Pediatric issues in disaster management, Part 1: The emergency medical system and surge capacity


  • Sharon E. Mace, MD
  • Ghazala Sharieff, MD
  • Andrew Bern, MD
  • Lee Benjamin, MD
  • Dave Burbulys, MD
  • Ramon Johnson, MD
  • Merritt Schreiber, PhD



disaster, pediatric disasters, pediatrics, children, infants


Although children and infants are likely to be victims in a disaster and are more vulnerable in a disaster than adults, disaster planning and management has often overlooked the specific needs of pediatric patients. The authors discuss key components of disaster planning and management for pediatric patients, including emergency medical services, hospital/facility issues, evacuation centers, family separation/reunification, children with special healthcare needs (SHCNs), mental health issues, and overcrowding/ surge capacity. Specific policy recommendations and an appendix with detailed practical information and algorithms are included.The first part of this three-part series on pediatric issues in disaster management addresses the emergency medical system from the field to the hospital and surge capacity including the impact of crowding.
The second part addresses the appropriate setup and functioning of evacuation centers and family separation and reunification.The third part deals with special patient populations: children with SHCNs and mental health issues.

Author Biographies

Sharon E. Mace, MD

Professor of Medicine, Emergency Department, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.

Ghazala Sharieff, MD

Clinical Professor, Emergency Department, University of California, San Diego, California; Rady Children’s Hospital, San Diego, California.

Andrew Bern, MD

Attending Physician, Emergency Department, Delray Medical Center, Delray, Florida.

Lee Benjamin, MD

Assistant Professor, Emergency Department, Duke University Medical Center, Durham, North Carolina.

Dave Burbulys, MD

Associate Professor of Medicine, David Geffen School of Medicine at UCLA, Emergency Department, Harbor- UCLA Medical Center, Torrance, California.

Ramon Johnson, MD

Attending Physician, Emergency Department, Mission Hospital Regional Medical Center, Mission Viejo, California.

Merritt Schreiber, PhD

Associate Research Psychologist, UCLA– Center for Public Health and Disasters, Los Angeles, California.


Pitts SR, Niska RW, Xu J, et al.: National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl. Health Stat Report. 2008; (7): 1-38.

Burt CW, Middleton KR: Factors associated with ability to treat pediatric emergencies in US hospitals. Pediatr Emerg Care. 2007; 23(10): 681-689.

The Institute of Medicine’s Report: Emergency Care for Children: Growing Pains.Washington, DC: National Academies Press, 2007. Available at Accessed December 10, 2008.

The Institute of Medicine’s Report: Hospital-Based Emergency Care: At the Breaking Point.Washington, DC: National Academies Press, 2007.Available Accessed December 10, 2008.

Gausche-Hil M, Schmitz C, Lewis RJ: Pediatric preparedness of US emergency departments: A 2003 survey. Pediatrics. 2007; 120(6): 1229-1237.

Middleton KR, Burt CW: Availability of pediatric services and equipment in emergency departments: United States 2002-2003. Adv Data. 2006; 367: 1-16.

Goodman DC: The pediatric subspecialty workforce: Time to test our assumptions. Pediatrics. 2006; 118(6): 2545-2547.

Mayer ML: Are we there yet? Distance to care and relative supply among pediatric medical subspecialties. Pediatrics. 2006; 118(6): 2313-2321.

Gaskin DJ, Mitchell JM: Health status and access to care for children with special health care needs. J Ment Health Policy Econ. 2005; 8(1): 29-35.

Mace SE, Bern AI: Needs assessment: Are DMATs up for the challenge of a pediatric disaster. Am Emerg Med. 2007; 25: 762-769.

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

Ginter PM,Wingate MS, Rucks AC, et al.: Creating a regional pediatric disaster preparedness network: Imperative and issues. Matern Child Health J. 2006; 10(4): 391-396.

Curry MD, Larson PG, Mansfield CJ, et al.: Impacts of a flood disaster on an ambulatory pediatric clinic population. Clin Pediatr. 2001; 40: 571-574.

