Pediatric DisasterPediatric DisasterLife Support (PDLSLife Support (PDLS©©))
Continuing Medical EducationContinuing Medical EducationUniversity of Massachusetts Medical SchoolUniversity of Massachusetts Medical School
A Course in Caring forA Course in Caring forChildren During DisasterChildren During Disaster
PDLSPDLS©©::The Needs of Children The Needs of Children During DisastersDuring Disasters
IntroductionIntroduction
The Pediatric PatientThe Pediatric Patient
NewbornNewborn 0-3 mos 0-3 mos
InfantInfant 3-18 mos 3-18 mos
ToddlerToddler 1-3 1/2 yrs 1-3 1/2 yrs
Pre-schoolPre-school 3-5 yrs 3-5 yrs
School AgeSchool Age 6-10 yrs 6-10 yrs
Adolescent / TeenAdolescent / Teen 11-18 yrs 11-18 yrs
Definition of DisasterDefinition of Disaster
AAny community emergency that disrupts ny community emergency that disrupts
normal community function causing normal community function causing concern for the safety of the citizens.concern for the safety of the citizens.
Mass Casualty Incident (MCI)Mass Casualty Incident (MCI)
AA disaster that produces large numbers of disaster that produces large numbers of
injured victims. Children should be given injured victims. Children should be given special attention.special attention.
Level I MCILevel I MCI
Local medical resources are available and Local medical resources are available and adequateadequate
Regional backup resources may be put on alertRegional backup resources may be put on alert
Level II MCILevel II MCI
Requires multi-jurisdiction (Regional) medical mutual Requires multi-jurisdiction (Regional) medical mutual aidaid
Mutual aid agreements should provide back-up plans Mutual aid agreements should provide back-up plans for jurisdictions stripped of their local resourcesfor jurisdictions stripped of their local resources
Level III MCILevel III MCI
Activation of the State Disaster Plan is requiredActivation of the State Disaster Plan is required
Requests for Federal Assistance may be Requests for Federal Assistance may be necessarynecessary
Phases of a Disaster ResponsePhases of a Disaster Response
Activation PhaseActivation Phase
Notification and initial responseNotification and initial response
Organization of command and scene assessmentOrganization of command and scene assessment
Phases of a Disaster ResponsePhases of a Disaster Response
Implementation PhaseImplementation Phase
Search and rescueSearch and rescue
Victim triage, initial stabilization and transportVictim triage, initial stabilization and transport
Definitive management of scene hazards and victimsDefinitive management of scene hazards and victims
Phases of a Disaster ResponsePhases of a Disaster Response
Recovery PhaseRecovery Phase
Scene withdrawalScene withdrawal
Return to normal operationsReturn to normal operations
DebriefingDebriefing
Natural Disasters (Natural Disasters (ExamplesExamples))
Forest firesForest fires
HurricanesHurricanes
FloodsFloods
TornadoesTornadoes
Winter stormsWinter storms
EarthquakesEarthquakes
Man-Made Disasters (Man-Made Disasters (ExamplesExamples))
Building firesBuilding fires
ExplosionsExplosions
Chemical / radioactive contaminationChemical / radioactive contamination
Transportation accidentsTransportation accidents
Civil disturbancesCivil disturbances
Military actionsMilitary actions
Lessons Learned Lessons Learned From Prior Disaster From Prior Disaster ExperienceExperience
Factors That Determine the Magnitude Factors That Determine the Magnitude of a Disasterof a Disaster
Type of disaster, initial force, time course, Type of disaster, initial force, time course, secondary eventssecondary events
Number of victim declared injured, and percent Number of victim declared injured, and percent of total population displaced by the eventof total population displaced by the event
Location and accessibilityLocation and accessibility
Time of dayTime of day
Resources available in the areaResources available in the area
Social, economic and political conditions at the Social, economic and political conditions at the time of the eventtime of the event
EarthquakeEarthquake
Forces Experienced at the Surface of the EarthForces Experienced at the Surface of the Earth
horizontalhorizontal
verticalvertical
circularcircular
fissuringfissuring
Impact of Earthquakes on BuildingsImpact of Earthquakes on Buildings
Structural Damage Structural Damage Stresses of varying amplitude cause distortion on Stresses of varying amplitude cause distortion on
load carrying parts of buildings. Some parts of load carrying parts of buildings. Some parts of structures are unable to tolerate significant structures are unable to tolerate significant distortiondistortion
Non-Structural DamageNon-Structural Damage Furniture, fixtures, glass and unsecured equipment Furniture, fixtures, glass and unsecured equipment
