Pediatric disaster response in developed countries: Ten guiding principles
DOI:
https://doi.org/10.5055/ajdm.2007.0024Keywords:
disaster response, pediatrics, preparednessAbstract
Mass casualty incidents and large-scale disasters involving children are likely to overwhelm a regional disaster response system. Children have unique vulnerabilities that require special considerations when developing pediatric response systems. Although medical and trauma strategies exist for the evaluation and treatment of children on a daily basis, the application of these strategies under conditions of resource-constrained triage and treatment have rarely been evaluated. A recent report, however, by the Institute of Medicine did conclude that on a day-to-day basis the US healthcare system does not adequately provide emergency medical services for children. The variability, scale, and uncertainty of disasters call for a set of guiding principles rather than rigid protocols when developing pediatric response plans. The authors propose the following guiding principles in addressing the well-recognized, unique vulnerabilities of children: 1) terrorism prevention and preparedness, 2) all-hazards preparedness, 3) postdisaster disease and injury prevention, 4) nutrition and hydration, 5) equipment and supplies, 6) pharmacology, 7) mental health, 8) identification and reunification of displaced children, 9) day care and school, and 10) perinatology. It is hoped that the 10 guiding principles discussed in this article will serve as a basic framework for developing pediatric response plans and teams in developed countries.
References
Markenson D, Redlener I: Pediatric disaster terrorism preparedness national guidelines and recommendations: Findings of an evidence- based consensus process. Biosecurity Bioterrorism. 2004; 2(4): 301-314.
Lynch EL, Thomas TL: Pediatric consideration in chemical exposures: Are we prepared? Pediatr Emerg Care. 2004; 20(3): 198-208.
Roshal LM: Pediatric disasters. Prehosp Dis Med. 1999; 14 (1): 5-7.
Sirbaugh PE, Pepe PE, Shook JE, et al.: A prospective, population- based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest. Ann Emerg Med. 1999; 33: 174-184.
Young KD, Seidel JS: Pediatric cardiopulmonary resuscitation: A collective review. Ann Emerg Med. 1999; 33: 195-205.
Glaeser PW, Linzer J, Tunik MG, et al.: Survey of nationally registered emergency medical services providers: Pediatric education. Ann Emerg Med. 2000; 36: 33-38.
Committee on the Future of Emergency Care in the United States Health System, Institute of Medicine of the National Academies: Emergency care for children: Growing pains. Available at http://newton.nap.edu/execsumm_pdf/11655. Accessed December 15, 2006.
Gausche-Hill M: Integrating children into our emergency care system: Achieving the vision. Ann Emerg. Med. 2006; 48(2): 131-134.
American Academy of Pediatrics Committee on Environmental Health, Committee on Infectious Diseases, Michael WS, Julia AM: Chemical–biological terrorism and its impact on children. Pediatrics. 2006; 118(3): 1267-1278.
Stalcup SA, Oscherwitz M, Cohen MS, et al.: Planning for a pediatric disaster—Experience gained from caring for 1600 Vietnamese orphans. N Engl J Med. 1975; 293: 691-695.
Chung S, Shannon M: Hospital planning for acts of terrorism and other public health emergencies involving children. Arch Dis Child. 2005; 90(12): 1300-1307.
Beslan, North Ossetia: www.globalsecurity.org/military/world/war/chechnya-beslan.htm. Accessed April 12, 2007.
Hogan DE, et al.: Emergency department impact of the Oklahoma city terrorist bombing. Ann Emerg Med. 1999; 34(2): 160-167.
Brandenburg M, Regens JL: Terrorist attacks against children: Vulnerabilities, management principles and capability gaps. J Homeland Secur Emerg Manage. 2006; 3(4): Article 1. Available at: http://www.bepress.com/jhsem/vol3/iss4/1. Accessed April 12, 2007.
American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American Academy of Pediatrics Committee on Medical Liability, Task Force on Terrorism: The pediatrician and disaster preparedness. Pediatrics. 2006; 117(2): 560-565.
National Disaster Life Support Foundation: All-hazards course overview and DISASTER paradigm. In Basic Disaster Life Support Provider Manual, Version 2.5. American Medical Association Press, 2004: 1-1 - 1-27.
Peleg K, Michaelson M, et al.: Principles of emergency management in disasters. Adv Ren Replace Ther. 2003; 10(2): 117-121.