Mace SE, Jones JT, Bern AI: An analysis of disaster medical assistance team (DMAT) deployments in the United States. Prehosp Emerg Care. 2007; 11: 30-35.

Mackenzie EJ, Rivara FP, Jurkovich GJ, et al.: A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006; 354(4): 366-378.

Terkelsen CJ, Sorensen JT, Nielsen TT: Is there any time left for primary percutaneous coronary intervention according to the 2007 updated American College of Cardiology/American Health Association ST-segment elevation myocardial infarction guidelines and the D2B alliance? J Am Coll Cardiol. 2008; 52(15): 1211-1215.

Alberts MJ, Latchaw RE, Selman WR, et al.: Recommendations for comprehensive stroke centers: A consensus statement from the brain attack coalition. Stroke. 2005; 36(7): 1597-1616.

Blizzard JC, Michels JE, Richardson WH, et al.: Cost-benefit analysis of a regional poison center. Clin Toxicol. 2008; 46(5): 450-456.

Starfield BH: The regionalization of perinatal services: Summary of the evaluation of national demonstration program. JAMA. 1985; 253: 799-804.

Carr BG: Emergency department categorization. Acad Emerg Med. 2007; 14(4): 381-382.

Gerard WA: The Macy Foundation Report. Ann Emerg Med. 1995; 26: 238-239.

Goldfrank L, Henneman PL, Ling LJ, et al.: Emergency center categorization standards. Acad Emerg Med. 1999; 6: 638-655.

American Academy of Pediatrics, Pediatric Section:Task force on regionalization of services for critically ill or injured children. Pediatrics. 2000; 105(1): 152-155.

Wetta-Hall R, Berg-Copas GM, Ablan E, et al.: Regionalization: Collateral benefits of emergency preparedness activities. J Public Health Manag Pract. 2007; 13(5): 469-475.

Dainiak N, Delli Carpini D, Bohan M, et al.: Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys. 2006; 65(1): 16-24.

Sasser SM, Hunt RC, Sullivent EE, et al.: Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep. 2009; 58 (RR-1): 1-35.

Hing E, Hall MJ, Xu J: National Hospital Ambulatory Medical Care Survey: 2006 outpatient department summary. Natl Health Stat Report. 2008; (4): 1-31.

Owens PL, Zodet MW, Berdahl T, et al.: Annual report on health care for children and youth in the United States: Focus on injuryrelated emergency department utilization and expenditures. Ambul Pediatr. 2008; 8(4): 219-240, e17.

Wang NE, Saynina O, Kurtz-Duriseti K, et al.: Variability in pediatric utilization of trauma facilities in California: 1999 to 2005. Ann Emerg Med. 2008; 52(6): 607-615.

Fowkes V, Blossom HJ, Anderson HK, et al.: Emergency preparedness for health professionals in a statewide AHEC program: The first two years. Acad Med. 2007; 82(8): 781-787.

Gebhart ME, Pence R: START triage: Does it work? Disaster Manag Response. 2007; 6(3): 68-73.

Van Gelder CM, Frantz R, Bogucki S: Emergency medical services in Connecticut. Prehosp Emerg Care. 2005; 9(2): 219-226.

Vavilala MS, Cummings P, Sharar SR, et al.: Association of hospital trauma designation with admission patterns of injured children. J Trauma. 2004; 57(1): 119-124.

Change RK, Klitzner TS: Resources, use, and regionalization of pediatric cardiac services. Curr Opin Cardiol. 2003; 18(2): 98-101.

Watson RS: Location, location, location: Regionalization and outcome in pediatric critical care. Curr Opin Crit Care. 2002; 8(4): 344-348.

Stoto MA, Morse L: Regionalization in local public health systems: Public health preparedness in the Washington Metropolitan area. Public Health Rep. 2008; 123(4): 461-473.

Ablah E, Tinius AM, Konda K, et al.: Regional Health System Response to the 2007 Greensburg, Kansas, EF5 Tornado. Disaster Med Public Health Prep. 2007; 1(2): 90-95.

