Pediatric and Family Disaster Planning

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Pediatric and Family Disaster Planning
Considerations for Emergency Managers
Lou Romig MD, FAAP, FACEP Miami Childrens
Hospital FL-5 DMAT/MSRT South
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No excuses!

• Children are involved directly or indirectly in
  the great majority of disasters and multicasualty
  incidents

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Small problems become big problems when they
involve our children
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When in danger, when in doubt, run in circles,
scream and shout.
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"Where in the hell is the cavalry on this one?''
Kate Hale, 8/27/92, Dade County Emergency Manager
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Y.O.Y.O
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Youre On Your Own

• The majority of disasters generate fewer than 50
  injuries. Most of those are not critical. The
  cavalry will not be coming!
• Even if the feds are coming, its going to take
  time.

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Key Concept

• Pediatric disaster planning at all levels and for
  all hazards must be family-centered

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Who are emergency managers?
YOU ARE!
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Emergency Managers Goals

• Facilitate family preparedness and independence
• Reunite and keep families together
• Assure the provision of appropriate sheltering
  and care before, during, and after an incident
• Meet the needs of families with special
  healthcare challenges
• Work with other community agencies and
  organizations to prepare for family care

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Facilitating Family Preparedness

• Provide a realistic and honest community risk
  assessment
• Publicize and furnish family preparedness tools
  via internet, brochures, health fairs, media,
  etc.
• Work with school systems to distribute education
  and information
• Work with healthcare agencies and resource
  suppliers to assist families with CSHCN in their
  disaster planning

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Keeping families together

• Work with school systems on reunification plans
  (shelter in place?)
• Emphasize need for reunification planning at a
  family level
• Plan shelters so that families can stay together,
  especially those with special medical needs
• Work with medical facilities and EMS/Law
  Enforcement to promote information sharing for
  locating victims

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Adequate Care and Sheltering
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Adequate Care and Sheltering

• Special needs sheltering
• Shelter staff training and resources
• Safety
• Nutrition
• Waste disposal
• Infectious diseases
• Child care
• Stress management

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Special Needs Sheltering

• Keep families together!
• Community shelters or hospitals?
• Mix children with adults?
• Expanded definition of special needs
• Pediatric-specific medical and nutritional
  supplies
• Pediatric protocols/training for professional
  caregivers

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Staff Training and Resources

• Who will staff regular and special needs
  shelters?
• Who can or should be turned away from regular
  shelters?
• Pediatric training? What level?
• Pediatric protocols for care or medical referral
• Reference materials
• Resources for phone or other advice
• Shelter sick call?

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Shelter Safety

• Childproof your shelters (hazmats, trip hazards,
  etc.)
• Protect frail elderly or others from rambunctious
  children
• Attempt to assure security of all medications
• Smoking, weapons, alcohol, drug policies

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Nutrition/Waste Disposal

• Assure provision of age-appropriate food and
  drinks and availability of snacks
• Watch choking hazards!
• Disposal of diapers, wipes,etc.
• Biohazard disposal (diabetic needles and lancets,
  wound dressings, etc.)

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Infectious Diseases

• Screening at time of shelter entry
• How to handle new onset illnesses
• Medical isolation/segregation within the shelter
• When to involve Public Health
• Assessment of at-risk populations (elderly,
  potentially immuno-compromised occupants)
• Need for passive immunization (ex VZIG)

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Child Care
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Stress Management

• Mental health professionals with child/family
  training
• Information, information, information
• Provide energy outlets for kids
• Provide parents with time away from kids
• Provide best possible sleep environment
• Therapeutic play (drawing, role play)

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Jonathan, age 6, Hurricane Lili
Tree breaking
Rain
Scared Jonathan
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Emergency Managers Goals

• Facilitate family preparedness and independence
• Reunite and keep families together
• Assure the provision of appropriate sheltering
  and care before, during, and after an incident
• Meet the needs of families with special
  healthcare challenges
• Work with other community agencies and
  organizations to prepare for family care

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Families with CSHCN

• Whos out there? (families, daycare and
  residential facilities)
• Liaison with EMS (Emergency Information Form from
  AAP/ACEP)
• Assist families and facilities with disaster
  planning
• Family-centered sheltering
• Emergency supply resources

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Planning Partnerships
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Planning Partners

• Emergency managers/planners
• Emergency responders
• Community response organizations
• School and childcare systems
• Medical facilities and practitioners, including
  mental health professionals
• Families and family organizations

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Emergency Responders

• Work to assure that local responders can deal
  with the daily emergency needs of children and
  families.