Brandenburg MA: Pediatric considerations in disaster. In Hogan DE (ed.): Disaster Medicine. Philadelphia, PA: Lippincott, Williams and Wilkins, 2006: 29-39.
Spaite DW: The future of emergency care in the United States health system: The Institute of Medicine Subcommittee on Prehospital Emergency Medical Services. Ann Emerg Med. 2006; 48(2): 126-130.
Institute of Medicine: The future of emergency care in the United States Health System. Ann Emerg Med. 2006; 48(2): 115- 120.
Institute of Medicine, Committee on the Future of Emergency Care in the United States Health System: Emergency care for children: Growing pains. National Academy of Sciences, 2006.
Seidel JS, Henderson DP: Approach to the pediatric patient in the emergency department. In Barkin R, et al. (eds.): Pediatric Emergency Medicine: Concepts and Clinical Practice. 2nd ed. St. Louis: CV Mosby, 1997: 1-7.
May BM, Hogan DE, Feighner K: Impact of a tornado on a community hospital. J Am Osteopath Assoc. 2002; 102(4): 225-228.
Injury Prevention Service, Oklahoma State Department of Health: Investigation of deaths and injuries resulting from May 3, 1999 tornadoes. Oklahoma City, OK: Injury Prevention Service, Oklahoma State Department of Health, 2000.
Mandelbaum I, Nahrwold D, Boyer DW: Management of tornado casualties. J Trauma. 1966; 6(3): 353-361.
Brenner SA, Noji EK: Head and neck injuries from 1990 Illinois tornado. Am J Public Health. 1992; 82 (9): 1296-1297.
Quintana DA, Jordan FB, et al.: The spectrum of pediatric injuries after a bomb blast. J Pediatr Surg. 1997; 32(2): 307-310; discussion 310-311.
Bohonos JJ, Hogan DE: The medical impact of tornadoes in North America. J Emerg Med. 1999; 17(1): 67-73.
Peleg K, Aharonson-Daniel L, Stein M, et al., for Israeli Trauma Group (ITG): Gunshot and explosion injuries: Characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann Surg. 2004; 239(3): 311-318.
Aharonson-Daniel L, Waisman Y, Dannon YL, et al., Members of the Israel Trauma Group: Epidemiology of terror-related versus non-terror-related traumatic injury in children. Pediatrics. 2003; 112(4): e280-e284.
Amir LD, Aharonson-Daniel L, Peleg K, et al., for Israel Trauma Group: The severity of injury in children resulting from acts against civilian populations. Ann Surg. 2005; 241(4): 666-670.
Mintz Y, Shapira SC, et al.: The experience of one institution dealing with terror: The El Aqsa Intifada riots. Isr Med Assoc J. 2002; 4 (7): 554-556.
Waisman Y, Aharonson-Daniel L, et al.: The impact of terrorism on children: A two-year experience. Prehosp Disaster Med. 2003; 18(3): 242-248.
Kluger Y, Peleg K, Daniel-Aharonson L, et al., for Israeli Trauma Group: The special injury pattern in terrorist bombings. J Am Coll Surg. 2004; 199(6): 875-879.
Christopher GW, Cieslak TJ, Pavlin JA: Biological warfare. A historical perspective. JAMA. 1997; 278(5): 412-417.
Patt HA, Feigin RD: Diagnosis and management of suspected cases of bioterrorism: A pediatric perspective. Pediatrics. 2002; 109(4): 685-692.
Bearer CF: How are children different from adults? Environ Health Perspect. 1995; 103 (Suppl 6): 7-12.
Slater MS, Trunkey DD: Terrorism in America: An evolving threat. Arch Surg. 1997; 132(10): 1059-1066.
Macintyre AG, Christopher GW, et al.: Weapons of mass destruction events with contaminated casualties: Effective planning for health care facilities. JAMA. 2000; 283(2): 242-249.
FDA: FDA approves pediatric doses of atropen. FDA Talk Paper. June 2003: T03-45.
Henretig FM, Mechem C, Jew R: Potential use of autoinjectorpackaged antidoted for treatment of pediatric nerve agent toxicity. Ann Emerg Med. 2002; 40(4): 405-408.
American Academy of Pediatrics Committee on Environmental Health: Radiation disasters and children. Pediatrics. 2003; 111(6, Part 1): 1455-1466.
