A S K T H E E X P E R T

Disaster Risk and Children Part II: How Pediatric HealthcareProfessionals Can Helpjspn_321 1..3

John S. Murray and Stephen Monteiro

Column Editor: John S. Murray

Ask the Expert provides research-based answers to practice questions submitted by JSPN readers.

Search termsChildren, disasters, emergency management,

poverty, risk.

Author contact:John.Murray@childrens.harvard.edu, with a

copy to the Editor: roxie.foster@UCDenver.edu

doi: 10.1111/j.1744-6155.2011.00321.x

Question: As the world experiences more frequentand increasingly deadly natural disasters, what canpediatric healthcare professionals do to help?

John S. Murray, PhD, RN, FAAN and StephenMonteiro, MS, EMT-P respond: In the first of thedisaster risk and children two-part series, wedescribed why children living in poverty-strickenpopulations are impacted most during disasters. Inthis column, we propose ways in which pediatrichealthcare professionals can help mitigate risk.

REDUCING RISK—HOW PEDIATRIC HEALTHCAREPROFESSIONALS CAN HELP

Risk factors that complicate disasters are multifac-eted in nature. While some pediatric disasterresponse principles in industrialized parts of theworld may have application in developing countries,many will not. For example, implementation ofdisaster relief ideologies in developing countriesaffected by war, genocide, famine, or widespreaddisease would be ineffective due to the multitude ofresource challenges and safety risks. Additionally, indeveloping countries where disaster efforts might beuseful—conditions where basic necessities such aswater, food, shelter, sanitation, and basic healthcareservices are not available—disaster assistance maybe impossible (Bradenburg & Arneson, 2007).However, most experts agree that efforts to reducedisaster risk can make populations less vulnerable to

tragedies (Tekeli-Yesil, Dedeoqlu, Tanner, Braun-Fahrlaender, & Obrist, 2010). Pediatric healthcareprofessionals are particularly well positioned tomake noteworthy contributions to developingcountries as part of disaster response at all levels—mitigation, preparedness, response, recovery, andresilience building. The mitigation, preparedness,response, and recovery framework (see Figure 1)serves as an excellent guide for illustrating selectedactivities pediatric healthcare professionals canleverage when attempting to improve disasterresponse for children in poverty-stricken locations.

MITIGATION

Efforts to lessen risk must focus on helping the poorto find more suitable locations for building resi-dences, schools, and hospitals that can better with-stand the forces of disasters. Countries such as theUnited States, Italy, and Japan have numerouslessons learned related to earthquakes and struc-tures that can withstand the effects of powerfultremors. These best practices should be shared withthe international community at large by healthcareprofessionals who are part of disaster response teams(Murray, 2011; United Nations Office for the Coordi-nation of Humanitarian Affairs, 2011).

Early warning systems are a critical link betweenpreparedness and mitigating risk in disasters. Unnec-essary death could be significantly reduced witheffective early warnings. While most developing

Journal for Specialists in Pediatric Nursing

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countries cannot afford advanced systems, disasterexperts articulate that simple telephone calls, word ofmouth, and use of radio can help alert those indanger. Disaster response healthcare professionalscan help by empowering people in developing coun-tries through information dissemination and settingup warning dissemination systems tailored to meetthe specific needs of individual communities and cul-tures (United Nations Office for the Coordination ofHumanitarian Affairs, 2011).

PREPAREDNESS

For pediatric healthcare professionals who haveresponded to disasters in poverty-stricken regions,the decision to commit staff, resources, and timeoften begins with identifying and defining the “onthe ground” needs. Careful evaluation of the localconditions can help mitigate associated risks. Notingcurrent travel advisories, assessing the security situ-ation, determining the availability and accessibilityto food and clean water, and assessing sanitary con-ditions, the status of transportation and infrastruc-ture, and the availability of emergency evacuationall contribute to outlining challenges that disasterteams may likely encounter (Department of Home-land Security, 2008; Murray, in press).

Predisaster response-preparedness planningactivities help organize members and resources, aidin decreasing anxiety, and help align expectations.Planning assists with identifying medical andpharmaceutical supplies necessary and relevantpredeployment training (Department of HomelandSecurity, 2008; Murray, in press). For example,

when Children’s Hospital Boston sent teams to Portau Prince following the devastating January 2010earthquake, the simulation lab was used to teachbasic disaster medicine. General guidance ondeployment to austere conditions, team building,and team dynamics exercises as well as specializedtraining specific to the Haitian population’s needswere provided.

RESPONSE

Response can be the most exciting aspect of thedisaster preparedness cycle. It is also the most chal-lenging. One challenge confronted during disasterresponse is the likely adjustment of care paradigmbased on resources, local norms, and sustainability.As team members begin to improvise and innovateto create solutions to basic problems, disasterresponse teams must continue to balance the desireto help with the caution to minimize harm (Depart-ment of Homeland Security, 2008).

