Developing Consensus on Appropriate Standards of Disaster Care for Children

Kanter, Robert K.; Andrake, John; Boeing, Nancy M.; Callahan, James M.; Cooper, Arthur; Lopez-Dwyer, C.; Marcin, James P.; Odetola, Folafoluwa O.; Ryan, Anne E.; Terndrup, Thomas E.; Tobin, Joseph R.

doi:10.1097/dmp.0b013e318190a27a

Cited by 13 publications

(8 citation statements)

References 32 publications

(46 reference statements)

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“…A similar consensus and modified Delphi technique was used to derive pediatric standards to be applied during disasters. 24 The proposed system is based on acceptable assumed risk of a preventable untoward outcome or medical event, given a certain patient surge scenario. The system seeks to balance the needs of those who may be at a higher risk for a CME if denied a resource (eg, disaster victims) compared with those who currently have benefit from the resources but are at lower risk of a CME without the provision.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Disposition Classification (Reverse Triage) System to Create Surge Capacity

Kelen

Sauer

Clattenburg

et al. 2015

Disaster med. public health prep.

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Section: Discussionmentioning

confidence: 99%

Pediatric Disposition Classification (Reverse Triage) System to Create Surge Capacity

Kelen

Sauer

Clattenburg

et al. 2015

Disaster med. public health prep.

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“…MCC strategies emphasize the following interventions1: mechanical ventilation, intravenous fluid resuscitation, vasopressors, antidotes, antibiotics, sedation, and analgesics. These interventions are similar to those recommended by a panel of pediatric acute care clinicians 27…”

Section: Mcc: Pediatric Implicationsmentioning

confidence: 63%

“…These interventions are similar to those recommended by a panel of pediatric acute care clinicians. 27…”

Section: Critical Care Interventionsmentioning

confidence: 99%

Mass Critical Care: Pediatric Considerations in Extending and Rationing Care in Public Health Emergencies

Kanter¹,

Cooper²

2009

Disaster med. public health prep.

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This article applies developing concepts of mass critical care (MCC) to children. In public health emergencies (PHEs), MCC would improve population outcomes by providing lifesaving interventions while delaying less urgent care. If needs exceed resources despite MCC, then rationing would allocate interventions to those most likely to survive with care. Gaps between estimated needs and actual hospital resources are worse for children than adults. Clear identification of pediatric hospitals would facilitate distribution of children according to PHE needs, but all hospitals must prepare to treat some children. Keeping children with a family member and identifying unaccompanied children complicate PHE regional triage. Pediatric critical care experts would teach and supervise supplemental providers. Adapting nearly equivalent equipment compensates for shortages, but there is no substitute for age-appropriate resuscitation masks, IV/suction catheters, endotracheal/gastric/chest tubes. Limitations will be encountered using adult ventilators for infants. Temporary manual bag valve ventilation and development of shared ventilators may prolong survival until the arrival of ventilator stockpiles. To ration MCC to children most likely to survive, the Pediatric Index of Mortality 2 score meets the criteria for validated pediatric mortality predictions. Policymakers must define population outcome goals in regard to lives saved versus life-years saved.

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“…A further 122 were excluded as they either related to EMT practice in the predeployment phase, took place in a HIC or did not relate to patient safety practices. The remaining 39 records comprised 30 peer-reviewed papers15 26–54 and 9 grey literature documents to be included in the data synthesis 13 14 19–25. The 30 peer-reviewed papers generated 82 patient safety statements, and the grey literature generated 220 patient safety statements.…”

Section: Resultsmentioning

confidence: 99%

The patient safety practices of emergency medical teams in disaster zones: a systematic analysis

et al. 2019

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IntroductionDisaster zone medical relief has been criticised for poor quality care, lack of standardisation and accountability. Traditional patient safety practices of emergency medical teams (EMTs) in disaster zones were not well understood. Improving the quality of healthcare in disaster zones has gained importance within global health policy. Ascertaining patient safety practices of EMTs in disaster zones may identify areas of practice that can be improved.MethodsA systematic search of OvidSP, Embase and Medline databases; key journals of interest; key grey literature texts; the databases of the WHO, Médecins Sans Frontieres and the International Committee of the Red Cross; and Google Scholar was performed. Descriptive studies, case reports, case series, prospective trials and opinion pieces were included with no limitation on date or language of publication.ResultsThere were 9685 records, evenly distributed between the peer-reviewed and grey literature. Of these, 30 studies and 9 grey literature texts met the inclusion criteria and underwent qualitative synthesis. From these articles, 302 patient safety statements were extracted. Thematic analysis categorised these statements into 84 themes (total frequency 632). The most frequent themes were limb injury (9%), medical records (5.4%), surgery decision-making (4.6%), medicines safety (4.4%) and protocol (4.4%).ConclusionPatient safety practices of EMTs in disaster zones are weighted toward acute clinical care, particularly surgery. The management of non-communicable disease is under-represented. There is widespread recognition of the need to improve medical record-keeping. High-quality data and institutional level patient safety practices are lacking. There is no consensus on disaster zone-specific performance indicators. These deficiencies represent opportunities to improve patient safety in disaster zones.

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Developing Consensus on Appropriate Standards of Disaster Care for Children

Cited by 13 publications

References 32 publications

Pediatric Disposition Classification (Reverse Triage) System to Create Surge Capacity

Pediatric Disposition Classification (Reverse Triage) System to Create Surge Capacity

Mass Critical Care: Pediatric Considerations in Extending and Rationing Care in Public Health Emergencies

The patient safety practices of emergency medical teams in disaster zones: a systematic analysis

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