Pediatric Surge:Pediatric Surge:But We Don’t DO But We Don’t DO

Peds!Peds!

Marilyn J. Chapman, RNC, MSNMarilyn J. Chapman, RNC, MSN

June 20, 2012June 20, 2012

ObjectivesObjectives

Describe a method to recruit pediatric Describe a method to recruit pediatric volunteers to serve as victims during an volunteers to serve as victims during an emergency preparedness drillemergency preparedness drill

Describe resources that can be used to Describe resources that can be used to expand capabilities during a pediatric expand capabilities during a pediatric medical surge eventmedical surge event

Describe ways to expand abilities to Describe ways to expand abilities to respond to a pediatric patient surgerespond to a pediatric patient surge

ScenarioScenario

• Charleston, MO: The USGS confirmed that a catastrophic earthquake with a magnitude of 8.0 occurred virtually in the center of the New Madrid Seismic Zone (NMSZ), with an epicenter at Charleston, MO.

• Mt. Carmel, IL: A second large earthquake with a magnitude of 7.0 occurred a short time later on the Wabash Valley Seismic Zone (WVSZ).

ScenarioScenario

• Midwest, U.S.: Catastrophic structural damage is reported across the central portion of the Midwest. Injuries are in the thousands and hundreds have died. Small quakes and aftershocks are predicted over the next 72 hours.

• Illinois: Thousands of buildings (to include many hospitals) have suffered significant damage; though catastrophic damage and outright destruction is less significant in central and northern Illinois

Scenario AssumptionsScenario Assumptions

•3,000 serious patients; 6,000 non-serious 3,000 serious patients; 6,000 non-serious patients – est. state capacity in 1patients – est. state capacity in 1stst 24 hrs = 24 hrs = 1,000 pts. More than 15,000 injured requiring 1,000 pts. More than 15,000 injured requiring care.care.

•Limited air-med-evacuation assets for the 500 Limited air-med-evacuation assets for the 500 patients with head, crush, and multi-trauma.patients with head, crush, and multi-trauma.

•Thousands of pediatric patients requiring Thousands of pediatric patients requiring hospitalization, blood transfusions, respiratory hospitalization, blood transfusions, respiratory support, and other medical supplies.support, and other medical supplies.

Obtaining VolunteersObtaining Volunteers

• Reviewed patient list sent by exercise Reviewed patient list sent by exercise planners – 24 patients, ages 4 months – 13 planners – 24 patients, ages 4 months – 13 yearsyears

• Put out a call to entire hospital staff Put out a call to entire hospital staff requesting parents and children between the requesting parents and children between the ages of 7 and 12 years of age to participateages of 7 and 12 years of age to participate

• Offered documentation of service hours for Offered documentation of service hours for participationparticipation

Using VolunteersUsing Volunteers

• Received 15 child volunteers from 9 familiesReceived 15 child volunteers from 9 families

• Volunteers were 7 – 17 years of ageVolunteers were 7 – 17 years of age

• Matched ages and sex to patient profile list – Matched ages and sex to patient profile list – the remainder of patients were simulated by the remainder of patients were simulated by dollsdolls

• Used the 17 year old as the mother of the 4 Used the 17 year old as the mother of the 4 month old represented by one of the dollsmonth old represented by one of the dolls

Using VolunteersUsing Volunteers

• Children were asked to come in casual clothes Children were asked to come in casual clothes and if dirty from playing outside that was okayand if dirty from playing outside that was okay

• Each child was given a lanyard with the victim Each child was given a lanyard with the victim age and patient profile along with any pertinent age and patient profile along with any pertinent clinical information received with the profileclinical information received with the profile

• The youngest children were accompanied by The youngest children were accompanied by their parent throughout the “victim” processtheir parent throughout the “victim” process

Using VolunteersUsing Volunteers

• Every parent signed a consent for participation Every parent signed a consent for participation for their childfor their child

• An observer assigned roles, distributed An observer assigned roles, distributed lanyards to the “victims”, and coordinated lanyards to the “victims”, and coordinated movement of “victims” into and through the movement of “victims” into and through the EDED

• Once a “victim” was cleared for transfer to a Once a “victim” was cleared for transfer to a patient room, the observer gathered the patient room, the observer gathered the volunteers, gave them lunch and released volunteers, gave them lunch and released them for the daythem for the day

