Operation Child-ID: reunifying children with their legal guardians after Hurricane Katrina

Child Abuse in Times of Crises: Lessons Learned

The COVID-19 pandemic has created conditions which heighten risk for child abuse. As key players in times of crisis, pediatric emergency medicine providers must be equipped with the tools to recognize, respond to, and mitigate risk of child abuse. An exploration of the scientific literature, stakeholder organization reports and lay press was undertaken to understand the impact of large-scale U.S. crises, including infectious disease, financial downturn, natural disaster, and violence, on child abuse risk and inform prevention strategies. Review of the literature suggests a relationship between crises and child abuse risk, though gaps in the research remain. We outline the role of pediatric emergency medicine providers in partnering with communities in organizing and advocating for systems that better protect children and strengthen families.

Separated After a Disaster: Trust and Privacy Issues in Sharing Children's Personal Information

BACKGROUND

After disasters, unaccompanied children may present to an emergency department requiring reunification. An effective reunification system depends on the willingness of guardians to utilize it.

OBJECTIVE

Assess guardian willingness to share children's personal information for reunification purposes after a disaster, perceived concerns and beliefs, and trust in reunification agencies.

METHODS

Guardians of children presenting to 2 pediatric emergency departments were approached to participate in a survey-based study. Willingness to share their children's personal information was scored on a scale of 1 to 19 (1 point per item). Perceived concerns about and importance of sharing information, level of trust in reunification agencies, and guardian demographics were collected. Chi-square was used to compare trust and attitudes/beliefs. Multivariate linear regression was used to determine factors associated with willingness to share information.

RESULTS

A total of 363 surveys were completed (response rate, 80%). Most guardians (95.6%) were willing to share at least some information (mean, 16 items; range, 1-19). Half were concerned about protection (55.4%) or abuse (52.3%) of their child's information. Hospitals were trusted more than other reunification agencies (P < .001). Perception of reunification importance was associated with willingness to share (P < .001).

CONCLUSIONS

Guardians are willing to share their children's information to facilitate reunification after disasters, but have privacy concerns.

Creation of a Collaborative Disaster Preparedness Video for Daycare Providers: Use of the Delphi Model for the Creation of a Comprehensive Disaster Preparedness Video for Daycare Providers

OBJECTIVE

Eight million American children under the age of 5 attend daycare and more than another 50 million American children are in school or daycare settings. Emergency planning requirements for daycare licensing vary by state. Expert opinions were used to create a disaster preparedness video designed for daycare providers to cover a broad spectrum of scenarios.

METHODS

Various stakeholders (17) devised the outline for an educational pre-disaster video for child daycare providers using the Delphi technique. Fleiss κ values were obtained for consensus data. A 20-minute video was created, addressing the physical, psychological, and legal needs of children during and after a disaster. Viewers completed an anonymous survey to evaluate topic comprehension.

RESULTS

A consensus was attempted on all topics, ranging from elements for inclusion to presentation format. The Fleiss κ value of 0.07 was obtained. Fifty-seven of the total 168 video viewers completed the 10-question survey, with comprehension scores ranging from 72% to 100%.

CONCLUSION

Evaluation of caregivers that viewed our video supports understanding of video contents. Ultimately, the technique used to create and disseminate the resources may serve as a template for others providing pre-disaster planning education. (Disaster Med Public Health Preparedness. 2019;13:123-127).

Prolonged elevated body mass index in preschool children after the Great East Japan Earthquake

BACKGROUND

The Great East Japan Earthquake followed by tsunamis and the Fukushima Daiichi Nuclear Power Plant (NPP) accident caused catastrophic damage. The effects of the disaster on the growth of affected children are of great concern but remain unknown.

METHODS

The subject group was derived from two Japanese nationwide retrospective cohorts (historical control and exposure groups, respectively). The exposure group experienced the disaster at 47-59 months of age. We analyzed longitudinal changes in standard deviation score (SDS) for height and body mass index (BMI) using normal Japanese children's standards. Moreover, we analyzed the details of the affected children in Fukushima using Fukushima-specific growth charts established with the historical control data to clarify any indirect effect of the disaster on growth.

RESULTS

Affected children in Fukushima had significantly higher BMI SDS than the historical control group (difference, 0.13; 95% CI: 0.044-0.21, P = 0.0029) and the regional controls (difference, 0.14; 95% CI: 0.074-0.20, P < 0.0001) 1.5 years after the disaster. Similar sustained increases in BMI SDS were also found with Fukushima-specific growth charts, but the phenomenon was detected only in boys. Notably, the BMI SDS of affected children who lived near the NPP had been increasing after the disaster, whereas those in distant areas had not changed. In contrast, height SDS had not changed throughout the analysis.