Disaster work is the same as everyday work, just
more intense, more chaotic, more stressful and
just plain more
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Emergency Responders

• Disaster Training
• Pediatric threat-specific risks
• Pediatric assessment
• Pediatric MCI triage
• Pediatric treatment
• Pediatric decontamination

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Emergency Responders

• Disaster Training (cont)
• Appropriate transport modes and destinations
• Communication skills
• Stress management
• Reference resources

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Emergency Responders

• Pediatric specific equipment
• Protocols
• Pediatric drug preparations and delivery systems
  (Atropen, CWIK tool)

www.cwikresponse.com
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Emergency Responders

• Special attention to CSHCN
• Medicolegal aspects (children without guardians)
• Disaster documentation
• Awareness of local family reunification schemes

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Community Responders

• Help to assure that local volunteer responders
  (such as CERT members) receive pediatric training
• Monitor NGO plans for inclusion of consideration
  of family issues

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School and Childcare Systems

• Work with public and private school systems in
  their disaster planning
• Help schools integrate with local response
  systems
• Provide risk assessments to schools and childcare
  facilities
• Establish minimum standards for disaster/disaster
  planning training for all licensed childcare
  workers and school systems?

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Medical Facilities and Practitioners

• Increase practitioner awareness of the need for
  personal, family and office/facility disaster
  planning.
• Encourage medical practitioners to assist their
  patients with family disaster planning.
• Encourage practitioners to become disaster
  responders (Citizen Corps, Medical Reserve Corps)

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Medical Facilities and Practitioners

• Help to assure that pediatric issues are
  addressed in all fixed medical facility disaster
  plans and drills
• Help hospitals integrate into community disaster
  response plans (incident management structure,
  communications, field response, responsibility
  for care of unusual pediatric patient loads)

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 IS 700 - National Incident Management System
(NIMS), An Introduction

• US Fire Academy
• Emergency Management Institute
• http//training.fema.gov/EMIWEB/IS/is700.asp

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Mental Health Professionals

• Key players in emergency planning and response
• Help to anticipate community reactions and
  behaviors
• Assist with proactive education to mitigate
  mental health complications after disasters
• Provide individual and system-level guidance
  after a disaster
• Must include pediatric and family considerations

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Families and Family Organizations

• Incorporate family representatives and advocates
  in the community planning process
• Encourage family advocates to champion family
  disaster preparedness
• Listen and learn from families

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Emergency Managers Goals

• Facilitate family preparedness and independence
• Reunite and keep families together
• Assure the provision of appropriate sheltering
  and care before, during, and after an incident
• Meet the needs of families with special
  healthcare challenges
• Work with other community agencies and
  organizations to prepare for family care

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Feeling a little overwhelmed?
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Planning for Kids and Terrorism
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Kids and Terrorism

• It has happened. It will happen again.
• Children are soft targets for hard-core
  terrorists.
• Very few are really ready to protect and care for
  children in a hazmat incident, much less a WMD
  setting.

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Kids and Terrorism

• Assess your communities for terrorist risk, with
  a special eye toward large family-oriented
  gathering places and venues where large numbers
  of children are usually found.
• Look at the community composition around major
  potential target sites. Are there residential
  areas, schools, hospitals nearby?

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Kids and Terrorism

• Help families assess their own risks of being
  involved in a terrorist incident
• As victims, direct or indirect
• As responders
• Help them plan accordingly.

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Kids and Terrorism

• Provide information in the form of facts, not
  speculation.
• Dont ignore the issue of terrorism and disaster
  preparedness in community outreach programs and
  schools. Information is power.

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Kids and Terrorism

• Monitor the expert sources for new information
  and products addressing the needs of children and
  families in the WMD setting.
• Pediatric Preparedness for Disasters and
  Terrorism A National Consensus Conference,
  Executive Summary
• http//www.bt.cdc.gov/children/pdf/working/execsum
  m03.pdf

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Additional Resources

• American Academy of Pediatrics http//www.aap.org/
  terrorism/index.html
• American Academy of Child and Adolescent
  Psychiatry http//www.aacap.org/publications/Dis
  asterResponse/index.htm
• EMSC website www.ems-c.org

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Conclusions

• The cavalry may not come. Plan!
• We are all emergency planners and managers.
• Children are small but they can present their own
  big issues in disaster preparedness.
• Children and families need advocates at all
  levels of disaster planning.
• Planning should be family-centered, all hazards
  based.

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Final thought

• Our ability to care for children in disasters
  will never be better than our ability to care for
  them on a daily basis.

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Thank you! Questions?
Louromig_at_bellsouth.net Louromig_at_jumpstarttriage.co
m Download lectures at www.jumpstarttriage.com