Using VolunteersUsing Volunteers• After the exercise letters were written for After the exercise letters were written for

each child confirming the service hourseach child confirming the service hours

• Letters were delivered to the parents along Letters were delivered to the parents along with a t-shirt or bag for each volunteerwith a t-shirt or bag for each volunteer

• Parents and children commented that this Parents and children commented that this was a good experience for them and they was a good experience for them and they learned a lotlearned a lot

• No one said they were afraid during the No one said they were afraid during the exerciseexercise

Pediatric SurgePediatric SurgeMercy absorbed 62 pediatric patientsMercy absorbed 62 pediatric patients

(budgeted Average Daily Census = 2.5)(budgeted Average Daily Census = 2.5)

• 15 in the initial surge – all went to the 15 in the initial surge – all went to the Pediatric UnitPediatric Unit

• 4 from a school collapse – 1 to ICU, 3 to 4 from a school collapse – 1 to ICU, 3 to Pediatric UnitPediatric Unit

• 4 from the pediatric hospital evacuation – 4 from the pediatric hospital evacuation – 3 to ICU/CCU, 1 to Pediatric Unit3 to ICU/CCU, 1 to Pediatric Unit

Pediatric SurgePediatric Surge

• 20 from a pediatric mental health facility – 20 from a pediatric mental health facility –

placed on Behavioral Health Unitplaced on Behavioral Health Unit

• 4 Russian speaking children without parents 4 Russian speaking children without parents – –

used Russian-speaking Respiratory used Russian-speaking Respiratory Therapist, Therapist,

eventually sent to Pediatric Uniteventually sent to Pediatric Unit

Pediatric SurgePediatric Surge

• 11 ventilator dependent patients – placed in 11 ventilator dependent patients – placed in

PACU, staff called in to care for patientsPACU, staff called in to care for patients

• 4 neonates whose mothers delivered 4 neonates whose mothers delivered

prematurely – infants placed in Special Care prematurely – infants placed in Special Care

Nursery, mothers to Labor & Delivery for Nursery, mothers to Labor & Delivery for

assessment and then to Mother/Baby Unitassessment and then to Mother/Baby Unit

OutcomesOutcomes• Every patient sent to Mercy during the drill Every patient sent to Mercy during the drill

was placed within the hospital and treated was placed within the hospital and treated

• Alternate care locations were rapidly Alternate care locations were rapidly identified within the hospital and Mercy staff identified within the hospital and Mercy staff found to care for patientsfound to care for patients

• Used 2 senior charge nurses in the HICS role Used 2 senior charge nurses in the HICS role of Resources Unit Leader to determine of Resources Unit Leader to determine patient placement, staffing requirements and patient placement, staffing requirements and equipment needs – they do this every day equipment needs – they do this every day and are really good at itand are really good at it

ReunificationReunification

• American Red Cross Patient Connection American Red Cross Patient Connection

system was activatedsystem was activated

• Pictures were taken of incoming patients Pictures were taken of incoming patients and parentsand parents

• Patients accompanied by parents were not Patients accompanied by parents were not separated from parents for any reasonseparated from parents for any reason

ReunificationReunification

• Do not cut off ID bands from transferring Do not cut off ID bands from transferring institutions – these can aid in reunificationinstitutions – these can aid in reunification

• If these bands are cut off –If these bands are cut off –• Have registrars record the informationHave registrars record the information• Place the actual band in the patient recordPlace the actual band in the patient record• Take a photo and copy into the chart with Take a photo and copy into the chart with

other identifying photosother identifying photos

ReunificationReunification• Load camera software into system so that Load camera software into system so that

any printer may be used to print picturesany printer may be used to print picturesOROR

• Invest in a photo printer for each camera Invest in a photo printer for each camera and issue printer with cameraand issue printer with camera

• Be sure you have photo paper available, the Be sure you have photo paper available, the larger the betterlarger the better

• Use personnel from the Labor Pool to deal Use personnel from the Labor Pool to deal with patient identification and photo printing with patient identification and photo printing while ED staff triage and treat patientswhile ED staff triage and treat patients

ReunificationReunification

• Have parent identify child from photo board Have parent identify child from photo board and have child identify parent from photo and have child identify parent from photo boardboard