Guilmette RA, Muggenberg BA: Decorporation therapy for inhaled plutonium nitrate using repeatedly and continuously administered DTPA. Int J Radiat Biol. 1993; 63: 395-403.
Hogan DE, Meadows SM, Kellison T: Nuclear and radiological emergencies. J Okla State Med Assoc. 2003 Oct; 96(10):499-503.
Seaman J, Maguire S: ABC of Conflict and disaster: The special Needs of children and women. BMJ. 2005; 331(7507): 34-36.
O’Connor ME, Burkle FM, Olness K: Infant feeding practices in complex emergencies: A case study approach. Prehosp Dis Med. 2001; 16(4): 231-238.
Quinn B, Baker R, Pratt J: Hurricane Andrew and a pediatric emergency department. Ann Emerg Med. 1994; 23(4): 737-741.
Amitai Y, Shlomo A, Raphael S, et al.: Atropine Poisoning in children during the Persian Gulf crisis: A national survey in Israel. In Danon Y, Shemer J (eds.): Chemical Warfare Medicine. Jerusalem: Gefen Publishing,1994: 99-105.
Hiss J, Arensburg B: Suffocation from misuse of gas masks during the Gulf War. In Danon Y, Shemer J (eds): Chemical Warfare Medicine. Jerusalem: Gefen Publishing, 1994: 106-108.
Curtis T, Miller BC, Berry EH: Changes in reports and incidence of child abuse following natural disasters. Child Abuse Negl. 2000; 24(9): 1151-1162.
Centers for Disease Control and Prevention: Interim Immunization Recommendations for Individuals Displaced by Hurricane Katrina. MMWR Morb Mortal Wkly Rep. 2005; 54: 749- 750.
Brandenburg MA, Ogle MB, Washington BA, et al.: Operation child-safe: A strategy for preventing unintentional pediatric injuries at a Hurricane Katrina evacuee shelter. Prehosp Disaster Med. 2006; 21(5): 359-365.
Famine-affected, refugee, and displaced populations: Recom - mendations for public health issues. MMWR Morb Mortal Wkly Rep. 1992; 41(RR-12): 1-76.
Toole MJ: Micronutrient deficiencies in refugees. Lancet. 1992; 339: 1214-1216.
Toole MJ, Waldman RJ: The public health aspects of complex emergencies and refugee situation. Annu Rev Public Health. 1997; 18: 283-312.
Burkle FM: Complex emergencies: An introduction. Prehosp Disaster Med. 2001; 16(4): 182-183.
Yip R, Sharp TW: Acute malnutrition and high childhood mortality related to diarrhea. Lessons from the 1991 Kurdish refugee crisis. JAMA. 1993; 270(5): 587-590.
Mandalakas A, Torjesen K, Olness K: How to Help the Children in Complex Humanitarian Emergencies: A Practical Manual. International Pediatric Association. Available at http://www. ipachildhealth.org/programs/Children_in_Disasters.pdf. Accessed April 12, 2007.
Young H, Borrel A, Holland D, et al.: Public nutrition in complex emergencies. Lancet. 2004; 365: 1899-1909.
Moss J, Ramakrishnan M, Storms D, et al.: Child Health in Complex Emergencies. Washington, DC: National Academies Press, 2004. Available at http://www.nap.edu/catalog/11527.html. Accessed February 28, 2007.
Al Gasser N, Dresden E, Keeney GB, et al.: Status of women and infants in complex humanitarian emergencies. J Midwifery Women’s Health. 2004; 49 (Suppl 1): 7-13.
Loretti A, Leus X, Van Holsteijn B: Relevant in times of turmoil: WHO and public health in unstable situations. Prehosp Disast Med. 2001; 16 (4): 184-191.
Middleton KR, Burt CW: Availability of pediatrics services and equipment in emergency departments: United States, 2002–03. US Department of Health and Human Services, Centers For Disease Control and Prevention, National Center for Health Statistics. Adv Data. 2006; 367: 1-16.
Centers for Disease Control and Prevention: Emergency preparedness and response. April 14, 2005. Available at http://www.bt.cdc.gov/stockpile/. Accessed April 12, 2007.
US Department of Health and Human Services, Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep.. Available at http://www.cdc.gov/mmwr. Accessed November 18, 2006.
