Introduction: Children frequently are the victims of disasters due to natural hazards and acts of terrorism. However, there is a lack of specific, comprehensive, pediatric, emergency preparedness planning worldwide. A disaster or mass-casualty event (MCE) within the New York City (NYC) metropolitan region involving pediatric patients could overwhelm existing pediatric resources. The New York City Department of Health and Mental Hygiene (NYCDOHMH) recognized the need to plan for a MCE with a large number of pediatric victims and funded a project called the NYC Pediatric Disaster Coalition (PDC). The PDC's primary goal is to create a coalition that addresses gaps in the ability and infrastructure of the NYC Regional Health Care System to provide effective and timely large-scale pediatric care during a MCE. Methods: The PDC was created and includes 11 of 43 NYC Pediatric and Children's Hospital programs, experts in pediatric emergency preparedness, emergency medicine and intensive care (PICU), the NYCDOHMH, the NYC Office of Emergency Management, and the Fire Department of New York emergency medical services. The participants formed two committees to develop prehospital Triage/Transport and PICU Surge Capacity plans. The committees met twice per month to develop plans using an iterative process. Results:After an extensive literature review and multiple draft revisions, Prehospital Triage and PICU Surge plans were formulated. Once implemented, they will provide specific pediatric triage criteria, transport matching severity of illness to appropriate tiered resources, and additional hospital PICU surge capacity. A "train the trainers" course to educate heakhcare providers in the essentials of pediatric intensive care, including simulation techniques, was implemented. Conclusions: The PDC project has been an effective multidisciplinary group approach to planning for a citywide, regional, large-scale pediatric MCE. This structure could be used as a replicable model for other large urban centers.
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.
IntroductionA Mass-Casualty Event (MCE) involving pediatric victims could overwhelm existing pediatric resources. Therefore, early recognition of critically ill infants and children is essential for proper distribution among pediatric capable hospitals. However, emergency medical services (EMS) personnel have limited experience with pediatric assessments, and less with pediatric mass-casualty triage (MCT). To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) in collaboration with the Fire Department (FDNY) and Office of Emergency Management, made simple alterations to the START-based NYC-MCT Algorithm that can be rapidly and accurately applied by EMS personnel in the field with minimal additional education and preparation, obviating the requirement for extensive and expensive retraining.MethodsThe PDC includes experts in pediatric emergency preparedness, emergency medicine, critical care, and trauma surgery in NYC, as well as DOHMH, FDNY-OMA, and OEM. Its Triage Subcommittee determined the minimum essential pediatric alterations to the Algorithm, which then was tested by FDNY-EMS.ResultsAfter focused literature review and multiple draft revisions aimed to maximize pediatric benefit yet minimize unnecessary complexity, the Algorithm was modified to ensure that: (1) five rescue breaths will be provided to infants or children prior to being categorized as Dead or Expectant; (2) infants under 12 months old will be categorized as Critical and receive priority transport, and (3) children initially categorized as Delayed or Minor will be uptriaged to a new Urgent (Orange) category to receive such care in a rapid manner. To date, > 3,000 FDNY personnel have been trained in its use, and tested its accuracy using tabletop scenarios. Mean accuracy is 80–90%.ConclusionsThe model is an effective, multidisciplinary approach to planning. Minimum alterations to the Algorithm were adopted by the regional EMS system. The Modified Algorithm improves identification of critically ill infants and children. This approach could be adopted by other large urban centers.
GC. The Emergency Unit of Black Lion Hospital serves more than 20,000 patients per year. It was distinguished and emergency department crowding is one of the leading problems facing emergency physicians, nurses, and their patients. Multiple factors identified a cause for emergency unit crowding. Methods: Before the implementation of the project, the root cause of the emergency unit was overcrowding (patient process hold up); the input and output was analyzed using Ishikawa Cause and Effect Diagram in order to identify the factors that affected the emergency unit crowding. Results: Since 2014, there have been significant improvements regarding the attendant/patient flow in the emergency unit following interventions that were implemented. Some of the interventions identified included: proper indoor waiting areas which have adequate space and audio visual aids; patient identification cards; a separate entry/exit point for patients, attendants, and health professionals, as well as a scheduled patient visiting time; an information desk at the front gate; and encouraging ownership and collaborative activities in the emergency unit flow by all members of staffs and other stakeholders. Separate diagnostic, pharmacy, and cashier areas from patient examination and triage areas are all interventions that were implemented. Conclusion: The way forward is to work towards 100% compliance, with 1:1 Patient:Attendant ratio at 100 %, through the strengthened implementation of all the strategies identified.
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