Kaji AH, Lewis RJ: Hospital disaster preparedness in Los Angeles County. Acad Emerg Med. 2006; 13(11): 1198-1203.

Sampalis JS, Denis R, Lavoie A, et al.: Trauma care regionalization: A process-outcome evaluation. J Trauma. 1999; 46(4): 565-581.

Kahn JM, Branas CC, Schwab CW, et al.: Regionalization of medical critical care: What can we learn from the trauma experience? Crit Care Med. 2008; 36(11): 3085-3088.

Pottenger BC, Diercks DB, Bhatt DL: Regionalization of care for ST-segment elevation myocardial infarction: Is it too soon? Ann Emerg Med. 2008; 52(6): 677-685.

Hartman M,Watson RS, Linde-Zwirble W, et al.: Pediatric traumatic brain injury is inconsistently regionalized in the United States. Pediatrics. 2008; 122(1): e172-e180.

Culica D, Aday LA, Rohrer JE: Regionalized trauma care systems in Texas: Implications for redesigning trauma systems. Med Sci Monit. 2007; 13(5): SR9-SR18.

Pham TN, Gibran NS: Thermal and electrical injuries. Surg Clin North Am. 2007; 87(1): 185-206, vii-viii.

Fisher CG, Noonan VK, Dvorak MJ: Changing face of spine trauma care in North America. Spine. 2006; 31(11 Suppl): S2-S8, S36.

Liberman M, Mulder DS, Jurkovich GJ, et al.: The association between trauma system and trauma center components and outcome in a mature regionalized trauma system. Surgery. 2005; 137(6): 647-658.

Atasay B, Arsan S: Organization of neonatal care services and its importance. J Perinat Med. 2003; 31(5): 392-394.

Lamonte MP, Bahouth MN, Magder LS, et al.: A regional system of stroke care provides thrombolytic outcomes comparable with the NINDS stroke trial. Ann Emerg Med. 2009; 54(3): 319-327.

Switzer JA, Hess DC: Development of regional programs to speed treatment of stroke. Curr Neurol Neurosci Rep. 2008; 8(1): 35-42.

Kereiakes DJ: Specialized centers and systems for heart attack care. Am Heart Hosp J. 2008; 6(1): 14-20.

Henry TD, Sharkey SW, Burke MN, et al.: A regional system to provide timely access to percutaneous coronary intervention for STelevation myocardial infarction. Circulation. 2007; 116(7): 721-728.

Rathore SS, Epstein AJ, Nallamothu BK, et al.: Regionalization of ST-segment elevation acute coronary syndromes care: Putting a national policy in proper perspective. J Am Coll Cardiol. 2006; 47(7): 1346-1349.

Wardem GD, Heimbach D: Regionalization of burn care—A concept whose time has come. J Burn Care Rehabil. 2003; 24(3): 173-174.

Van Waning NR, Kleiber C, Freyenberger B: Development and implementation of a protocol for transfer out of the pediatric intensive care unit. Crit Care Nurse. 2005; 25(3): 50-55.

Urkin J, Segal I, Barak N, et al.: Referral criteria from community clinics to pediatric emergency departments. Scientific World J. 2008; 8: 350-356.

Cicero MX, Baum CR: Pediatric disaster preparedness: Best planning for the worst-case scenario. Pediatr Emerg Care. 2008; 24(7): 478-481.

Nordberg M: Real-time pediatric disaster response system taking shape. Emerg Med Serv. 2007; 36(2): 43.

Distefano SM, Graf JM, Lowry AM, et al.: Getting kids from the Big Easy hospitals to our place (not easy): Preparing, improvising, and caring for children during mass transport after a disaster. Pediatrics. 2006; 117(5, Part 3): S421-S427.

Baldwin S, Robinson A, Barlow P, et al.: Moving hospitalized children all over the southeast: Interstate transfer of pediatric patients during Hurricane Katrina. Pediatrics. 2006; 117(5, Part 3): S416-S420.

Emgushov O: Coordinated care special needs shelter. Public Health Rep. 2008; 123(3): 371-375.

