populations at risk - pediatrics dr. daniel kollek executive director the centre for excellence in...
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Populations At Risk - Pediatrics
Dr. Daniel KollekExecutive Director
The Centre for Excellence in Emergency Preparedness
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Content
• Who CEEP is• Why focus on children?• Child specific issues• The CEEP process and resources
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What is CEEP?
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Why focus on children?
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Child specific issues
• Physiology• Anatomy• Development• Psychosocial• Other
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Physiology• Children have a higher minute ventilation.• Due to shorter stature, they are more likely to be exposed to heavier than air
respiratory toxins.• Children have a large skin to body mass – more hypothermia and transdermal
absorption of toxins.• Children are at much higher risk of dehydration and shock.• It is harder to establish intravenous access in children. • Children vary enormously in both size and weight and thus, routine protocols and
standing orders are difficult to establish.• Malnutrition is a more significant problem with smaller children.
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Anatomy• Children’s skeletons are far more pliable than adults and provides less protection
for internal organs. • The ratio of mass of head to mass of body is larger in children than adults and
thus, the likelihood of a head injury in a child is higher.
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Developmental• Children’s cognitive and motor skills vary with age, development, and occasionally
with other underlying illnesses. • It is not always possible to know if a child has deviated from their usual functional
norm.• Children do not always have the psychological and cognitive maturity to be able to
process events.• A child may not have the language skills to provide a clinical history.• In an event where a child is separated from a caregiver, the child may not have the
cognitive ability to recognise the risk and evade it.
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Psychosocial• Families should, ideally, be treated as a unit. This needs to be taken into
consideration for any situation where isolation is required.• Even though the child may not be a primary victim, children may be truly or
virtually orphaned as a result of an event that impacts on their parents. • Disaster planning needs to involve school and child-care staff for:
– a disaster that occurs during day-time hours– an event that involves long term closure of schools
• The need for child care has impact on the hospital caregivers and staff. • Children are possible targets of predators, more so when separated from their
usual caregivers.
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Other• Children exposed to radiation are at a higher risk of developing radiation-induced
cancer such as thyroid cancers.• Presently hospitals are not allowed to provide immediate and on-going care to
children who are unable to provide consent and whose guardians are not available for a variety of reasons. There is implied consent for most resuscitative therapy but the consent issues are less clear when it comes to non-acute care.
• Children do not always identify that they are in pain or may not be examined due to pain.
• Caregivers are not always comfortable calculating doses for smaller children. • Many vaccination protocols do not make allowances for children
or in fact, the vaccine may not be approved for small children.
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Child specific injuries
• Head injury• Skeletal injury• Thermoregulation• Blood loss• Emotional Trauma
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Mechanisms of injury - 1 Head injury
• Head injuries account for approximately 60% of all MCE and disaster injuries in the pediatric population.
• In states of unconsciousness, children’s upper airways tend to get obstructed due to:– relatively large, flaccid tongue – large head flexion induced by the prominent occiput
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Mechanisms of injury - 2 Skeletal injury
• Children have more pliant and flexible bones than adults and are therefore subject to fewer bone fractures.
• Internal organ are not uncommon.
• Injuries to children and adolescents also include growth plate injury.
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Mechanisms of injury - 3 Thermoregulation
• Children are at a higher risk of thermal injury and its aftereffects because of:– the less mature thermoregulatory mechanism in children– The higher surface area-to-mass ratio compared to adults
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Mechanisms of injury - 4 Blood loss
• Children have relatively small amounts of blood (80 ml/kg),
• What may seem to be minor bleeding may in effect represent a significant volume loss and severe shock.
• Children’s cardiovascular system is generally free of chronic disabling conditions therefore, children may tolerate hypovolemic stress better than adults.
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Mechanisms of injury – 5Emotional Trauma
• In addition to physical injuries, emotional trauma, caused for example by separation from the parents, is an important factor in pediatric care.
• Children may also be more easily frightened by events that they cannot understand such as a health care provider in PPE.
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Prognosis
• Children tolerate multiple organ injuries better than adults
• Prognosis usually depends on the severity of the head injury, if present.
• Children have a better prognosis for most, if not all, disaster-related conditions.
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Disaster Response and Children• Prehospital Care Pediatric Guidelines • Mass Casualty Triage Guidelines for Pediatrics (as
opposed to Normal Triage)• General Guidelines for Treatment Areas • Pediatric Equipment/Resources lists• Psychosocial Needs & Treatment guidelines• Health Care Facility Pediatric Risk Assessment• Health Care Facility Pediatric Readiness
Assessment tool• Guidelines for Children with Special Needs
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Disaster Response and Children• Prehospital Care Pediatric Guidelines • Mass Casualty Triage Guidelines for Pediatrics (as
opposed to Normal Triage)• General Guidelines for Treatment Areas • Pediatric Equipment/Resources lists• Psychosocial Needs & Treatment guidelines• Health Care Facility Pediatric Risk Assessment• Health Care Facility Pediatric Readiness Assessment
tool• Disaster guidelines for Children with Special Needs
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The CEEP process• Defining a need• Convening an expert group• Literature search• First document draft• Iterative review• Penultimate draft• Group meeting for final review and approval• Submission for endorsement• Posting and distribution
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How to access CEEP resources
www.ceep.cawww.ceep.ca/tools.htm
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