CONCLUSIONS

Prolonged elevated BMI SDS was detected only in affected children in Fukushima. This phenomenon may be explained by an indirect effect of the NPP accident.

Disease prevalence among nursery school children after the Great East Japan earthquake

Objective

To investigate the relationship between personal experience of the Great East Japan Earthquake and various disease types among nursery school children.

Design

We conducted a nationwide survey of nursery school children born between 2 April 2006 and 1 April 2007. Nursery school teachers completed questionnaires if they agreed to join the study. Questionnaire items for children consisted of their birth year and month, sex, any history of moving into or out of the current nursery school, presence of diseases diagnosed by a physician at the age of 66–78 months and type of disaster experience. The survey was conducted from September 2012 to December 2012.

Setting

Japan, nationwide.

Participants

A total of 60 270 nursery school children were included in the analysis, 840 of whom experienced the disaster on 11 March 2011.

Main outcome measures

The health status of children 1.5 years after the disaster based on nursery school records.

Results

Experiencing the disaster significantly affected the prevalence of overall and individual diseases. Furthermore, there was a difference in disease prevalence between boys and girls. In boys, experiencing the tsunami (OR 2.53, 95% CI 1.22 to 5.24) and living in an evacuation centre (OR 2.92, 95% CI 1.46 to 5.83) were remarkably associated with a higher prevalence of atopic dermatitis, but these trends were not observed among girls. Instead, the home being destroyed (OR 3.50, 95% CI 2.02 to 6.07) and moving house (OR 4.19, 95% CI 2.01 to 8.71) were positively associated with a higher prevalence of asthma among girls.

Conclusions

Our study indicates that experiencing the disaster may have affected the health status of nursery school children at least up to 1.5 years after the disaster. Continuous monitoring of the health status of children is necessary to develop strategic plans for child health.

An Approach to Developing Local Climate Change Environmental Public Health Indicators in a Rural District

Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network's framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as "high vulnerability." Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment.

The Tohoku Medical Megabank Project: Design and Mission

The Great East Japan Earthquake (GEJE) and resulting tsunami of March 11, 2011 gave rise to devastating damage on the Pacific coast of the Tohoku region. The Tohoku Medical Megabank Project (TMM), which is being conducted by Tohoku University Tohoku Medical Megabank Organization (ToMMo) and Iwate Medical University Iwate Tohoku Medical Megabank Organization (IMM), has been launched to realize creative reconstruction and to solve medical problems in the aftermath of this disaster. We started two prospective cohort studies in Miyagi and Iwate Prefectures: a population-based adult cohort study, the TMM Community-Based Cohort Study (TMM CommCohort Study), which will recruit 80 000 participants, and a birth and three-generation cohort study, the TMM Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study), which will recruit 70 000 participants, including fetuses and their parents, siblings, grandparents, and extended family members. The TMM CommCohort Study will recruit participants from 2013 to 2016 and follow them for at least 5 years. The TMM BirThree Cohort Study will recruit participants from 2013 to 2017 and follow them for at least 4 years. For children, the ToMMo Child Health Study, which adopted a cross-sectional design, was also started in November 2012 in Miyagi Prefecture. An integrated biobank will be constructed based on the two prospective cohort studies, and ToMMo and IMM will investigate the chronic medical impacts of the GEJE. The integrated biobank of TMM consists of health and clinical information, biospecimens, and genome and omics data. The biobank aims to establish a firm basis for personalized healthcare and medicine, mainly for diseases aggravated by the GEJE in the two prefectures. Biospecimens and related information in the biobank will be distributed to the research community. TMM itself will also undertake genomic and omics research. The aims of the genomic studies are: 1) to construct an integrated biobank; 2) to return genomic research results to the participants of the cohort studies, which will lead to the implementation of personalized healthcare and medicine in the affected areas in the near future; and 3) to contribute the development of personalized healthcare and medicine worldwide. Through the activities of TMM, we will clarify how to approach prolonged healthcare problems in areas damaged by large-scale disasters and how useful genomic information is for disease prevention.

Child maltreatment and disaster prevention: a qualitative study of community agency perspectives

Introduction:

Child maltreatment (CM) is a significant public health problem that increases following natural disasters. Ecological approaches have been used to study these complex phenomena, and the current research fits within this perspective by conducting qualitative interviews with disaster response and family-serving community agencies. The purpose of the study was to identify whether or not community agencies identified CM as an issue that is relevant for disaster planning and response and their perspectives on risk and protective factors for CM risk following disaster.