Zilm F, Berry R, Pietrzak MP, et al.: Integrating disaster preparedness and surge capacity in emergency facility planning. J Ambul Care Manage. 2008; 31(4): 377-385.

Arrieta MI, Foreman RD, Crook ED, et al.: Insuring continuity of care for chronic disease patients after a disaster: Key preparedness elements. Am J Med Sci. 2008; 336(2): 128-133.

Patton-Levine JK,Vest JR,Valadez AM: Caregivers and families in medical special needs shelters: An experience during Hurricane Rita. Am J Disaster Med. 2007; 2(2): 81-86.

Deal BJ, Fountain RA, Russell-Brooddus CA, et al.: Challenges and opportunities of nursing care in special needs shelters. Disaster Manag Response. 2006; 4(4): 100-105.

Pyles LA, Hines C, Patock M, et al.: Development of a web-based database to manage American College of Emergency Physicians/ American Academy of Pediatrics Emergency Information Forms. Acad Emerg Med. 2005; 12(3): 257-261.

Thierbach AR,Wolcke BB, Perpho T, et al.: Medical support for children’s mass gatherings. Prehosp Disaster Med. 2003; 18(1): 14-19.

Use guidelines to prepare for children with special needs, or risk tragedy. ED Manag. 2000; 12(8, Suppl 1-2): 85-90.

Emergency preparedness for children with special needs: Committee on Pediatric Emergency Medicine. American Academy of Pediatrics. Pediatrics. 1999; 104(4): e53.

Council on School Health: Disaster planning for schools. Pediatrics. 2008; 122(4): 895-901.

Yen MY, Shih FY: Transforming schools into pre-designed alternative care sites as part of preparedness plan for pandemic H5N1 influenza. J Formos Med Assoc. 2008; 107(9): 673-676.

Garrett AL, Grant R, Mafrid P, et al.: Children and megadisasters: Lessons learned in the new millennium. Adv Pediatr. 2007; 54: 189-214.

Emergency Preparedness: A quick guide for school staff. School Nurse News. 2007; 24(4): 6, 8.

Olympia RP,Wan E, Avner JR: The preparedness of schools to respond to emergencies in children: A national survey of school nurses. Pediatrics. 2005; 116(6): e738-e745.

EMSC Partnership for Children/National Association of EMS Physicians Model Pediatric Protocols: 2003 revision. Prehosp Emerg Care. 2004; 8(4): 343-365.

Gausche-Hill M, Johnson RW,Warden CR, et al.: The role of the emergency physician in emergency medical services for children. Ann Emerg Med. 2003; 42(2): 206-215.

Romig LE: PREP for peds—Patient physiology, rescuer responses, equipment, protocols. Size-up and approach tips for pediatric calls. JEMS. 2001; 26(5): 24-33.

Mulligan-Smith D, O’Connor RE, Markenson D: EMSC partnership for children: National Association of EMS Physicians Model Pediatric Protocols. Prehosp Emerg Care. 2000; 42(2): 111-130.

Vrotsos KM, Pirrallo RG, Guse CE, et al.: Does the number of system paramedics affect clinical benchmark thresholds? Prehosp Emerg Care. 2008; 12(3): 302-306.

Stratton SJ, Underwood LA,Whalen SM, et al.: Prehospital pediatric endotracheal intubation: A survey of the United States. Prehosp Disaster Med. 1993; 8(4): 323-326.

Youngquist ST, Henderson DP, Gausche-Hill M, et al.: Paramedic self-efficacy and skill retention in pediatric airway management. Acad Emerg Med. 2008; 15(12): 1295-1303.

Warren L, Sapien R, Fullerton-Gleason L: Is online pediatric continuing education effective in a rural state? Prehosp Emerg Care. 2008; 12(4): 498-502.

Stevens SL, Alexander JL: The impact of training and experience on EMS providers’ feelings toward pediatric emergencies in a rural state. Pediatr Emerg Care. 2005; 21(1): 12-17.

