In recent years, attention has been given to disaster preparedness for first responders and first receivers (hospitals). One such focus involves the decontamination of individuals who have fallen victim to a chemical agent from an attack or an accident involving hazardous materials. Children often are overlooked in disaster planning. Children are vulnerable and have specific medical and psychological requirements. There is a need to develop specific protocols to address pediatric patients who require decontamination at the entrance of hospital emergency departments. Currently, there are no published resources that meet this need. An expert panel convened by the New York City Department of Health and Mental Hygiene developed policies and procedures for the decontamination of pediatric patients.The panel was comprised of experts from a variety of medical and psychosocial areas.Using an iterative process, the panel created guidelines that were approved by the stakeholders and are presented in this paper.These guidelines must be utilized, studied, and modified to increase the likelihood that they will work during an emergency situation.
A mass casualty event can result in an overwhelming number of critically injured pediatric victims that exceeds the available capacity of pediatric critical care (PCC) units, both locally and regionally. To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) was established. The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from 18 of 25 major NYC PCC-capable hospitals. A PCC surge committee created recommendations for making additional PCC beds available with an emphasis on space, staff, stuff (equipment), and systems. The PDC assisted 15 hospitals in creating PCC surge plans by utilizing template plans and site visits. These plans created an additional 153 potential PCC surge beds. Seven hospitals tested their plans through drills. The purpose of this article was to demonstrate the need for planning for disasters involving children and to provide a stepwise, replicable model for establishing a PDC, with one of its primary goals focused on facilitating PCC surge planning. The process we describe for developing a PDC can be replicated to communities of any size, setting, or location. We offer our model as an example for other cities. (Disaster Med Public Health Preparedness. 2017;11:473-478).
PurposeThere remains a lack of comprehensive pediatric emergency preparedness planning worldwide. A disaster or mass-casualty incident (MCI) involving pediatric patients could overwhelm existing pediatric resources within the New York City (NYC) metropolitan region. The NYC Department of Health and Mental Hygiene (DOHMH) recognizing the importance to plan for a MCI with a large number of pediatric victims, implemented a project (the Pediatric Disaster Coalition; PDC), to address gaps in the healthcare system to provide effective and timely pediatric care during a MCI.MethodsThe PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from the NYC pediatric/children's hospitals, DOHMH, Office of Emergency Management, and Fire Department (FDNY). Two committees addressed pediatric prehospital triage, transport, and pediatric critical care (PCC) surge capacities. They developed guidelines and recommendations for pediatric field triage and transport, matching patients' needs to resources, and increasing PCC Surge Capacities.ResultsSurge recommendations were formulated. The algorithm developed provides specific pediatric triage criteria that identify severity of illness using the traditional Red, Yellow, and Green categories plus an Orange designation for continual reassessments that has been adopted by FDNY that has trained > 3,000 FDNY EMS personnel in its use. Triaged patients can be transported to appropriate resources based on a tiered system that defines pediatric hospital capabilities. The Surge Committee has created PCC Surge Capacity Guideline that can be used by hospitals to create their individual PCC surge plans. 15 of 25 NYC hospitals with PCC capabilities are participating with PDC planning; 5 have completed surge plans, 3 are nea completion, and 7 are in development. The completed plans add 92 surge beds to 244 regularly available PICU beds. The goal is to increase the PCC surge bed capacity by 200 + beds.ConclusionsThe project is an effective, multidisciplinary group approach to planning for a regional, large-scale pediatric MCI. Regional lead agencies must emphasize pediatric emergency preparedness in their disaster plans.
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Purpose:The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has supported a federal grant establishing a Pediatric Disaster Coalition (PDC) comprised of pediatric critical care (PCC) and emergency preparedness consultants from major city hospitals and health agencies. One of the PDC's goals was to develop recommendation for hospitalbased PCC surge plans. Methods: Members of the PDC convened bi-weekly and among other projects, developed guidelines for creating PCC surge capacity plans. The PDC members, acting as consultants, conducted scheduled visits to hospitals in NYC and actively assisted in drafting PCC surge plans as annexes to existing hospital disaster plans. The support ranged from facilitating meetings to providing draft language and content, based on each institutions request. Results: New York City has 25 hospitals with PCC services with a total of 244 beds. Five major hospitals have completed plans, thereby adding 92 PCC beds to surge capacity. Thirteen additional hospitals are in the process of developing a plan. The PDC consultants participated in meetings at 11 of the planning hospitals, and drafted language for 10 institutions. The PDC continues to reach out to all hospitals with the goal of initiating plans at all 25 PCC hospitals. Conclusions: Providing surge guidelines and the utilization of on-site PDC consultants was a successful model for the development and implementation of citywide PCC surge capacity planning. Visiting hospitals and actively assisting them in creating their plans was an effective, efficient and well received, method to create increased PCC surge capacity. By first planning with major hospitals, a significant increase of surge beds (92 or 38%) was created, from a minimal number of hospitals. Once hospitals complete plans, it is anticipated that there will be the addition of at least 200 PCC surge beds that can be incorporated in to regional city-wide response to pediatric mass-casualty incident.
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