Pediatric disaster triage education and skills assessment: A coalition approach

Katherine Kenningham, MD; Kathryn Koelemay, MD, MPH; Mary A. King, MD, MPH

doi:10.5055/jem.2014.0168

Authors

Katherine Kenningham, MD
Kathryn Koelemay, MD, MPH
Mary A. King, MD, MPH

DOI:

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

Keywords:

disasters, pediatric MCI triage, provider performance

Abstract

Objective: This study aims to 1) demonstrate one method of pediatric disaster preparedness education using a regional disaster coalition organized workshop and 2) evaluate factors reflecting the greatest shortfall in pediatric mass casualty incident (MCI) triage skills in a varied population of medical providers in King County,WA.

Design: Educational intervention and cross-sectional survey.

Setting: Pediatric disaster preparedness conference created de novo and offered by the King County Healthcare Coalition, with didactic sessions and workshops including a scored mock pediatric MCI triage.

Participants: Ninety-eight providers from throughout the King County, WA, region selected by their own institutions following invitation to participate, with 88 completing exit surveys.

Interventions: Didactic lectures regarding pediatric MCI triage followed by scored exercises.

Main outcome measures: Mock triage scores were analyzed and compared according to participant characteristics and workplace environment.

Results: A half-day regional pediatric disaster preparedness educational conference convened in September 2011 by the King County Healthcare Coalition in partnership with regional pediatric experts was so effective and well-received that it has been rescheduled yearly (2012 and 2013) and has expanded to three Washington State venues sponsored by the Washington State Department of Health. Emergency department (ED) or intensive care unit (ICU) employment and regular exposure to pediatric patients best predicted higher mock pediatric MCI triage scores (ED/ICU 80 percent vs non-ED/ICU 73 percent, p = 0.026; regular pediatric exposure 80 percent vs less exposure 77 percent, p = 0.038, respectively). Pediatric Advanced Life Support training was not found to be associated with improved triage performance, and mock patients whose injuries were not immediately life threatening tended to be over-triaged (observed trend).

Conclusions: A regional coalition can effectively organize member hospitals and provide education for focused populations using specialty experts such as pediatricians. Providers working in higher acuity environments and those with regular pediatric patient exposure perform better mock pediatric MCI triage than their counterparts after just-in-time training. Pediatric MCI patients with less than life-threatening injuries tended to be over-triaged.

Author Biographies

Katherine Kenningham, MD

Pediatric Resident, University of Washington School of Medicine, Seattle, Washington; Seattle Children’s Hospital, Seattle, Washington

Kathryn Koelemay, MD, MPH

Public Health – Seattle and King County, Seattle, Washington; Affiliate Assistant Professor, Department of Health Services, University of Washington School of Public Health, Seattle, Washington

Mary A. King, MD, MPH

Assistant Professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Harborview Medical Center, Seattle, Washington; Seattle Children’s Hospital, Seattle, Washington

References

Gausche-Hill M: Pediatric disaster preparedness: Are we really prepared? J Trauma. 2009; 67: S73-S76.

Branson RD: Disaster planning for pediatrics. Respir Care. 2011; 56(9): 1457-1463.

Middleton KR, Burt CW: Availability of pediatric services and equipment in emergency departments: United States, 2002-03. Adv Data. 2006; 367: 1-16.

Sirbaugh PE, Gurwitch 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.

Siegel D, Strauss-Riggs K, Costello A: Pediatric Disaster Preparedness Curriculum Development (conference report). National Center for Disaster Medicine and Public Health. 2011.

Tegtmeyer K, Conway EE, Upperman JS, et al.: Education in a pediatric emergency mass critical care setting. Pediatr Crit Care Med. 2011; 12(6): S135-S140.

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

King County Office of Emergency Management: 2009 King County Regional Hazard Identification and Vulnerability Analysis (HIVA). King County, Washington. Available at http://www.kingcounty.gov//App_Media/safety/prepare/documents/RHMP2009/2009_RHMP_Sec5HIVA_001.pdf. Accessed January 8, 2014.

Markenson D, Redlener I: Executive Summary: Pediatric Preparedness for Disasters and Terrorism, A National Consensus Conference. New York, NY: National Center for Disaster Preparedness, Columbia University Mailman School of Public Health, 2003.

Jenkins JL, McCarthy ML, Sauer LM, et al.: Mass-casualty triage: Time for an evidence-based approach. Prehosp Disast Med. 2008; 23(1): 3-8.

Behar S, Upperman J, Ramirez M, et al.: Training medical staff for pediatric disaster victims: A comparison of different teaching methods. Am J Disaster Med. 2008; 3(4): 189-199.

Cicero MX, Blake E, Gallant N, et al.: Impact of an educational intervention on residents’ knowledge of pediatric disaster medicine. Pediatr Emerg Care. 2009; 25: 447-451.

King County Healthcare Coalition committees: King County Healthcare Coalition Web site. Available at www.kingcountyhealthcarecoalition.org/about-the-coalition/participate. Accessed January 9, 2014.

The JumpSTART Algorithm: The JumpSTART Pediatric MCI Triage Tool and other pediatric disaster and emergency medicine resources Web site. Available at www.jumpstarttriage.com. Accessed January 9, 2014.

SALT Mass Casualty Triage Algorithm: Radiation Emergency Medical management Web site. Available at www.remm.nlm.gov/salttriage.htm. Accessed January 9, 2014.

SALT Mass Casualty Triage: Concept Endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of EMS physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association. Disaster Med Public Health Prep. 2008; 2(4): 245-246.

Dieckmann RA, Brownstein D, Gausche-Hill M: The pediatric assessment triangle: A novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010; 26(4): 312-315.

Meguerdichian MJ, Clapper TC: The Broselow tape as an effective medication dosing instrument: A review of the literature. J Pediatr Nurs. 2012; 27(4): 416-420.

Broselow Pediatric Emergency Tape. Armstrong Medical Industries, Inc.Web site. Available at www.armstrongmedical.com/index.cfm/go/product.detail/sec/3/ssec/14/fam/2371. Accessed January 9, 2014.

Surge World: Children’s Hospital of Los Angeles. Available at lachildrenshospital.net/SurgeWorld/. Accessed January 9, 2014.

Ballow S, Behar S, Claudius I, et al.: Hospital-based disaster preparedness for pediatric patients: How to design a realistic set of drill victims. Am J Disaster Med. 2008; 3(3): 171-180.

Engum SA, Mitchell MK, Scherer LR, et al.: Prehospital triage in the injured pediatric patient. J Pediatr Surg. 2000; 35: 82-87.

Koelemay K, Sakata V, Blayney C, et al.: Disaster response: Are you ready for the kids? (4 hour workshop). Paper presented at the Integrated Medical, Public Health, Preparedness and Response Training Summit, Nashville, TN, May 21, 2012.

Berg B, Arnone C, Cannon-Davis J, et al.: Pediatric emergencies: Preparing at triage using height and weight. J Emerg Nurs. 2013; 39(4): 409-411.