Wood D, Kalinowski EJ, Miller DR: Pediatric continuing education for emergency medical technicians. The National Council of State Emergency Medical Services Training Coordinators. Pediatr Emerg Care. 2004; 20(4): 261-268.

Sanddal ND, Sanddal TL, Pullum JD, et al.: A randomized, prospective, multisite comparison of pediatric prehospital training methods. Pediatr Emerg Care. 2004; 20(2): 94-100.

Babl FE, Vinci RJ, Bauchner H, et al.: Pediatric pre-hospital advanced life support care in an urban setting. Pediatr Emerg Care. 2001; 17(1): 5-9.

Glaeser PW, Linzer J, Tunik MG, et al.: Survey of nationally registered emergency medical services providers: Pediatric education. Ann Emerg Med. 2000; 36(1): 33-38.

JCAHO 2007 Standards. Available at www.JCAHO.ORG. Accessed May 23, 2009.

Aghababian R (eds.): Pediatric Disaster Life Support. Shrewsbury, MA: UMMS Office of Continuing Medical Education. 1997.

Burt CW, McCaig LF, Rechtsteiner EA: Ambulatory medical care utilization estimates for 2005. Adv Data. 2007; 388: 1-15.

Niska RW, Burt CW: Training for terrorism-related conditions in hospitals: United States, 2003-2004. Adv Data. 2006; 380: 1-8.

Burt CW, McCaig LF: Staffing, capacity, and ambulance diversion in emergency departments: United States, 2003-2004. Adv Data. 2006; 376: 1-23.

Niska RW, Burt CW: Emergency response planning in hospitals: United States, 2003-2004. Adv Data. 2007; 391: 1-13.

Niska RW, Burt CW: National ambulatory medical care survey: Terrorism preparedness among office-based physicians: United States, 2003-2004. Adv Data. 2007; 390: 1-10.

Burt CW, McCaig LF,Valverde RH: Analysis of ambulance transports and diversions among US emergency departments. Ann Emerg Med. 2006; 47(4): 317-326.

Burt CW, Arispe IE: Characteristics of emergency departments serving high volumes of safety-net patients: United States, 2000. Vital Health Stat 13. 2004; 155: 1-16.

Siegel B, Regenstein M, Shin P: Health reform and the safety net: Big opportunities; major risks. J Law Med Ethics. 2004; 32(3): 426-432.

Moskop JC, Sklar DP, Geiderman JM, et al.: Emergency department crowding, Part 1: Concept, causes, and moral consequences. Ann Emerg Med. 2009; 53(5): 605-611.

Timm NL, Ho ML, Luria JW: Pediatric emergency department overcrowding and impact on patient flow outcomes. Acad Emerg Med. 2008; 15(9): 832-837.

Simon HK, Hirsh DA, Rogers AJ, et al.: Pediatric emergency department overcrowding: Electronic medical record for identification of frequent, lower acuity visitors. Can we effectively identify patients for enhanced resource utilization? J Emerg Med. 2009; 36(3): 311-316.

Cherry RA, Trainer M: The current crisis in emergency care and the impact on disaster preparedness. BMC Emerg Med. 2008; 8: 7.

Gilligan P,Winder S, Singh I, et al.: The boarders in the emergency department (BED) study. Emerg Med J. 2008; 25(5): 265-269.

Yen K, Gorelick MH: Strategies to improve flow in the pediatric emergency department. Pediatr Emerg Care. 2007; 23(10): 745-749.

Hostetler MA, Mace SE, Brown K, et al.: Emergency department overcrowding and children. Pediatr Emerg Care. 2007; 23(7): 507-515.

Takakuwa KM, Shofer FS, Abbuhl SB: Strategies for dealing with emergency department overcrowding: A one-year study on how bedside registration affects patients throughput times. J Emerg Med. 2007; 32(4): 337-342.

New CDC survey results echo report from IOM. ED Manag. 2006; 18(11): 129-131.

Hirshon JM, Morris DM: Emergency medicine and the health of the public: The critical role of emergency departments in US public health. Emerg Med Clin North Am. 2006; 24(4): 815-819.

