Pediatric DisasterPediatric DisasterLife Support (PDLSLife Support (PDLS©©))

Continuing Medical EducationContinuing Medical EducationUniversity of Massachusetts Medical SchoolUniversity of Massachusetts Medical School

A Course in Caring forA Course in Caring forChildren During DisasterChildren During Disaster

PDLSPDLS©©::The Needs of Children The Needs of Children During DisastersDuring Disasters

IntroductionIntroduction

The Pediatric PatientThe Pediatric Patient

NewbornNewborn 0-3 mos 0-3 mos

InfantInfant 3-18 mos 3-18 mos

ToddlerToddler 1-3 1/2 yrs 1-3 1/2 yrs

Pre-schoolPre-school 3-5 yrs 3-5 yrs

School AgeSchool Age 6-10 yrs 6-10 yrs

Adolescent / TeenAdolescent / Teen 11-18 yrs 11-18 yrs

Definition of DisasterDefinition of Disaster

AAny community emergency that disrupts ny community emergency that disrupts

normal community function causing normal community function causing concern for the safety of the citizens.concern for the safety of the citizens.

Mass Casualty Incident (MCI)Mass Casualty Incident (MCI)

AA disaster that produces large numbers of disaster that produces large numbers of

injured victims. Children should be given injured victims. Children should be given special attention.special attention.

Level I MCILevel I MCI

Local medical resources are available and Local medical resources are available and adequateadequate

Regional backup resources may be put on alertRegional backup resources may be put on alert

Level II MCILevel II MCI

Requires multi-jurisdiction (Regional) medical mutual Requires multi-jurisdiction (Regional) medical mutual aidaid

Mutual aid agreements should provide back-up plans Mutual aid agreements should provide back-up plans for jurisdictions stripped of their local resourcesfor jurisdictions stripped of their local resources

Level III MCILevel III MCI

Activation of the State Disaster Plan is requiredActivation of the State Disaster Plan is required

Requests for Federal Assistance may be Requests for Federal Assistance may be necessarynecessary

Phases of a Disaster ResponsePhases of a Disaster Response

Activation PhaseActivation Phase

Notification and initial responseNotification and initial response

Organization of command and scene assessmentOrganization of command and scene assessment

Phases of a Disaster ResponsePhases of a Disaster Response

Implementation PhaseImplementation Phase

Search and rescueSearch and rescue

Victim triage, initial stabilization and transportVictim triage, initial stabilization and transport

Definitive management of scene hazards and victimsDefinitive management of scene hazards and victims

Phases of a Disaster ResponsePhases of a Disaster Response

Recovery PhaseRecovery Phase

Scene withdrawalScene withdrawal

Return to normal operationsReturn to normal operations

DebriefingDebriefing

Natural Disasters (Natural Disasters (ExamplesExamples))

Forest firesForest fires

HurricanesHurricanes

FloodsFloods

TornadoesTornadoes

Winter stormsWinter storms

EarthquakesEarthquakes

Man-Made Disasters (Man-Made Disasters (ExamplesExamples))

Building firesBuilding fires

ExplosionsExplosions

Chemical / radioactive contaminationChemical / radioactive contamination

Transportation accidentsTransportation accidents

Civil disturbancesCivil disturbances

Military actionsMilitary actions

Lessons Learned Lessons Learned From Prior Disaster From Prior Disaster ExperienceExperience

Factors That Determine the Magnitude Factors That Determine the Magnitude of a Disasterof a Disaster

Type of disaster, initial force, time course, Type of disaster, initial force, time course, secondary eventssecondary events

Number of victim declared injured, and percent Number of victim declared injured, and percent of total population displaced by the eventof total population displaced by the event

Location and accessibilityLocation and accessibility

Time of dayTime of day

Resources available in the areaResources available in the area

Social, economic and political conditions at the Social, economic and political conditions at the time of the eventtime of the event

EarthquakeEarthquake

Forces Experienced at the Surface of the EarthForces Experienced at the Surface of the Earth

horizontalhorizontal

verticalvertical

circularcircular

fissuringfissuring

Impact of Earthquakes on BuildingsImpact of Earthquakes on Buildings

Structural Damage Structural Damage Stresses of varying amplitude cause distortion on Stresses of varying amplitude cause distortion on

load carrying parts of buildings. Some parts of load carrying parts of buildings. Some parts of structures are unable to tolerate significant structures are unable to tolerate significant distortiondistortion