Methods:

Agencies (n=16) from 2 geographical areas participated - one that recently experienced a natural disaster (Louisiana (LA), n=7) and one that had not (Georgia (GA), n=9). Agency representatives completed semi-structured telephone interviews (n=16) and follow up in person focus groups (n=14). Theory-driven, thematic analyses were completed.

Results:

Results suggested that community agencies agree that post-disaster environments increase the risk for CM and that CM prevention has a role in disaster response planning. Risk and protective factors were identified according to Bronfenbrenner’ s ecological framework.

Conclusion:

Study results support the need to include CM prevention efforts within disaster planning and provide guidance for future research to inform such efforts.

Delayed family reunification of pediatric disaster survivors increases mortality and inpatient hospital costs: a simulation study

BACKGROUND

Disasters occur randomly and can severely tax the health care delivery system of affected and surrounding regions. A significant proportion of disaster survivors are children, who have unique medical, psychosocial, and logistical needs after a mass casualty event. Children are often transported to specialty centers after disasters for a higher level of pediatric care, but this can also lead to separation of these survivors from their families. In a recent theoretical article, we showed that the availability of a pediatric trauma center after a mass casualty event would decrease the time needed to definitively treat the pediatric survivor cohort and decrease pediatric mortality. However, we also found that if the pediatric center was too slow in admitting and discharging patients, these benefits were at risk of being lost as children became "trapped" in the slow center. We hypothesized that this effect could result in further increased mortality and greater costs.

METHODS

Here, we expand on these ideas to test this hypothesis via mathematical simulation. We examine how a delay in discharge of part of the pediatric cohort is predicted to affect mortality and the cost of inpatient care in the setting of our model.

RESULTS

We find that mortality would increase slightly (from 14.2%-16.1%), and the cost of inpatient care increases dramatically (by a factor of 21) if children are discharged at rates consistent with reported delays to reunification after a disaster from the literature.

CONCLUSIONS

Our results argue for the ongoing improvement of identification technology and logistics for rapid reunification of pediatric survivors with their families after mass casualty events.

Public Expectations for Nonemergency Hospital Resources and Services During Disasters

Objective

The public's expectations of hospital services during disasters may not reflect current hospital disaster plans. The objective of this study was to determine the public's expected hospital service utilization during a pandemic, earthquake, and terrorist bombing.

Methods

A survey was distributed to adult patients or family members at 3 emergency departments (EDs). Participants identified resources and services they expect to need during 3 disaster scenarios. Linear regression was used to describe factors associated with higher expected utilization scores for each scenario.

Results

Of the 961 people who participated in the study, 66.9% were women, 47.5% were white, and 44.6% were black. Determinants of higher pandemic resource utilization included persons who were younger (P < .01); non-white (P < .001); had higher ED visits (P < .01), hospitalization (P = .001), or fewer primary care provider visits (P = .001) in the past year; and did not having a reunification plan (P < .001). Determinants of higher earthquake resource utilization included persons who were non-white (P < .001); who were a patient or spouse (vs parent) participating in the study (P < .05 and P = .001); and had higher ED visits in the past year (P = .001). Determinants of higher bombing resource utilization included persons who were female (P = .001); non-white (P < .001); had higher ED (P = .001) or primary care provider (P < .01) visits in past year; and experienced the loss of home or property during a past disaster (P < .05).

Conclusions

Public expectations of hospitals during disasters are high, and some expectations are inappropriate. Better community disaster planning and public risk communication are needed. (Disaster Med Public Health Preparedness. 2013;0:1–8)

Survey of emergency management professionals to assess ideal characteristics of a photographic-based family reunification tool

OBJECTIVE

A reunification tool that captures images of children at the time of the disaster would enable parents to locate their missing children, particularly if the children are unable to communicate their identity. This study assessed the ideal features and parameters of a photographic-based reunification tool.

METHODS

A convenience sample of federal, state, and hospital-based emergency management professionals were surveyed to elicit their preferences regarding an image-based reunification algorithm, to assess the parents' level of difficulty in viewing images with facial trauma, and to determine the minimum percentage of successful reunifications needed to justify adoption of a reunification tool.

