUSION

Documents developed for a planned evacuation can be used for any planned or unplanned evacuation. We believe the tools we used to prepare, execute, and manage our evacuation and relocation would assist any health care facility to be better prepared to safely and efficiently evacuate patients in the event of a disaster, or to create surge capacity, and relocate them to another facility. (Disaster Med Public Health Preparedness. 2017;11:479-486).

Emergency Preparedness and the Development of Health Care Coalitions: A Dynamic Process

Health care emergency preparedness has undergone significant changes since the first widespread distribution of federal funds occurred in 2002. Prior to the development of the Health Resources and Service Administration Bioterrorism Preparedness grant, support to hospitals and public health was limited to smaller regional preparedness programs such as the Chemical Stockpile Emergency Preparedness Program. Measurable progress with both the hospital preparedness program and public health emergency preparedness requires development of partnerships, establishment of coalitions, development of measurable objectives, and a community willingness to work together to solve complex preparedness problems.

Building health care system capacity: training health care professionals in disaster preparedness health care coalitions

INTRODUCTION

This study aimed to learn from the experiences of well-established, disaster preparedness-focused health care coalition (HCC) leaders for the purpose of identifying opportunities for improved delivery of disaster-health principles to health professionals involved in HCCs. This report describes current HCC education and training needs, challenges, and promising practices.

METHODS

A semi-structured interview was conducted with a sample of leaders of nine preparedness-focused HCCs identified through a 3-stage purposive strategy. Transcripts were analyzed qualitatively.

RESULTS

Training needs included: stakeholder engagement; economic sustainability; communication; coroner and mortuary services; chemical, biological, radiological, nuclear, and explosives (CBRNE); mass-casualty incidents; and exercise design. Of these identified training needs, stakeholder engagement, economic sustainability, and exercise design were relevant to leaders within HCCs, as opposed to general HCC membership. Challenges to education and training included a lack of time, little-to-no staff devoted to training, and difficulty getting coalition members to prioritize training. Promising practices to these challenges are also presented.

CONCLUSIONS

The success of mature coalitions in improving situational awareness, promoting planning, and enabling staff- and resource-sharing suggest the strengths and opportunities that are inherent within these organizations. However, offering effective education and training opportunities is a challenge in the absence of ubiquitous support, incentives, or requirements among health care professions. Notably, an online resource repository would help reduce the burden on individual coalitions by eliminating the need to continually develop learning opportunities.

Surge capacity principles: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

BACKGROUND

This article provides consensus suggestions for expanding critical care surge capacity and extension of critical care service capabilities in disasters or pandemics. It focuses on the principles and frameworks for expansion of intensive care services in hospitals in the developed world. A companion article addresses surge logistics, those elements that provide the capability to deliver mass critical care in disaster events. The suggestions in this article are important for all who are involved in large-scale disasters or pandemics with injured or critically ill multiple patients, including front-line clinicians, hospital administrators, and public health or government officials.

METHODS

The Surge Capacity topic panel developed 23 key questions focused on the following domains: systems issues; equipment, supplies, and pharmaceuticals; staffing; and informatics. Literature searches were conducted to identify evidence on which to base key suggestions. Most reports were small scale, were observational, or used flawed modeling; hence, the level of evidence on which to base recommendations was poor and did not permit the development of evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions from the previous task force were also included for validation by the expert panel.

RESULTS

This article presents 10 suggestions pertaining to the principles that should guide surge capacity and capability planning for mass critical care, including the role of critical care in disaster planning; the surge continuum; targets of surge response; situational awareness and information sharing; mitigating the impact on critical care; planning for the care of special populations; and service deescalation/cessation (also considered as engineered failure).

CONCLUSIONS

Future reports on critical care surge should emphasize population-based outcomes as well as logistical details. Planning should be based on the projected number of critically ill or injured patients resulting from specific scenarios. This should include a consideration of ICU patient care requirements over time and must factor in resource constraints that may limit the ability to provide care. Standard ICU management forms and patient data forms to assess ICU surge capacity impacts should be created and used in disaster events.

Mapping US pediatric hospitals and subspecialty critical care for public health preparedness and disaster response, 2008

OBJECTIVE

The objective is to describe by geographic proximity the extent to which the US pediatric population (aged 0-17 years) has access to pediatric and other specialized critical care facilities, and to highlight regional differences in population and critical resource distribution for preparedness planning and utilization during a mass public health disaster.

METHODS

The analysis focused on pediatric hospitals and pediatric and general medical/surgical hospitals with specialized pediatric critical care capabilities, including pediatric intensive care units (PICU), pediatric cardiac ICUs (PCICU), level I and II trauma and pediatric trauma centers, and general and pediatric burn centers. The proximity analysis uses a geographic information system overlay function: spatial buffers or zones of a defined radius are superimposed on a dasymetric map of the pediatric population. By comparing the population living within the zones to the total population, the proportion of children with access to each type of specialized unit can be estimated. The project was conducted in three steps: preparation of the geospatial layer of the pediatric population using dasymetric mapping methods; preparation of the geospatial layer for each resource zone including the identification, verification, and location of hospital facilities with the target resources; and proximity analysis of the pediatric population within these zones.

RESULTS

Nationally, 63.7% of the pediatric population lives within 50 miles of a pediatric hospital; 81.5% lives within 50 miles of a hospital with a PICU; 76.1% lives within 50 miles of a hospital with a PCICU; 80.2% lives within 50 miles of a level I or II trauma center; and 70.8% lives within 50 miles of a burn center. However, state-specific proportions vary from less than 10% to virtually 100%. Restricting the burn and trauma centers to pediatric units only decreases the national proportion to 26.3% for pediatric burn centers and 53.1% for pediatric trauma centers.

CONCLUSIONS

This geospatial analysis describes the current state of pediatric critical care hospital resources and provides a visual and analytic overview of existing gaps in local pediatric hospital coverage. It also highlights the use of dasymetric mapping as a tool for public health preparedness planning.