Pediatric care in disasters

Challenges of Providing Health Care in Complex Emergencies: A Systematic Review

Providing health care in times of complex emergencies (CEs) is one of the most vital needs of people. CEs are situations in which a large part of the population is affected by social unrest, wars, and food shortages. This systematic review study was conducted to identify the challenges of health-care delivery in CEs. We searched terms related to health-care delivery and CEs in PubMed, Web of Sciences, Science Direct, and Google scholar databases, as well as Persian databases SID and Magiran. The searching keywords included: "Health Care, Complex Crises, War, Humanitarian, Refugees, Displaced Persons, Health Services, and Challenges." Of 409 records, we selected 6 articles based on the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist. Studies were analyzed through qualitative content analysis. The results show that CEs affect health-care delivery in 4 primary areas: the workforce, infrastructure, information access, and organization of health services. These areas can pose potential threats for health-care providers and planners at times of emergencies. Thus, they should be informed about these challenges to strengthen the health-care system.

Disasters in Germany and France: An Analysis of the Emergency Events Database From a Pediatric Perspective

OBJECTIVE

The objective of this study was to conduct comprehensive analyses of disaster patterns for Germany and France from a pediatric perspective.

METHODS

An analysis of the Emergency Events Database (EM-DAT), epidemiological database with standard methods of descriptive and comparative statistics respecting the strengthening the reporting of observational studies in epidemiology (STROBE) criteria, was performed.

RESULTS

Between 2006 and 2016, there were 41 and 42 disasters in Germany and France claiming 259 and 4973 lives, respectively. Ages of afflicted individuals were not specified in EM-DAT. In Germany, most events were storms (37%), extreme temperatures (17%), floods (17%), and transport accidents (17%). In France, most events were storms (45%), extreme temperatures (17%), floods (19%), and transport accidents (14%). In Germany, most lives (96) were lost in transport accidents. In France, most casualties were due to the heat waves of 2006 and 2015 (1388 and 3275). Reported event types in Germany and France were similar, but heat waves struck France more significantly than Germany.

CONCLUSIONS

Pediatric data are not explicitly captured in EM-DAT, but reported disaster patterns suggest that exposures to heat and cold, storms, trauma, chemicals, water, and infectious agents are possible mechanisms of injury. Age-stratified disaster data are needed to enable a timely, transparent, coordinated, and sustained data-driven approach to pediatric disaster resilience.

Pediatricians and Global Health: Opportunities and Considerations for Meaningful Engagement

Pediatric practitioners whose expertise is primarily focused on the care of children within health settings in the United States are increasingly engaged in global child health (GCH). The wide spectrum of this involvement may include incorporating short-term or longer-term GCH commitments in clinical care, teaching and training, mentoring, collaborative research, health policy, and advocacy into a pediatric career. We provide an overview of routes of engagement, identify resources, and describe important considerations for and challenges to better equipping US pediatric practitioners to participate in meaningful GCH experiences. This article is part of a series on GCH describing critical issues relevant to caring for children from an international perspective.

Pediatric Emergency Care in Disaster-Affected Areas: A Firsthand Perspective after Typhoons Bopha and Haiyan in the Philippines

Disasters are defined as man-made or natural causes that disrupt a population and cause widespread human, material, economic, or environmental losses, exceeding that population's capacity to cope using its own resources. This review highlights the epidemiology and disease patterns in disasters, with specific application to the care of children in the austere environments created in the aftermath of disasters. The review also attempts to describe the experience from a firsthand field hospital perspective of a multinational team in caring for patients in the aftermath of two natural disasters in the Philippines, during both Typhoon Bopha and Typhoon Haiyan. In doing so, we will place these experiences in the context of the current literature on the subject of pediatric management during disaster emergencies and describe lessons learned to refine team approaches and patient care methodologies. The review also discusses methods for improvement in emergency preparedness for disasters, with specific mention of the roles of telemedicine and just-in-time simulation training, when feasible. Lastly, it will review the importance of community and military collaboration and planning for aftercare post-departure of foreign medical teams.

Injuries and surgical needs of children in conflict and disaster: From Boston to Haiti and beyond

Comprehensive care of patients in conflict and disaster requires coordination of medical, social, and public health agencies. Pediatric patients in these settings comprise a particularly vulnerable group subject to disruption of social networks and separation from family, inadequate surgical care due to lack of surgeon, anesthetist, and nursing specialization, and a general lack of advocacy within the global public health agenda. In the recent upswell of attention to the global surgical burden of disease and deficiencies in necessary infrastructure, the needs of pediatric surgical patients remain underappreciated and underemphasized amid calls for improvement in global surgical health. Experience in recent natural and man-made disasters has demonstrated that pediatric patients makeup a significant proportion of those injured, and has perhaps refocused our need to better characterize the surgical needs of children in conflict and disaster. In addition to treat such patients, we recognize the unmet challenges of improving pediatric emergency and surgical infrastructures in the low- and middle-income country settings where conflict and disaster occur most often, and continuing to advocate for vulnerable children worldwide and keep them out of harm's way.