Meeting children's needs: A mixed-methods approach to a regionalized pediatric surge plan—The Los Angeles County experience

Authors

  • Bridget M. Berg, MPH
  • Valerie M. Muller, MPH
  • Millicent Wilson, MD
  • Roel Amara, RN, BSN
  • Kay Fruhwirth, RN, MSN
  • Kathleen Stevenson, RN, BSN
  • Rita V. Burke, PhD, MPH
  • Jeffrey S. Upperman, MD

DOI:

https://doi.org/10.5055/ajdm.2014.0168

Keywords:

pediatric, disaster, surge capacity, mixed-methods

Abstract

Introduction: Children are one of the most vulnerable populations during mass casualty incidents because of their unique physiological, developmental, and psychological attributes. The objective of this project was to enhance Los Angeles County's (LAC) pediatric surge capabilities. The purpose of this study was threefold: (1) determine gaps in pediatric surge capacity and capabilities; (2) double pediatric inpatient capacity; and (3) document a plan to address gaps and meet pediatric inpatient surge. We hypothesized that LAC would be able to meet the identified pediatric surge target by leveraging resources of hospitals within the region. Deliverables included a pediatric surge plan for LAC, pediatric surge training resources, and pediatric supplies for hospitals participating in LAC's Hospital Preparedness Program (HPP).

Methods: After Institutional Review Board approval, the authors used a mixed-methods approach to explore gaps in hospital capacity and capabilities in a large urban county. Hospitals were surveyed via Qualtrics® on 38 questions regarding capacity, staffing, availability of pediatric supplies, and existing pediatric surge plans. Publicly available inpatient bed data were collected from the Office of Statewide Health Planning and Development for the year ending June 2010 and supplemented by hospital survey responses. Population data was used from US Census 2010. This combined dataset was analyzed for capacity, pediatric designations, and capabilities. To supplement this data, three focus groups were conducted between April 2011 and May 2012. Focus group topics included: supplies and training needed for pediatric surge, surge targets, and plan development and functionality.

Results: Hospitals varied in pediatric capacity and capability. Forty-six percent of facilities provide inpatient pediatric services. Forty-one hospitals are designated as an Emergency Department Approved for Pediatrics. Identified gaps included: limited pediatric bed capacity, geographic variability, limited pediatric intensive care unit capacity, limited pediatric specialty physician resources, varying availability of pediatric trained staff, less availability of pediatric critical care supplies, and limited ability to accept and receive children. Focus group stakeholders requested advance and just-in-time training and reference guides to supplement the plan.

Conclusion: LAC was able to create a pediatric surge plan that doubles pediatric acute and pediatric intensive care bed capacity by using participating HPP hospitals. A tiered system was created based on capacity and capability with varying surge targets and guidance on types of patients that could be cared for at each tier. This plan will assist the LAC Emergency Medical Services Agency distribute pediatric patients during a surge event that disproportionately impacts children.

Author Biographies

Bridget M. Berg, MPH

Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California

Valerie M. Muller, MPH

Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California

Millicent Wilson, MD

Los Angeles County Emergency Medical Services Agency, Los Angeles, California

Roel Amara, RN, BSN

Los Angeles County Emergency Medical Services Agency, Los Angeles, California

Kay Fruhwirth, RN, MSN

Los Angeles County Emergency Medical Services Agency, Los ANgeles, California

Kathleen Stevenson, RN, BSN

Patient Care Services, Children’s Hospital Los Angeles, Los Angeles, California

Rita V. Burke, PhD, MPH

Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California.

Jeffrey S. Upperman, MD

Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California

References

Barfield WD, Krug SE, Kanter RK, et al.: Neonatal and pediatric regionalized systems in pediatric emergency mass critical care. Pediatr Crit Care Med. 2011; 12(6 Suppl): S128-S134.

Markenson D, Redlener I: Pediatric terrorism preparedness national guidelines and recommendations: Findings of an evidenced-based consensus process. Biosecur Bioterror. 2004; 2(4): 301-319.

Hohenhaus SM: Practical considerations for providing pediatric care in a mass casualty incident. Nurs Clin North Am. 2005; 40(3): 523-533.

Allen GM, Parrillo SJ, Will J, et al.: Principles of disaster planning for the pediatric population. Prehosp Disaster Med. 2007; 22(6): 537-540.

King MA, Koelemay K, Zimmerman J, et al.: Geographical maldistribution of pediatric medical resources in Seattle-King County. Prehosp Disaster Med. 2010; 25(4): 326-332.

Stratton SJ: Editorial comments—Surge capacity implications and geographic mal-distribution of pediatric medical resources in Seattle-King County. Prehosp Disaster Med. 2010; 25(4): 333-334.

Garrett, AL, Redlener IE: Pediatric emergency preparedness for natural disasters, terrorism, and public health emergencies. A National Consensus Conference 2009 Update: National Center for Disaster Preparedness. Mailman School of Public Health Columbia University, 2009. Available at http://academiccommons.columbia.edu/catalog/ac:126143. Accessed August 13, 2014.

Kissoon N: Deliberations and recommendations of the Pediatric Emergency Mass Critical Care Task Force: Executive Summary. Pediatr Crit Care Med. 2011; 12 (6 Suppl): 103-108.

American Academy of Pediatrics: Joint policy statement—Guidelines for care of children in the emergency department. J Emerg Nurs. 2013; 39(2): 116-131.

