The New York City Pediatric Disaster Coalition: A Regional Model for Pediatric Mass-Casualty Planning

Abstract

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.