Pediatric patients in a disaster: Part of the all-hazard, comprehensive approach to disaster management


  • Sharon E. Mace, MD
  • Constance Doyle, MD
  • Susan Fuchs, MD
  • Marianne Gausche-Hill, MD
  • Kristi L. Koenig, MD
  • Annalise Sorrentino, MD
  • Ramon W. Johnson, MD



disaster, pediatric disasters, infants and children


Disasters affect all ages of patients from the newborn to the elderly. Disaster emergency management includes all phases of comprehensive emergency management from preparedness to response and recovery. Disaster planning and management has frequently overlooked the unique issues involved in dealing with the pediatric victims of a disaster. The following will be addressed: disaster planning and management as related to pediatric patients and the integration of pediatric disaster management as part of an all-hazard, comprehensive emergency management approach. Key recommendations for dealing with children, infants, and special needs patients in a disaster are delineated.

Author Biographies

Sharon E. Mace, MD

Emergency Services Institute, Cleveland Clinic, Cleveland, Ohio.

Constance Doyle, MD

Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.

Susan Fuchs, MD

Department of Emergency Medicine, Children’s Memorial Hospital, Chicago, Illinois.

Marianne Gausche-Hill, MD

Department of Emergency Medicine, Harbor UCLA Medical Center, Hermosa Beach, California.

Kristi L. Koenig, MD

Center for Disaster Medical Sciences, University of California, Irvine School of Medicine, Orange, California.

Annalise Sorrentino, MD

Department of Pediatric Emergency Medicine, University of Alabama, Birmingham, Alabama.

Ramon W. Johnson, MD

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


Gnauck KA, Nufer KE, LaValley JM, et al.: Do pediatric and adult disaster victims differ? A descriptive analysis of clinical encounters from four natural disaster DMAT deployments. Prehosp Disas Med. 2007; 22: 67-73.

Kano M,Wood MM, Siegel JM, et al.: Disaster research and epidemiology. In Koenig KL, Schultz CH (eds.): Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practices. New York: Cambridge University Press, 2010: 3-20.

Landesmann LY: Public Health Management of Disasters. 2nd ed. Washington, DC: American Public Health Association, 2005: 33-43.

Mace SE, Jones JT, Bern AI: An analysis of Disaster Medical Assistance Team (DMAT) deployments in the United States. Prehosp Emerg Care. 2007; 11(1): 30-35.

The Institute of Medicine’s Report: Emergency Care for Children: Growing Pains.Washington, DC: National Academies Press, 2007. Available at Accessed April 26, 2012.

Mace SE, Bern AI: Needs assessment:Are DMAT’s 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. Biosec Bioterror. 2004; 2(4): 301-319.

Ginter PM, Wingate MS, Rucis 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.

Miller A: Public testimony given 2/2/10 at National Commission on Children and Disasters Public Meeting. Available at Accessed April 26, 2012.

Broughton DD, Allen EE, Hannemann, et al.: Getting 5000 families back together: Reuniting fractured families after a disaster: The role of the National Center for Missing & Exploited Children. Pediatrics. 2006; 117(5 Pt 3): S442-S445.

Vetter S, Dulaev I, Mueller M, et al.: Impact of resilience enhancing programs on youth surviving the Beslan school siege. Child Adolesc Psychiatry Ment Health. 2010; 22: 4-11.

Toppo G: Ten years later, the real story behind Columbine. USA today. Available at Accessed April 26, 2012.

Available at Accessed April 26, 2012.

Teague DC: Mass casualties in the Oklahoma City bombing. Clin Orthop Relat Res. 2004; 422: 77-81.

Krol DM, Redlener M, Shapiro A, et al.: A mobile medical care approach targeting underserved populations in post-Hurricane Katrina Mississippi. J Health Care Poor Underserved. 2007; 18(2): 331-340.

Emergency Nurses Association: DCH Emergency Nurses care for hundreds after tornadoes strike Tuscaloosa, Alabama. ENA Connection. 2011; 35(6): 11-12.