During disaster response, pediatric healthcareprofessionals have a critical role to play in support ofdisease and injury mitigation. A key component ofpediatric disaster response is preventing and treatingsecondary medical conditions and injuries followingdisasters, such as wound infections, dehydration,and gastroenteritis (Bradenburg & Arneson, 2007).Seaman and Maguire (2005), in their work in devel-oping countries, have found children to be at greaterrisk than adults for communicable diseases andenvironmental exposure in the aftermath of large-scale disasters. In the immediate stage of disasterresponse, the overwhelming majority of resultingdeaths can be attributed to preventable illnesses,such as diarrhea, malnutrition, and infections(Seaman & Maguire, 2005). Pediatric healthcareprofessionals can play an important role in address-ing and potentially preventing injuries and illness,thereby reducing morbidity, through proactivepublic health education and injury prevention cam-paigns (Bradenburg & Arneson, 2007).

RECOVERY

In the United States, several lessons learned con-cerning the recovery period of disasters have beenuncovered over the past 6 years. Meeting the mentalhealth needs of children as well as reunification ofchildren with family members is paramount duringrecuperation from catastrophe (Bradenburg &Arneson, 2007; Murray, 2011). Pediatric disasterresponse experts have shown that how children

Figure 1 Emergency Management Framework for Disaster Response.

Ask the Expert J. S. Murray and S. Monteiro

2 Journal for Specialists in Pediatric Nursing •• (2012) ••–•• © 2012, Wiley Periodicals, Inc.

respond to the stress of disasters, especially whenseparated from their parents, has significant mentalhealth implications (Bradenburg & Arneson, 2007;Murray, 2011). Pediatric healthcare professionalsserve as an important resource for meeting thebehavioral health needs of children affected bydisaster (Bradenburg & Arneson, 2007; Murray,2011). Pediatric experts responding to disaster canimplement basic psychosocial interventions such ascounseling and educating families, communityleaders, teachers, and others about common post-disaster behavioral health needs of children(Bradenburg & Arneson, 2007).

Recent disasters, such as the tornado in Joplin,Missouri, in the United States, and the earthquakeand ensuing tsunami in the northeast coastal regionof Japan, illustrate how disasters of enormous scalecan result in the displacement of numbers of chil-dren and families. Basic plans to care for largenumbers of displaced children are possible—even indeveloping countries. Such plans are key to sounddisaster preparedness, and critical to keeping fami-lies together and reuniting children with familymembers when displaced. Preventing separationwhere possible and reuniting families as soon aspossible during disaster recovery is critical for themental well-being of families, lessening the dis-ruption in communities and minimizing potentialbehavioral health adjustment difficulties in children(Abramson, Park, Stehling-Ariza, & Redlener, 2010;Bradenburg & Arneson, 2007; Murray, 2011; Nager,2009). Primitive tracking systems using paper andpencils or pens are all that is required to begin a list ofdisplaced children. Recording information such asthe child’s name, identifying characteristics (e.g.,birthmarks, scars), personal effects, names of friendsand family members, and where the child considersto be home are all helpful in tracking and reunitingchild evacuees during disasters (Bradenburg &Arneson, 2007; Murray, 2011; Nager, 2009).

CONCLUSION

Experience has demonstrated that pediatric health-care professionals play a pivotal role in disasterresponse during all points, from mitigation to recov-ery. A unique opportunity exists for global commu-nities to learn from each other’s experiences andlessons learned to improve outcomes during disas-ters, especially where poverty and disaster risks aregreatest.

John S. Murray, PhD, RN, FAANDirector

Nursing Research, Surgical Programs/EmergencyDepartment

Children’s Hospital BostonBoston, Massachusetts, USA

Stephen Monteiro, MS, EMT-PDirector

Emergency ManagementChildren’s Hospital Boston

Boston, Massachusetts, USA

References

Abramson, D., Park, Y., Stehling-Ariza, T., & Redlener, I.(2010). Children as bellwethers of recovery:Dysfunctional systems and the effects of parents,households, and neighborhoods on serious emotionaldisturbance in children after Hurricane Katrina. DisasterMedicine and Public Health Preparedness, 4, S17–S27.doi:10.1001/dmp.2010.7

Bradenburg, M., & Arneson, W. (2007). Pediatric disasterresponse in developing countries: Ten guiding principles.American Journal of Disaster Medicine, 2(3), 151–162.

Department of Homeland Security. (2008). Nationalresponse framework. Retrieved from http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf

Murray, J. S. (2011). Six years later: Emotional disturbancein children continues following Hurricane Katrina.American Journal of Nursing, 111(8), 52–55.doi:10.1097/01.NAJ.0000403364.74552.a4.

Murray, J. S. (in press). National Disaster Medical System:Providing disaster care of national significance. AmericanJournal of Nursing.

Nager, A. (2009). Family reunification: Concepts andchallenges. Clinical Pediatric Emergency Medicine, 10(3),195–207. doi:10.1016/j.cpem.2009.06.003

Seaman, J., & Maguire, S. (2005). ABC of conflict anddisaster: The special needs of children and women.British Medical Journal, 331(7507), 34–36.

Tekeli-Yesil, S., Dedeoqlu, N., Tanner, M.,Braun-Fahrlaender, C., & Obrist, B. (2010). Individualpreparedness and mitigation actions for a predictedearthquake in Istanbul. Disasters, 34(4), 910–930.

United Nations Office for the Coordination ofHumanitarian Affairs. (2011). Early warning and earlywarning systems. Retrieved from http://ocha.unog.ch/drptoolkit/PEarlyWarning.html

J. S. Murray and S. Monteiro Ask the Expert

3Journal for Specialists in Pediatric Nursing •• (2012) ••–•• © 2012, Wiley Periodicals, Inc.