• Have parent describe birthmarks, tattoos, Have parent describe birthmarks, tattoos, clothing, distinguishing marks, etc. before clothing, distinguishing marks, etc. before seeing childseeing child

• Place matching arm bands on parents and Place matching arm bands on parents and childrenchildren

• Think about other ways to prevent child Think about other ways to prevent child abduction during a chaotic situationabduction during a chaotic situation

PlanningPlanning

• Create a plan clearly identifying holding Create a plan clearly identifying holding locations for reunification locations for reunification

• Conduct a safety survey of those areas as a Conduct a safety survey of those areas as a part of your planpart of your plan

• Create a checklist based on the safety survey Create a checklist based on the safety survey to prepare the area for an influx of familiesto prepare the area for an influx of families

PlanningPlanning

• Create a staffing plan knowing that it will Create a staffing plan knowing that it will take more people than expected to deal with take more people than expected to deal with frightened childrenfrightened children

• Extra staff will be needed to hold for Extra staff will be needed to hold for procedures, watch unattended patients, procedures, watch unattended patients, prevent falls and wanderingprevent falls and wandering

• Consider using day care staffing ratios and Consider using day care staffing ratios and use the labor pooluse the labor pool

PlanningPlanning

• Remember that there are others who work in Remember that there are others who work in the hospital besides clinical caregivers – they the hospital besides clinical caregivers – they can be included in the Labor Poolcan be included in the Labor Pool

• Some of those individuals will be parents and Some of those individuals will be parents and can help in caring for groups of childrencan help in caring for groups of children

• Think about the size of the child and not just Think about the size of the child and not just the age in determining bed placementthe age in determining bed placement

PlanningPlanning

• Think about staff members from local Think about staff members from local Pediatric medical practicesPediatric medical practices

• Think about individuals who work in Day Care Think about individuals who work in Day Care facilitiesfacilities

• Think about using uninjured parents who Think about using uninjured parents who accompany injured children as helpers accompany injured children as helpers

PlanningPlanning

Insure that you have pediatric supplies on hand Insure that you have pediatric supplies on hand especially if you do not have a pediatric unit especially if you do not have a pediatric unit

• Diapers and formulaDiapers and formula

• T-shirts in various sizes to serve as gowns – can T-shirts in various sizes to serve as gowns – can also be used in decontamination situationsalso be used in decontamination situations

• Pediatric masksPediatric masks

PlanningPlanning

Insure that you have pediatric supplies on hand Insure that you have pediatric supplies on hand especially if you do not have a pediatric unit especially if you do not have a pediatric unit

• Small size needles and pediatric drip chambers if Small size needles and pediatric drip chambers if pumps are not availablepumps are not available

• IV Pumps – can your current pumps be set for low IV Pumps – can your current pumps be set for low dosesdoses

• Ventilators – can your current equipment be set Ventilators – can your current equipment be set for low volumes, pressures, ratesfor low volumes, pressures, rates

PlanningPlanning• Create pediatric dosing charts in advance Create pediatric dosing charts in advance

based on weight and agebased on weight and age

• Create drip rate charts in advance for your IV Create drip rate charts in advance for your IV tubing tubing

• Purchase pediatric emergency equipment Purchase pediatric emergency equipment based on the Broselow Color Coded based on the Broselow Color Coded Emergency System and/or the EMSC Emergency System and/or the EMSC Checklist for Care of Children in Emergency Checklist for Care of Children in Emergency Department Department

PlanningPlanning

• Study packet for Broselow Color Coded Study packet for Broselow Color Coded Emergency SystemEmergency System

http://www.ncdhhs.gov/dhsr/EMS/pdf/kids/DEPS_Broselow_Study.pdf

• Use the resources available on-line to create Use the resources available on-line to create plans specifically for pediatric patientsplans specifically for pediatric patients

www.luhs.org/emsc

Marilyn J. Chapman, RNC, MSNMarilyn J. Chapman, RNC, MSN

Director, Organizational Director, Organizational DevelopmentDevelopment

Mercy Hospital and Medical CenterMercy Hospital and Medical Center

Chicago, ILChicago, IL

312-567-2129312-567-2129

mchapman@mercy-chicago.orgmchapman@mercy-chicago.org