Weiner DL, Manzi SF, Briggs SM, et al.: Response to challenges and lessons learned from hurricanes Katrina and Rita. Pediatrics. 2011; 128; S31-S33.

Shannon M: Reuniting children with their families during disasters: A proposed plan for greater success. Am Disas Med. 2007; 2: 113-117.

DiStefano SM, Graf JM, Lowry AW, 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): S421-S427.

van Amerongen RH, Fine JS, Tunik MG, et al.: The Avianca Plane Crash: An emergency medical system’s response to pediatric survivors of the disaster. Pediatrics. 1993; 92: 105-110.

Okumura T, Uzukmi K, Fukudam D, et al.: The Tokyo subway Sarin attack: Disaster management, Part 1: Community emergency response. Acad Emerg Med. 1998: 5(6): 613-617.

Chisholm M, Hawkins C, Lacey C, et al.: Executive summary: EDs credit drills, community engagement with helping them manage casualties from tornado crises. ED Manag. 2011; 23(7): 73-84.

Kaji A,Koenig KL, Bey T: Surge capacity for healthcare systems: A conceptual framework. Acad Emerg Med. 2006; 13(11): 1157-1159.

Kaji A, Koenig KL, Lewis RJ: Current hospital disaster preparedness. JAMA. 2007; 298(18): 2188-2190.

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.

Shirm S, Liggin R, Dick R, et al.: Prehospital preparedness for pediatric mass casualty events. Pediatrics. 2007; 120: e756-e761.

Graham J, Shirm S, Liggin R, et al.: Mass casualty events at schools: A National Preparedness Survey. Pediatrics. 2006; 117: e8-e15.

Ferrer RR, Ramirez M, Sauser K, et al.: Emergency drills and exercises in healthcare organizations: Assessment of pediatric population involvement using after action reports. Am J Disaster Med. 209; 4(1): 23-32.

Jenkins JL, McCarthy M, Sauer LM, et al.: Changes needed in the care for sheltered persons: A multistate analysis from Hurricane Katrina. Am J Disast Med. 2009; 4(2): 101-106.

Rami JS, Singleton EK, Spurlock W, et al.: A school of nursing’s experience with providing health care for Hurricane Katrina evacuees. ABABNF J. 2008; 19(3): 102-106.

Mace SE, Sharieff G, Benjamin L, et al.: Pediatric issues in disaster management, Part III: Special health care needs patients and mental health issues. Am J Disast Med. 2010; 5(5): 261-274.

Shapiro A, Seim L, Christensen RC, et al.: Providing care to underserved children after a disaster: A national organization response. Pediatrics. 2006; Suppl 117(5): S412-S415.

Olteanu A, Arnberger R, Grant R, et al.: Persistence of mental health needs among children affected by Hurricane Katrina in New Orleans. Prehosp Disast Med. 2011; 26(1): 3-6.

DiMaggio C, Galea S, Richardson LD: Emergency department visits for behavioral and mental health care after a terrorist attack. Ann Emerg Med. 2007; 50(3): 327-334.

Hoven CW, Duarte CS, Lucas CP, et al.: Psychopathology among New York city public school children 6 months after September 11. Arch Gen Psychiatry. 2005; 62(5): 545-552.

McLaughlin KA, Fairbank JA, Gruber MJ, et al.: Trends in serious emotional disturbance among youths exposed to Hurricane Katrina. J Am Acad Child Adolesc Psychiatry. 2010; 49(10): 990-1000.

Stratton SJ, Hastings VP, Isabell D, et al.: The 1994 Northridge earthquake disaster response: The local emergency medical services agency experience. Prehosp Disaster Med. 1996; 11(3): 172-179.

Sirbaugh PE, Furwitch KD, Macias CG, et al.: Caring for evacuated children housed in the Astrodome: Creation and implementation of a Mobile Pediatric Emergency Response Team: Regionalized caring for displaced children after a disaster. Pediatrics. 2006; 117: S428-S438.

Mace SE, Sharieff G, Bern A, et al.: Pediatric issues in disaster management, Part 2: Evacuation centers and family separation/ reunification. Am J Disast Med. 2010; 5(3): 149-161.