are thrown from their position by the impact are thrown from their position by the impact
Consider Risks Consider Risks to Disaster to Disaster RespondersResponders
Disaster MitigationDisaster Mitigation
Prevention of disaster-related Prevention of disaster-related injury and illnessinjury and illness
Vectors of Transmission of Infectious Vectors of Transmission of Infectious Diseases Affected by DisasterDiseases Affected by Disaster
Airborne Airborne - Crowded habitationCrowded habitation
WaterborneWaterborne- Contaminated water supplyContaminated water supply- Children most susceptibleChildren most susceptible
FoodborneFoodborne- Problems with proper storageProblems with proper storage
Insect and Animal borneInsect and Animal borne- Decrease disease transmission controlDecrease disease transmission control
Disasters have Significant Disasters have Significant Psychological Impact on ChildrenPsychological Impact on Children
Philosophy of Disaster MedicinePhilosophy of Disaster MedicineWhen Children are VictimsWhen Children are Victims
Children are more susceptible to certain injuries or Children are more susceptible to certain injuries or environmental insults than adultsenvironmental insults than adults
Children with acute injuries or illness are more likely Children with acute injuries or illness are more likely to respond to rapid and efficient medical care than to respond to rapid and efficient medical care than adultsadults
Since children are not small adults they require Since children are not small adults they require equipment and pharmaceuticals designed for their equipment and pharmaceuticals designed for their needsneeds
Routine Medical Practices Routine Medical Practices UnalteredUnaltered in a Mass Casualty Situationin a Mass Casualty Situation
Attend immediately to airway, breathing and Attend immediately to airway, breathing and circulatory emergencies in a potentially viable circulatory emergencies in a potentially viable patientpatient
Provide appropriate management of painProvide appropriate management of pain
Perform systematic patient assessmentsPerform systematic patient assessments
Re-evaluate patients for changes in statusRe-evaluate patients for changes in status
Maintain patient dignityMaintain patient dignity
Routine Medical Practices Routine Medical Practices AlteredAltered in a Mass Casualty Situationin a Mass Casualty Situation
Extent of resuscitation effortsExtent of resuscitation efforts
Acceptable resultsAcceptable results
Timeliness of surgeryTimeliness of surgery
Indications for hospitalizationIndications for hospitalization
Use of ancillary servicesUse of ancillary services
Increase patient care responsibility of nursesIncrease patient care responsibility of nurses
Decision to transferDecision to transfer
Problems Common to Major DisastersProblems Common to Major Disasters
Inadequate rescue personnel and supplies for the Inadequate rescue personnel and supplies for the initial few daysinitial few days
Inadequate medical equipment, medical personnel Inadequate medical equipment, medical personnel and hospital space - particularly for childrenand hospital space - particularly for children
Inadequate food, clothing and shelter for victims and Inadequate food, clothing and shelter for victims and the displaced population - particularly for childrenthe displaced population - particularly for children
Inadequate communications, assessment of victims’ Inadequate communications, assessment of victims’ needs and initial on-site coordinationneeds and initial on-site coordination
The Convergence PhenomenonThe Convergence Phenomenon
Parents / Family MembersParents / Family Members
ReportersReporters
SpectatorsSpectators
Disaster Medical ReliefDisaster Medical ReliefRecommendations to RescuersRecommendations to Rescuers
Bring the right stuff - include supplies for Bring the right stuff - include supplies for newborn infants/childrennewborn infants/children
Bring the right staff - Pedi experienceBring the right staff - Pedi experience
Plan to be fairly self-sufficientPlan to be fairly self-sufficient
Control your own supplies and avoid careless Control your own supplies and avoid careless distributiondistribution
Maintain accurate records, logs and photo Maintain accurate records, logs and photo documentation to verify your effortsdocumentation to verify your efforts
The needs of many outweighThe needs of many outweighthe needs of a few the needs of a few
Mr. Spock Mr. Spock afterafter Charles Dickens Charles Dickens
Following DisasterFollowing Disasterthe Needs of Children Exceedthe Needs of Children Exceed
the Needs of Adultsthe Needs of Adultsandand
Children Should be Given PriorityChildren Should be Given Priority