Pediatric and Family Disaster Planning:

Considerations for Emergency Managers

Lou Romig MD, FAAP, FACEPMiami Children’s HospitalFL-5 DMAT/MSRT South

No excuses!No excuses!

Children are involved directly or

indirectly in the great majority of disasters

and multicasualty incidents

Small problems become big problems Small problems become big problems when they involve our childrenwhen they involve our children

““When in danger, When in danger, when in doubt,when in doubt, run in circles, run in circles,

scream and shout.”scream and shout.”

"Where in the hell is

the cavalry on this one?''

Kate Hale, 8/27/92, Dade County Emergency Manager

Y.O.Y.O

You’re On Your OwnYou’re 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, it’s going to take time.

Key ConceptKey Concept

Pediatric disaster planning at all levels and for all hazards must be

family-centered

Who are emergency managers?Who are emergency managers?

YOU ARE!

Emergency Managers: GoalsEmergency 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

Facilitating Family PreparednessFacilitating 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

Keeping families togetherKeeping families togetherWork 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

Adequate Care and ShelteringAdequate Care and Sheltering

Special needs sheltering

Shelter staff training and resources

Safety

Nutrition

Waste disposal

Infectious diseases

Child care

Stress management

Adequate Care and ShelteringAdequate Care and Sheltering

Special Needs ShelteringSpecial 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

Staff Training and ResourcesStaff Training and ResourcesWho 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 referralReference materialsResources for phone or other adviceShelter sick call?

Shelter SafetyShelter 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

Nutrition/Waste DisposalNutrition/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.)

Infectious DiseasesInfectious 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)

Child CareChild Care

Stress ManagementStress 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)

Jonathan, age 6, Hurricane Lili

Scared Jonathan

Rain

Tree breaking

Emergency Managers: GoalsEmergency 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

Families with CSHCNFamilies with CSHCN

Who’s 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

Planning PartnershipsPlanning Partnerships

Planning PartnersPlanning 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

Emergency RespondersEmergency 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…

Emergency RespondersEmergency Responders

Disaster TrainingPediatric threat-specific risks

Pediatric assessment

Pediatric MCI triage

Pediatric treatment

Pediatric decontamination

Emergency RespondersEmergency Responders

Disaster Training (con’t)Appropriate transport modes and destinations

Communication skills

Stress management

Reference resources

Emergency RespondersEmergency Responders

Pediatric specific equipment

Protocols

Pediatric drug preparations and delivery systems (Atropen, CWIK tool)

www.cwikresponse.com

Emergency RespondersEmergency Responders

Special attention to CSHCN

Medicolegal aspects (children without guardians)

Disaster documentation

Awareness of local family reunification schemes

Community RespondersCommunity 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

School and Childcare SystemsSchool 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?

Medical Facilities and PractitionersMedical 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)

Medical Facilities and PractitionersMedical 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)

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

US Fire Academy Emergency Management Institute

http://training.fema.gov/EMIWEB/IS/is700.asp

Mental Health ProfessionalsMental 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

Families and Family OrganizationsFamilies 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

Emergency Managers: GoalsEmergency 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

Feeling a little overwhelmed?

Planning for Kids and

Terrorism

Kids and TerrorismKids 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.

Kids and TerrorismKids 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?

Kids and TerrorismKids 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.

Kids and TerrorismKids and Terrorism

Provide information in the form of facts, not speculation.

Don’t ignore the issue of terrorism and disaster preparedness in community outreach programs and schools. Information is power.

Kids and TerrorismKids 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/execsumm03.pdf

Additional ResourcesAdditional Resources

American Academy of Pediatrics http://www.aap.org/terrorism/index.html

American Academy of Child and Adolescent Psychiatry http://www.aacap.org/publications/DisasterResponse/index.htm

EMSC website www.ems-c.org

ConclusionsConclusions

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.

Final thoughtFinal thought

Our ability to care for children in disasters will never be

better than our ability to care for them on a daily basis.

Thank you! Questions?Thank you! Questions?

Louromig@bellsouth.net

Louromig@jumpstarttriage.com

Download lectures at:www.jumpstarttriage.com