Twanmoh JR, Cunningham GP: When overcrowding paralyzes an emergency department. Manag Care. 2006; 15(6): 54-59.

Mistry RD, Brousseau DC, Alessandrini EA: Urgency classification methods for emergency department visits: Do they measure up? Pediatr Emerg Care. 2008; 24(12): 870-874.

Redstone P, Vancura JL, Barry D, et al.: Nonurgent use of the emergency department. J Ambul Care Manage. 2008; 31(4): 370-376.

Howard MS, Davis BA, Anderson C, et al.: Patients’ perspective on choosing the emergency department for nonurgent medical care: A qualitative study exploring one reason for overcrowding. J Emerg Nurs. 2005; 31(5): 429-435.

Luo X, Liu G, Frish K, et al.: Children’s health insurance status and emergency department utilization in the United States. Pediatrics. 2003; 112(2): 314-319.

LeDuc K, Rosebrook H, Rannie M, et al.: Pediatric emergency department recidivism: Demographic characteristics and diagnostic predictors. J Emerg Nurs. 2006; 32(2): 131-138.

Haines CJ, Lutes RE, Blaser M, et al.: Paramedic initiated nontransport of pediatric patients. Prehosp Emerg Care. 2006; 10(2): 213-219.

Larson G: Ambulance destination determination system for ambulance distribution as an alternative to ambulance diversion. J Emerg Nurs. 2008; 34(4): 357-358.

Asamoah OK,Weiss SJ, Ernst AA, et al.: A novel diversion protocol dramatically reduces diversion hours. Am J Emerg Med. 2008; 26(6): 670-675.

Carter AJ, Grierson R: The impact of ambulance diversion on EMS resource availability. Prehosp Emerg Care. 2007; 11(4): 421-426.

Pham JC, Patel R, Millin MG, et al.: The effects of ambulance diversion: A comprehensive review. Acad Emerg Med. 2006; 13(11): 1220-1227.

Patel PB, Derelet RW, Vinson DR, et al.: Ambulance diversion reduction: The Sacramento solution. Am J Emerg Med. 2006; 24(2): 206-213.

Menchine MD, Baraff LJ: On-call specialists and higher level of care transfers in California emergency departments. Acad Emerg Med. 2008; 15(4): 329-336.

McConnel KJ, Johnson LA, Arab N, et al.: The on-call crisis: A statewide assessment of the costs of providing on-call specialist coverage. Ann Emerg Med. 2007; 49(6): 727-733, e1-18.

Hexter DA: Shortage of on-call specialists threatens community safety net. Md Med. 2006; 7(2): 29-31.

Mohanty SA,Washington DL, Lambe S, et al.: Predictors of oncall specialist response time in California emergency departments. Acad Emerg Med. 2006; 13(5): 505-512.

Rudkin SE, Oman J, Langdorf MI, et al.: The state of ED on-call coverage in California. Am J Emerg Med. 2004; 22(7): 575-581.

Allan JD, Aldebron J: A systematic assessment of strategies to address the nursing faculty shortage. U.S. Nurs Outlook. 2008; 56(6): 286-297.

Laffan S: Job satisfaction and the effects of the current nationwide nursing shortage. N J Nurse. 2002; 32(7): 5-6.

Eastaugh SR: Overcrowding and fiscal pressures in emergency medicine. Hosp Top. 2002; 80(1): 7-11.

New study gauges scope of nursing shortage. Hosp Peer Rev. 2001; 26(6): 83-85.

Staffing in the ED despite the nursing shortage. RN. 2004; 67(2): 26hf1-26hf2.

Monssen RB, Finley S: Shortage of nurses and child health. J Pediatr Nurs. 2007; 22(3): 231-232.

DeLia D, Wood E: The dwindling supply of empty beds: Implications for hospital surge capacity. Health Aff (Milwood). 2008; 27(6): 1688-1694.