2010 Census data. Available at http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml. Accessed April 2013.

County of Los Angeles: Statistics: Geography, 2013. Available at http://www.lacounty.gov/wps/portal/!ut/p/b1/04_SjzS0MDQztDQwNzPVj9CPykssy0xPLMnMz0vMAfGjzOItDCDAyMInxNjAyCfQ0 i 8 0wNHA3ROk IRJFgUmgG1CBq 0Wo p 6mxkUGgGXH6DXAARwNU_f6-gWZA_T5eru5B5sYGfmbo9mMqIGB_uH4UmhJUH_gaElAQaEpIgRlUAR5 P - n n k 5 6 b q 5 0 b l u L l Z e m Y G p C s q A g B t v 3 B J /?1dmy& page=lac.home.government.aboutlacounty.hidden&urile=wcm%3apath%3a/lacounty+content/lacounty+site/home/government/about+la+county/categorylink_statistics. Accessed December 30, 2013.

Centers for Disease Control and Prevention: 2009 H1N1 early outreak and disease characteristics, 2009. Available at http://www.cdc.gov/h1n1flu/surveillanceqa.htm. Accessed December 30, 2013.

U.S. Department of Health & Human Services: Hospital Preparedness Program, 2014. Available at http://www.phe.gov/PREPAREDNESS/PLANNING/HPP/Pages/default.aspx. Accessed January 21, 2014.

County of Los Angeles Public Health: Service Planning Areas. Available at http://publichealth.lacounty.gov/chs/SPAMainServicePlanningAreas.htm. Accessed April 9, 2013.

Seaman J, Maguire S: ABC of conflict and disaster: The special needs of children and women. Br Med J. 2005; 331(7507): 34.

Keim ME, Pesik N, Twum-Danso NA: Lack of hospital preparedness for chemical terrorism in a major US city: 1996-2000. Prehosp Disaster Med. 2003; 18(3): 193-199.

McFee RB: Preparing for an era of weapons of mass destruction (WMD). Are we there yet? Why we should all be concerned. Part 1. Vet Hum Toxicol. 2002; 44(4): 193-199.

Klein KR, Atas JG, Collins J: Testing emergency medical personnel response to patients with suspected infectious disease. Prehosp Disaster Med. 2004; 19(03): 256-265.

Murphy JK: After 9/11: Priority focus areas for bioterrorism preparedness in hospitals. J Healthc Manag. 2004; 49(4): 227.

Webby RJ, Webster RG: Are we ready for pandemic influenza? Science. 2003; 302(5650): 1519-1522.

Shapiro DS: Surge capacity for response to bioterrorism in hospital clinical microbiology laboratories. J Clin Microbiol. 2003; 41(12): 5372-5376.

Gausche-Hill M: Integrating children into our emergency care system: Achieving the vision. Ann Emerg Med. 2006; 48(2): 131-134.

Dayton C, Ibrahim J, Augenbraun M, et al.: Integrated plan to augment surge capacity. Prehosp Disaster Med. 2008; 23(2): 113-119.

Koelemay K: Pediatric surge planning: Who’s minding the kids? Paper presented at California Hospital Association Disaster Planning for California Hospitals, Sacramento, CA, October 16, 2012. Available at http://ddcache1.net/calhospital.s1017.SU/sites/main/files/file-attachments/pedsurgeplanning_combined.pdf. Accessed August 13, 2014.

Frost P: Pediatric surge planning . . . solutions within reach. Paper presented at California Hospital Association: Disaster Planning for California Hospitals, Sacramento, CA, September 22, 2010. Available at http://cchealth.org/ems/pdf/master_ped_surge_planning.pdf. Accessed August 13, 2014.

R B. Regional pediatric disaster surge framework. California, 2012. Available at http://www.calhospitalprepare.org/post/centralvalley-regional-pediatric-disaster-surge-framework. Accessed August 14, 2014.

Schafermeyer RW, Asplin BR: Hospital and emergency department crowding in the United States. Emerg Med. 2003; 15(1): 22-27.

Menon DK, Taylor BL, Ridley SA: Modelling the impact of an influenza pandemic on critical care services in England. Anaesthesia. 2005; 60(10): 952-954.

Ratnapalan S, Martimianakis MA, Cohen-Silver JH, et al.: Pandemic management in a pediatric hospital. Clin Pediatr. 2013; 52(4): 322-328.

Charney RL, Armbrecht ES, Kennedy BR, et al.: Pandemic influenza extension areas in an urban pediatric hospital. Prehosp Disaster Med. 2012; 27(1): 75-80.

Campbell C: The benefits of designing a stratification system for New York City pediatric intensive care units for use in regional surge capacity planning and management. J Commun Health. 2010; 35(4): 337-347.

Published

07/01/2014

How to Cite

Berg, MPH, B. M., V. M. Muller, MPH, M. Wilson, MD, R. Amara, RN, BSN, K. Fruhwirth, RN, MSN, K. Stevenson, RN, BSN, R. V. Burke, PhD, MPH, and J. S. Upperman, MD. “Meeting children’s Needs: A Mixed-Methods Approach to a Regionalized Pediatric Surge plan—The Los Angeles County Experience”. American Journal of Disaster Medicine, vol. 9, no. 3, July 2014, pp. 171-8, doi:10.5055/ajdm.2014.0168.

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