Non-Structural DamageNon-Structural Damage Furniture, fixtures, glass and unsecured equipment Furniture, fixtures, glass and unsecured equipment

are thrown from their position by the impact are thrown from their position by the impact

Consider Risks Consider Risks to Disaster to Disaster RespondersResponders

Disaster MitigationDisaster Mitigation

Prevention of disaster-related Prevention of disaster-related injury and illnessinjury and illness

Vectors of Transmission of Infectious Vectors of Transmission of Infectious Diseases Affected by DisasterDiseases Affected by Disaster

Airborne Airborne - Crowded habitationCrowded habitation

WaterborneWaterborne- Contaminated water supplyContaminated water supply- Children most susceptibleChildren most susceptible

FoodborneFoodborne- Problems with proper storageProblems with proper storage

Insect and Animal borneInsect and Animal borne- Decrease disease transmission controlDecrease disease transmission control

Disasters have Significant Disasters have Significant Psychological Impact on ChildrenPsychological Impact on Children

Philosophy of Disaster MedicinePhilosophy of Disaster MedicineWhen Children are VictimsWhen Children are Victims

Children are more susceptible to certain injuries or Children are more susceptible to certain injuries or environmental insults than adultsenvironmental insults than adults

Children with acute injuries or illness are more likely Children with acute injuries or illness are more likely to respond to rapid and efficient medical care than to respond to rapid and efficient medical care than adultsadults

Since children are not small adults they require Since children are not small adults they require equipment and pharmaceuticals designed for their equipment and pharmaceuticals designed for their needsneeds

Routine Medical Practices Routine Medical Practices UnalteredUnaltered in a Mass Casualty Situationin a Mass Casualty Situation

Attend immediately to airway, breathing and Attend immediately to airway, breathing and circulatory emergencies in a potentially viable circulatory emergencies in a potentially viable patientpatient

Provide appropriate management of painProvide appropriate management of pain

Perform systematic patient assessmentsPerform systematic patient assessments

Re-evaluate patients for changes in statusRe-evaluate patients for changes in status

Maintain patient dignityMaintain patient dignity

Routine Medical Practices Routine Medical Practices AlteredAltered in a Mass Casualty Situationin a Mass Casualty Situation

Extent of resuscitation effortsExtent of resuscitation efforts

Acceptable resultsAcceptable results

Timeliness of surgeryTimeliness of surgery

Indications for hospitalizationIndications for hospitalization

Use of ancillary servicesUse of ancillary services

Increase patient care responsibility of nursesIncrease patient care responsibility of nurses

Decision to transferDecision to transfer

Problems Common to Major DisastersProblems Common to Major Disasters

Inadequate rescue personnel and supplies for the Inadequate rescue personnel and supplies for the initial few daysinitial few days

Inadequate medical equipment, medical personnel Inadequate medical equipment, medical personnel and hospital space - particularly for childrenand hospital space - particularly for children

Inadequate food, clothing and shelter for victims and Inadequate food, clothing and shelter for victims and the displaced population - particularly for childrenthe displaced population - particularly for children

Inadequate communications, assessment of victims’ Inadequate communications, assessment of victims’ needs and initial on-site coordinationneeds and initial on-site coordination

The Convergence PhenomenonThe Convergence Phenomenon

Parents / Family MembersParents / Family Members

ReportersReporters

SpectatorsSpectators

Disaster Medical ReliefDisaster Medical ReliefRecommendations to RescuersRecommendations to Rescuers

Bring the right stuff - include supplies for Bring the right stuff - include supplies for newborn infants/childrennewborn infants/children

Bring the right staff - Pedi experienceBring the right staff - Pedi experience

Plan to be fairly self-sufficientPlan to be fairly self-sufficient

Control your own supplies and avoid careless Control your own supplies and avoid careless distributiondistribution

Maintain accurate records, logs and photo Maintain accurate records, logs and photo documentation to verify your effortsdocumentation to verify your efforts

The needs of many outweighThe needs of many outweighthe needs of a few the needs of a few

Mr. Spock Mr. Spock afterafter Charles Dickens Charles Dickens

Following DisasterFollowing Disasterthe Needs of Children Exceedthe Needs of Children Exceed

the Needs of Adultsthe Needs of Adultsandand

Children Should be Given PriorityChildren Should be Given Priority