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

Rubinson L, Hick JL, Hanfling DG, et al.: Definitive care for the critically ill during a disaster: Medical resources for surge capacity: From a Task Force for Mass Critical Care Summit Meeting, January 26-27, 2007, Chicago, IL. Chest. 2008; 133(5 Suppl): 32S-35S.

Rubinson L, Hick JL, Hanfling DG, et al.: Definitive care for the critically ill during a disaster: A framework for optimizing critical care surge capacity: From a Task Fore for Mass Critical Care Summit Meeting, January 26-27, 2007, Chicago, IL. Chest. 2008; 133(5 Suppl): 18S-31S.

Mechem CC: Surge capacity:We all need it. How do we get it? JEMS. 2007; 21(11): 48-50.

Roccaforte JD, Cushman JG: Disaster preparedness, triage, and surge capacity for hospital definitive care areas: Optimizing outcomes when demands exceed resources. Anesthesiol Clin. 2007; 25(1): 161-77, xi.

Bonnett CJ, Peery BN, Cantrill SV, et al.: Surge capacity: A proposed conceptual framework. Am J Emerg Med. 2007; 25(3): 297- 306.

Kanter RK, Moran JR: Pediatric hospital and intensive care unit capacity in regional disasters: Expanding capacity by altering standards of care. Pediatrics. 2007; 119(1): 94-100.

Kanter RK, Moran JR: Hospital emergency surge capacity: An empiric New York statewide study. Ann Emerg Med. 2007; 50(3): 314-319.

Estacio PL: Surge capacity for health care systems: Early detection, methodologies, and process. Acad Emerg Med. 2006; 13(11): 1135-1137.

Barbisch DF, Koenig KL: Understanding surge capacity: Essential elements. Acad Emerg Med. 2006; 13(11): 1098-1102.

Rothman RE, Hsu EB, Kahn CA, et al.: Research priorities for surge capacity. Acad Emerg Med. 2006; 13(11): 1160-1168.

Phillips S: Current status of surge research. Acad Emerg Med. 2006; 13(11): 1103-1108.

Schultz CH, Koenig KL: State of research in high-consequence hospital surge capacity. Acad Emerg Med. 2006; 13(11): 1153-1156.

Romano M: At capacity and beyond. Ideas such as “surge” hospitals are getting a more careful look as healthcare wrestles with planning for large-scale disaster. Mod Health. 2005; 35(39): 6-7, 16, 1.

Moser R Jr, Connelly C, Baker L, et al.: Development of a state medical surge plan, Part 1: The procedures, process, and lessons learned or confirmed. Disaster Manag Response. 2005; 3(4): 112-117.

Davis DP, Poste JC, Hicks T, et al.: Hospital bed surge capacity in the event of a mass-casualty incident. Prehosp Disaster Med. 2005; 20(3): 169-176.

Kaji AH, Langford V, Lewis RJ: Assessing hospital disaster preparedness: A comparison of an on-site survey, directly observed drill performance, and video analysis of teamwork. Ann Emerg Med. 2008; 52(3): 195-201, e1-e12.

Adini B, Goldberg A, Laor D, et al.: Assessing levels of hospital emergency preparedness. Prehosp Disaster Med. 2006; 21(6): 451-457.

Higgins W,Wainright C, Lu N, et al.: Assessing hospital preparedness using an instrument based on the Mass Casualty Disaster Plan Checklist: Results of a statewide survey. Am J Infect Control. 2004; 32(6): 327-332.

Braun BI, Darcy L, Divi C, et al.: Hospital bioterrorism preparedness linkages with the community: Improvements over time. Am J Infect Control. 2004; 32(6): 317-326.



How to Cite

Mace, MD, S. E., G. Sharieff, MD, A. Bern, MD, L. Benjamin, MD, D. Burbulys, MD, R. Johnson, MD, and M. Schreiber, PhD. “Pediatric Issues in Disaster Management, Part 1: The Emergency Medical System and Surge Capacity”. American Journal of Disaster Medicine, vol. 5, no. 2, Mar. 2010, pp. 83-93, doi:10.5055/ajdm.2010.0011.




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