US Department of Health and Human Services, Centers for Disease Control and Prevention: Health alert network. Available at http://www2a.cdc.gov/han/Index.asp. Accessed November 8, 2006.
Wolraich ML, Aceves J, et al., for American Academy of Pediatrics Community on Psychosocial Aspects of Child and Family Health. How pediatricians can respond to the psychosocial implications of disasters. Pediatrics. 1999; 103(2): 521-523.
Baker DR: A public health approach to the needs of children affected by terrorism. J Am Med Womens Assoc. 2002; 57(2): 117- 118, 121.
National Disaster Life Support Foundation: Psychosocial aspects of terrorism in disasters. In Basic Disaster Life Support Provider Manual, Version 2.5. American Medical Association Press, 2004: 7-1 - 7-19.
Pfefferbaum B, Pfefferbaum RL, et al.: Children’s response to terrorism: A critical review of the literature. Curr Psychiatry Rep. 2003; 5(2): 95-100.
North CS, Smith EM: Post-Traumatic stress disorder in disaster survivors. Compr Ther. 1990; 16(12): 3-9.
McIntire MS, Sadeghi E: The pediatrician and mental health in a community wide disaster: Lessons from the aftermath of a tornado. Clin Pediatr. 1977; 16(8): 702-705.
Stewart MA: A study of the needs, coping styles and use of medical services of tornado victims. Can J Public Health. 1986; 77(3): 173-179.
Rosenberg SA, Fine PM, Robinson GL: Emotional effects of the Omaha tornado. Nebr Med J. 1980; 65(2): 24-26.
Goldstein RD, Wampler NS, Wise PH: War experiences and distress symptoms of Bosnian children. Pediatrics. 1997; 100(5): 873-878.
Pfefferbaum B, Seale TW, et al.: Media exposure in children one hundred miles from a terrorist bombing. Ann Clin Psychiatry. 2003; 15 (1): 1-8.
Madakasira S, O’Brien KF: Acute posttraumatic stress disorder in victims of a natural disaster. J Nerv Ment Dis. 1987; 175(5): 286-290.
Vogel JM, Vernberg EM: Children’s psychological responses to disasters. J Clin Child Psychol. 1993; 22(4): 464:484.
Brandenburg MA, Watkins SM, Brandenburg KL: Reunification of displaced children and their legal guardians after Hurricane Katrina. Disasters. (in press).
Brandenburg MA: Instructions for identifying and protecting displaced children. Health Alert Network Centers for Disease Control and Injury Prevention, September 28, 2005. CDCHAN- 00236-2005-09-28-ADV-N. Available at http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00236. Accessed April 11, 2007.
Neuzil KM, Hohlbein C, Zhu Y: Illness among schoolchildren during influenza season: Effect on school absenteeism, parental absenteeism from work, and secondary illness in families. Arch Pediatr Adolesc Med. 2002; 156(10): 986-991.
World Health Organization Writing Group: Non-pharmaceutical interventions for pandemic influenza, national and community measures. Emerg Infect Dis. 2006; 12(1): 88-94.
Duff EM, Cooper ES: Neural tube defects in Jamaica following Hurricane Gilbert. Am J Public Health. 1994; 84(3): 473-476.
Lederman SA, Rauh V, Weiss L, et al.: The effects of the World Trade Center event on birth outcomes among term deliveries at three lower Manhattan hospitals. Environ Health Perspect. 2004; 112(17): 1772-1778.
Glynn LM, Wadhwa PD, Dunkel-Schetter C, et al.: When stress happens matters: Effects of earthquake timing on stress responsivity in pregnancy. Am J Obstet Gynecol. 2001; 184(4): 637-642.
Neuberg M, Pawlosek W, Lopuszanski M, et al: The analysis of the course of pregnancy, delivery and postpartum among women touched by flood disaster in Kotlin Klodzki in July 1997. Ginekol Pol. 1998; 69(12): 866-870.
Seidman D, Hourvitz A, et al.: The effect of anxiety in pregnancy during the Persian Gulf War. In Danon Y, Shemer J (eds.): Chemical Warfare Medicine. Jerusalem: Gefen Publishing, 1994: 216-219.
Published
How to Cite
Issue
Section
License
Copyright 2007-2023, Weston Medical Publishing, LLC
All Rights Reserved