Pediatric Disaster Life Support (PDLS © ) Continuing Medical Education University of Massachusetts Medical School A Course in Caring for Children During Disaster

PDLS © : The Needs of Children During Disasters Introduction

The Pediatric Patient Newborn 0-3 mos Newborn 0-3 mos Infant 3-18 mos Infant 3-18 mos Toddler 1-3 1/2 yrs Toddler 1-3 1/2 yrs Pre-school 3-5 yrs Pre-school 3-5 yrs School Age 6-10 yrs School Age 6-10 yrs Adolescent / Teen yrs Adolescent / Teen yrs

Definition of Disaster A ny community emergency that disrupts normal community function causing concern for the safety of the citizens.

Mass Casualty Incident (MCI) A disaster that produces large numbers of injured victims. Children should be given special attention.

Level I MCI Local medical resources are available and adequate Local medical resources are available and adequate Regional backup resources may be put on alert Regional backup resources may be put on alert

Level II MCI Requires multi-jurisdiction (Regional) medical mutual aid Requires multi-jurisdiction (Regional) medical mutual aid Mutual aid agreements should provide back-up plans for jurisdictions stripped of their local resources Mutual aid agreements should provide back-up plans for jurisdictions stripped of their local resources

Level III MCI Activation of the State Disaster Plan is required Activation of the State Disaster Plan is required Requests for Federal Assistance may be necessary Requests for Federal Assistance may be necessary

Phases of a Disaster Response Activation Phase Notification and initial response Notification and initial response Organization of command and scene assessment Organization of command and scene assessment

Phases of a Disaster Response Implementation Phase Search and rescue Search and rescue Victim triage, initial stabilization and transport Victim triage, initial stabilization and transport Definitive management of scene hazards and victims Definitive management of scene hazards and victims

Phases of a Disaster Response Recovery Phase Scene withdrawal Scene withdrawal Return to normal operations Return to normal operations Debriefing Debriefing

Natural Disasters ( Examples ) Forest fires Forest fires Hurricanes Hurricanes Floods Floods Tornadoes Tornadoes Winter storms Winter storms Earthquakes Earthquakes

Man-Made Disasters ( Examples ) Building fires Building fires Explosions Explosions Chemical / radioactive contamination Chemical / radioactive contamination Transportation accidents Transportation accidents Civil disturbances Civil disturbances Military actions Military actions

Lessons Learned From Prior Disaster Experience

Factors That Determine the Magnitude of a Disaster Type of disaster, initial force, time course, secondary events Type of disaster, initial force, time course, secondary events Number of victim declared injured, and percent of total population displaced by the event Number of victim declared injured, and percent of total population displaced by the event Location and accessibility Location and accessibility Time of day Time of day Resources available in the area Resources available in the area Social, economic and political conditions at the time of the event Social, economic and political conditions at the time of the event

Earthquake Forces Experienced at the Surface of the Earth horizontal horizontal vertical vertical circular circular fissuring fissuring

Impact of Earthquakes on Buildings Structural Damage Stresses of varying amplitude cause distortion on load carrying parts of buildings. Some parts of structures are unable to tolerate significant distortion Stresses of varying amplitude cause distortion on load carrying parts of buildings. Some parts of structures are unable to tolerate significant distortion Non-Structural Damage Furniture, fixtures, glass and unsecured equipment are thrown from their position by the impact Furniture, fixtures, glass and unsecured equipment are thrown from their position by the impact

Consider Risks to Disaster Responders

Disaster Mitigation Prevention of disaster-related injury and illness

Vectors of Transmission of Infectious Diseases Affected by Disaster Airborne Airborne - Crowded habitation Waterborne Waterborne - Contaminated water supply - Children most susceptible Foodborne Foodborne - Problems with proper storage Insect and Animal borne Insect and Animal borne - Decrease disease transmission control

Disasters have Significant Psychological Impact on Children

Philosophy of Disaster Medicine When Children are Victims Children are more susceptible to certain injuries or environmental insults than adults Children are more susceptible to certain injuries or environmental insults than adults Children with acute injuries or illness are more likely to respond to rapid and efficient medical care than adults Children with acute injuries or illness are more likely to respond to rapid and efficient medical care than adults Since children are not small adults they require equipment and pharmaceuticals designed for their needs Since children are not small adults they require equipment and pharmaceuticals designed for their needs

Routine Medical Practices Unaltered in a Mass Casualty Situation Attend immediately to airway, breathing and circulatory emergencies in a potentially viable patient Attend immediately to airway, breathing and circulatory emergencies in a potentially viable patient Provide appropriate management of pain Provide appropriate management of pain Perform systematic patient assessments Perform systematic patient assessments Re-evaluate patients for changes in status Re-evaluate patients for changes in status Maintain patient dignity Maintain patient dignity

Routine Medical Practices Altered in a Mass Casualty Situation Extent of resuscitation efforts Extent of resuscitation efforts Acceptable results Acceptable results Timeliness of surgery Timeliness of surgery Indications for hospitalization Indications for hospitalization Use of ancillary services Use of ancillary services Increase patient care responsibility of nurses Increase patient care responsibility of nurses Decision to transfer Decision to transfer

Problems Common to Major Disasters Inadequate rescue personnel and supplies for the initial few days Inadequate rescue personnel and supplies for the initial few days Inadequate medical equipment, medical personnel and hospital space - particularly for children Inadequate medical equipment, medical personnel and hospital space - particularly for children Inadequate food, clothing and shelter for victims and the displaced population - particularly for children Inadequate food, clothing and shelter for victims and the displaced population - particularly for children Inadequate communications, assessment of victims’ needs and initial on-site coordination Inadequate communications, assessment of victims’ needs and initial on-site coordination

The Convergence Phenomenon Parents / Family Members Parents / Family Members Reporters Reporters Spectators Spectators

Disaster Medical Relief Recommendations to Rescuers Bring the right stuff - include supplies for newborn infants/children Bring the right stuff - include supplies for newborn infants/children Bring the right staff - Pedi experience Bring the right staff - Pedi experience Plan to be fairly self-sufficient Plan to be fairly self-sufficient Control your own supplies and avoid careless distribution Control your own supplies and avoid careless distribution Maintain accurate records, logs and photo documentation to verify your efforts Maintain accurate records, logs and photo documentation to verify your efforts

The needs of many outweigh the needs of a few Mr. Spock after Charles Dickens

Following Disaster the Needs of Children Exceed the Needs of Adults and Children Should be Given Priority