RESULTS

Of 322 emergency management professionals surveyed, 129 (40%) responded. Only 18% favored a photographic-based tool that would display images in which only the categories of age, gender, and facial features (eye, hair, and skin color) would exactly match the parent's description of the child. However, 72% preferred a broader, less-rigid system in which the images displayed would match all or most features in the parents' description of the missing child, allowing parents to view more of the image database. Most (85%) preferred a tool showing unedited images of living children, allowing parents to view facial trauma. However, more respondents reported that parents would find viewing unedited images with facial trauma somewhat or very difficult emotionally compared with edited images for both living (77% vs 20%, P < .001) and deceased children (91% vs 70%, P < .001.) In a disaster involving 1000 children, a tool that reunites a minimum of 10% of families would be adopted by over 50% of the participants. Participants were willing to accept a lower percentage of reunifications in a disaster involving 1000 children compared with disasters involving 10 (P < .001) or 100 children. (P < .001).

CONCLUSIONS

Emergency management professionals identified desirable characteristics of a photographic-based reunification tool, including an algorithm displaying unedited photographs of missing children that loosely matches the parents' description, acknowledging the parents' emotional difficulty in viewing photographs with facial trauma. Participants were also willing to accept a lower percentage of successful reunifications as the scale of the disaster size increased.

Disaster and mass casualty events in the pediatric population

Recent disasters involving pediatric victims have highlighted the need for pediatric hospital disaster preparedness. Although children represent 25% of the U.S. population, there are significant gaps in pediatric disaster preparedness across the country. Disaster planners and others tend to overlook pediatric needs, and therefore plans are often inadequate. To establish an effective hospital and community-based pediatric disaster management system, administrative and hospital leadership are key. Disaster planners and hospital leadership should establish and improve their management of pediatric victims in the event of a disaster through staff training, family reunification planning, and use of available pediatric disaster management tools.

Psychosocial considerations about children and radiological events

Children are identified as a vulnerable population in the case of radiological events because of their increased physical sensitivity to radiation and its impact on critical development stages. Using a comprehensive integrated risk framework, psychosocial risk protective factors are discussed in a social ecology paradigm. Children have been shown to be both vulnerable and resilient; they are both easily impressionable and also quick to adapt and learn. Psychosocial interventions during, after and most efficiently before an event can improve outcome, especially if they involve parents and schools, media and work organisations. Public education through children should be encouraged to increase knowledge of radiation and strategies to minimise exposure and irradiation. Children can become vectors of prevention, preparedness and mitigation through information and behavioural rehearsal. Special consideration must therefore be given to education, school programmes, practice rehearsal and media exposure.

Health informatics for pediatric disaster preparedness planning

OBJECTIVE

1. To conduct a review of the role of informatics in pediatric disaster preparedness using all medical databases. 2. To provide recommendations to improve pediatric disaster preparedness by the application of informatics.

METHODS

A literature search was conducted using MEDLINE, CINHL and the Cochrane Library using the key words "children" AND "disaster preparedness and disaster" AND "informatics".

RESULTS

A total of 314 papers were initially produced by the search and eight that met the selection criteria were included in the review. Four themes emerged: tools for disaster preparedness, education, reunification and planning and response.

CONCLUSION

The literature pertaining to informatics and pediatric disaster preparedness is sparse and many gaps still persist. Current disaster preparedness tools focus on the general population and do not specifically address children. The most progress has been achieved in family reunification; however, the recommendations delineated are yet to be completed.

Reunification: keeping families together in crisis

BACKGROUND

In reviewing the literature, there has not been a family reunification plan that has worked consistently during disasters. During Hurricane Katrina, there were children who were sent to a shelter in a different state than their patients. When children are involved, the issues become even more difficult, because some children who are preverbal cannot tell their names or their parents names. Tracking systems have been developed but are not interoperable. No central repository has been developed. There are also issues related to transporting patients, psychosocial issues as well as safety issues that are different when children will be unaccompanied by an adult.

METHODS

Two national meetings were held with experts from all over the country who have an expertise in the care of children. Six focused groups were identified: patient movement/transportation; technology/tracking; clinical issues, nonmedical issues; communication/regulatory issues; and pediatric psychosocial support. The second meeting was a consensus conference.

RESULTS

Recommendations from each subgroup were presented and voted on. All recommendations were accepted.

CONCLUSIONS

The issue of reunification of families in disaster is still a problem. Further work needs to be done on tracking systems that are interoperable before another large disaster strike, pediatric psychological issues after a disaster, transporting patients, and care of the pediatric patient who is not accompanied by an adult. Once a system has been developed, the system needs to be tested by large scale drills that practice moving children across state lines and from one area to another.