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

Bayer EW, Fitch J, Shannon M: Pediatric hospital surge capacity in public health emergencies. AHRQ Pub #: 09-0014.

MEMS: Modular Emergency Medical System (under the Nunn- Lugar-Domenici Domestic Preparedness Program, Department of Defense) Expanding Local Health Care Structure in a Mass Casualty Terrorism Incident. Casualty Transport Systems, 2002: 30-38.

Schultz CH, Stratton SJ: Improving hospital surge capacity: A new concept for emergency credentialing of volunteers. Ann Emerg Med. 2007; 49(5): 602-609.

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

Romig LE: Pediatric triage. A system to JumpSTART your triage of young patients at MCIS. J Emerg Med Serv. 2002; 27(7): 52-58, 60-63.

Illinois Emergency Services for Children. Pediatric Disaster Preparedness Guidelines. 2005. Available at peddisasterguide.pdf. Accessed October 27, 2010.

Illinois Emergency Services for Children: Disaster preparedness exercises addressing pediatric populations. December 2006. Available at Accessed April 26, 2012.

Tennessee Department of Health: Rules of Tennessee Department of Health Board for Licensing of Health Care Facilities. Chapter 1200-8-30 Standards for Pediatric Emergency Care Facilities. February 2008. Revised.

Bradenburg MA: Pediatric considerations in a disaster. In Hogan DE, Burstein JL (eds.): Disaster Medicine. 2nd ed. Philadelphia: Lippincott,Williams & Wilkins, 2007: 29-39.

Red Cross Disaster Safe Program. Available at Accessed April 26, 2012.

Baker DM, Havis-Cover P: Mass care and sheltering of sex offenders. 2009 Integrated Medical, Public Health Preparedness and Response Training Summit. Available at and personal notes. Accessed April 26, 2012.

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

Hick JL, Koenig KL, Barbisch D, et al.: Surge capacity concepts for healthcare facilities: The ‘CO-S-TR’ model for initial incident assessment. Disast Med Public Health Prep. 2008; 2(Suppl 1, special issue): 51-57.

Brewster PW: Disaster education and training: Linking individuals and organizational learning and performance. In Koenig KL, Schultz CH (eds.): Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practices. New York: Cambridge University press, 2010: chap 2, 21-32.

California Emergency Medical Services Authority: Disaster Medical Services Division—Hospital Incident Command System (HICS). Available at Accessed October 27, 2010.

Mace SE: Behavioral and psychiatric disorders in children and infants. In Tintinalli JE, Stapczynski JS, Ma GJ, Cline D, Cydulka RK, Meckler GD. (eds.): Tintinalli’s Emergency Medicine. 7th ed. New York: McGraw Hill, 2010: chap 137A.

Baren JM, Mace SE, Hendry PL: Children’s mental health emergencies, Part 3: Special situations: Child maltreatment, violence, and response to disasters. Pediatr Emerg Care. 2008; 24(8): 569-577.

NCCD. Available at Accessed April 26, 2012.

Schreiber M: Learning from 9/11: Toward a national model for children and families in mass casualty terrorism. In Daneli Y, Dingman RL (eds.): On the Ground After September 11: Mental Health Responses and Practical Knowledge Gained. New York: Haworth Press, 2005: chap 106, 605-609.

Wong M, Schreiber M, Gurwitch R: Psychological first aid for students and teachers: Listen, protect, connect—Model and teach. Vol 3.Washington, DC: United States Department of Education— Readiness and Emergency Management for Schools (REMS) Technical Assistance Center, 2008: 1-11.

Schreiber M:Available at Accessed April 26, 2012.

Committee on Pediatric Emergency Medicine: Pediatric mental health emergencies in the emergency medical system. Pediatrics. 2006; 118(4): 1-4.

Schwartz ED, Perry BD: The post-traumatic response in children and adolescents. Psychiatr Clin North Am. 1994; 17(2): 311-326.

