Outline. Local case study. Standardizing pediatric disaster response in King County
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1 Standardizing pediatric disaster response in King County Mary A. King, MD, MPH WAMI 2010 June 1, 2010 Outline Local case study Background on pediatric MCI King County barriers to pediatric disaster care King County Healthcare Coalition: Hospital guidelines for management of pediatric patients in disasters Local case study
2 Windstorm 2006 King County Wind mph Rain Floods Power loss 1.5 million (>75%) >300,000 homes x 4 days some x 11 days Windstorm 2006 Temperature < 30 degrees Many without power and heat Generators improperly vented Charcoal grills used indoors CO epidemic Widespread 260 CO poisoning cases Evaluated at 18 different SKC facilities 8 fatalities
3 CO epidemic Disproportionately affected children Median patient age 26 years 82/260 cases (32%) < 13 years old SKC population is 22% < 18 years old Pediatric MCI
4 Pediatric patients in MCI Critically ill or injured children may present to ANY and ALL hospitals Transfer to specialized hospital may be impossible Unstable patient Shortage of vehicles Impassable roads or bridges Specialized hospital cannot accommodate Children have unique needs Diseases Medical expertise Medical supplies Comfort level of providers Example: unique respiratory needs Airway anatomy different provider comfort/experience with intubation right mainstem intubations accidental extubations Equipment varies by size ETT bags masks suction catheters Ventilator issues flow trigger difficulties dead space weight limits modes conventional vs. HFOV
5 Developmental differences Preverbal cannot describe symptoms or relate identifying information Dependent on others for food, clothing, shelter Motor skills may deter escape from site of incident Cognitive development may limit abilities: How to flee from danger How to follow directions How to recognize a threat Pediatric special health care needs Prevalence: 1 in 8 children Range of needs* Prescription meds (75%) Increased level of care (46%) Emotional or behavioral services (29%) Limitation of activities (21%) Requirement for special therapies/equipment (17%) Encourage families to Emergency medical information form Copies of important medical records *HHS (2001)
6 Katrina Baton Rouge and Houston Pediatricians volunteered time Inadequate pediatric supplies Thomas DE et al. Baton Rouge pediatricians experiences meeting the health needs of evacuated children. Pediatrics. May, 2006;117(5):S Sirbaugh PE it al. Creation and implementation of a mobile pediatric emergency response team: regionalized caring for displaced children after a disaster. Pediatrics. May, 2006;117(5):S King county pediatric resources King county demographics Total population: 1.8 million Pediatric population: 409,000 (23%) County area: 2134 square miles Many major vulnerable bridges Long highway distances Flood zones
7 520 floating bridge WSDOT Traffic on a Friday
8 King county hazards earthquakes volcanic eruptions pandemics terrorist attacks wind-induced power outages floods King county 911 emergency zones King county hospitals that admit children
9 Where are our pediatric resources? Kids vs. pediatric resources Zone 1 Zone 3 Zone 5 % Population Bedspaces Nurses Physicians Kids vs. pediatric resources Zone 1 (East Side) and Zone 3 (South End) 77% of the pediatric population Zone 5 (City of Seattle) 82% of pediatric bedspaces 84% of pediatric nurses 97% of pediatric physicians
10 Pill hill vs. suburbia King county pediatric bedspaces Bedspaces PICU NICU Floor ED PACU OR Total Population 0-18 yrs Zone ,753 Zone ,797 Zone ,299 Total ,849 Improving access to pediatric beds 1) Survey number and type of pediatric beds Peds floor vs. PICU vs. NICU (WATrac) 2) Pediatric evacution plan Healthcare Coalition peds evac plan annex 3) Alternate care facility Pediatric resources and expertise
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12 I had a little bird, Its name was Enza. I opened the window, And in-flu-enza. Management of Pediatric Patients in Disasters Hospital Guidelines submitted by King County Healthcare Coalition Pediatric Triage Task Force and Public Health Seattle & King County Contains material adapted from: Children in Disasters: Hospital Guidelines for Pediatric Preparedness, 3rd Edition (2008) Available at: Hospital Planning: 10 Steps 1) Identify in-house pediatric expertise 2) Create pediatric leadership positions for key personnel and qualified staff Physician Coordinator Nursing Coordinator Pediatric Safe Area Coordinator Pediatric Logistics Unit Leader Pediatric Services Unit Leader 3) Increase pediatric and disaster training
13 Planning: Steps ) Plan for appropriate pediatric equipment 5) for appropriate pediatric pharmaceuticals 6) for appropriate pediatric nutrition 7) for special security needs of children 8) for transport issues 9) Add special considerations for children to your Hospital Decontamination Plan 10) Develop and exercise a hospital-based disaster pediatric triage system This is Cortez Evacuated in Hurricane Katrina: August 29, 2005 Reunited with her mother: March 17, 2006 Security issues and displaced children Tracking system Child ID system and protocol Pediatric Safe Area Safe Area Coordinator Safe Area Checklist Safe Area Registry Family Information and Support Center
14 Pediatric Assessment Triangle (PAT) PAT Triage PAT Criteria Age (years) Respiration Rate (per minute) Heart Rate (per minute) Infant Birth to 1 year Toddler 1 to 3 years Preschooler 3 to 6 years School-aged 6 to 12 years Adolescent 12 to 18 years
15 Job Aides/ annex materials Job Action Sheets Pediatric Services Unit Leader Pediatric Logistics Unit Leader Pediatric Safe Area Coordinator Pediatric Safe Area Checklist Pediatric Safe Area Registry Sheet Sample Pediatric Disaster Menu Possible Reactions of Children After a Disaster: A Guide for Parents and Caregivers (handout from NIH) Length-based color-coding Should all children be triaged according to their length-based Broselow color? Should we use same system throughout our region in prehospital, ED, and hospital settings? HMC Examples: Color-coded wrist band for every child Color-coded resuscitation sheets Color-coded resuscitation bags at every peds bed Color-coded CT scan radiation dose You may see in the coming year Hospital guidelines role-out Inclusion of pediatric bed specifics in WAtrac Creation of a pediatric response team at your hospital Standard use of length-based color coding
16 Are you ready? Contact Mary King MD, MPH Pediatric Intensivist, Seattle Children s Medical Director, HMC PICU Assistant Professor, University of Washington maryking@u.washington.edu Thank-you Kathryn Koelemay Cynthia Dold Brian Johnston Carolyn Blayney and Tricia Nora Lewis Rubinson Jerry Zimmerman Healthcare Coalition Public Health Seattle & King County
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