Mulligan-Smith D: The family’s special needs in a disaster. Prehosp Emerg Care. 1998; 2(4): 334-335.

Goenjian A: Post-traumatic stress reactions in children and adults after the 1988 Spitak earthquake in Armenia. Prehosp Disaster Med. 1996; 11(2): 111, S17.

Lundin T: The treatment of acute trauma. Psychiatr Clin North Am. 1994; 17(2): 385-391.

Centers for Disease Control and Prevention: Nationwide Estimates of Specific Health Care Needs Children Qualifying by Specific Types of Special Health Needs Criteria. Atlanta, GA: Center for Disease Control and Prevention, 2006.

Prezant DJ, Clair J, Belyaev A, et al.: Effects of the August 2003 blackout on the New York City healthcare delivery system: A lesson for disaster preparedness. Crit Care Med. 2005; 33: 96-101.

American College of Emergency Physicians: Emergency information form for children with special health care needs. Ann Emerg Med. 1999; 34: 577-582.

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

Schreiber M: The County of Los Angeles Public Health and Preparedness Program: Recommendations for the preparedness for children with special health care needs. UCLA Center for Public Health and Disasters, 2006. Available at www.CPHD.UCLA.EDU. Accessed April 26, 2012.

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

Council on School Health: Medical emergencies occurring at school. Pediatrics. 2008; 122: 887-894.

Illinois Emergency Medical Services for Children: School Nurse Education Course. School Emergency Response and Crisis Management. Illinois EMSC; chap 15. Available at Accessed April 26, 2012.

Illinois Emergency Medical Services for Children: School Nurse Education Course. Your Role in Emergency Care. Illinois EMSC; chap 1. Available at www.luhs.orgdeptsemscindex.htm. Accessed April 26, 2012.

Smitherman H, Soloway-Simon D: Special needs of children following a disaster. Clin Pediatr Emerg Med. 2002; 3(4): 262- 267.

Brandenburg MA, Arneson WL: Pediatric disaster response in developed countries:Ten guiding principles. Am J Disast Med. 2007; 2(3): 151-162.

Ward-Smith P, Linn JB, Korphage RM, et al.: Development of a pediatric palliative care team. J Pediatr Health Care. 2007; 21(4): 245-249.

Chung S, Shannon M: Reuniting children with their families during disasters: A proposed plan for greater success. Am J Disast Med. 2007; 2(3): 113-117.

Family Disaster Plan. American College of Emergency Physicians. Available at Accessed April 26, 2012.

Family Disaster Plan. American Academy of Pediatrics. Available at Accessed April 26, 2012.

Needle S: Pediatric private practice after Hurricane Katrina: Proposal for recovery. Pediatrics. 2008; 122: 836-842.

Martin SD, Bush AC, Lynch JA: A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs. Pediatrics. 206; 118: e620-e626.

Young D: Hospital report Katrina-related losses to lawmakers. Am J Health Syst Pharm. 2006; 63: 1486-1488.

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

Levine ME, Altman S, (eds.): America’s Health Care Safety Net: Intact but Endangered Institute of Medicine. Washington, DC: National Academy Press, 2000.

American Academy of Pediatrics, Committee on Pediatric Emergency Medicine: Overcrowding crisis in our nation’s emergency departments: Is our safety net unraveling? Pediatrics. 2004; 114(3): 878-888.

American College of Emergency Physicians 1998-1999: Safety net task force defending America’s safety net. Dallas, TX: American College of Emergency Physicians, 1999. Available at http://www.ACEPorglibrary/pdf/ed. Accessed April 26, 2012.



How to Cite

Mace, MD, S. E., C. Doyle, MD, S. Fuchs, MD, M. Gausche-Hill, MD, K. L. Koenig, MD, A. Sorrentino, MD, and R. W. Johnson, MD. “Pediatric Patients in a Disaster: Part of the All-Hazard, Comprehensive Approach to Disaster Management”. American Journal of Disaster Medicine, vol. 7, no. 2, Apr. 2012, pp. 111-25, doi:10.5055/ajdm.2012.0087.

Similar Articles

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)