Protecting the Public’s Health from Disease, Disasters, and Bioterrorism: Where are the Children? Daniel B. Fagbuyi, MD, FAAP Medical Director, Disaster Preparedness and Emergency Management Children’s National Medical Center, Washington, DC Assistant Professor, Pediatrics and Emergency Medicine The George Washington University School of Medicine, Washington, DC

SITUATION: The US is not adequately prepared for public health emergencies and disasters that involve childrenThe US is not adequately prepared for public health emergencies and disasters that involve children

BACKGROUND: Children make up ~25% of the US populationChildren make up ~25% of the US population Most disaster plans fail to factor in children “benign neglect”Most disaster plans fail to factor in children “benign neglect”

BACKGROUND: Children have physiological, anatomical, dermatological, immunological and developmental/psychosocial unique characteristicsChildren have physiological, anatomical, dermatological, immunological and developmental/psychosocial unique characteristics Predisposition to higher risk during a CBRNE (chem-bio-rad-nuc-explosive) event Predisposition to higher risk during a CBRNE (chem-bio-rad-nuc-explosive) event

DOES SIZE MATTER?

ASSESSMENT: Day to day pediatric emergency preparedness is lacking nationwideDay to day pediatric emergency preparedness is lacking nationwide Pre-hospital to In-patient critical care Pre-hospital to In-patient critical care Baseline deficiencies in pediatric surge capacity and healthcare system capability aboundBaseline deficiencies in pediatric surge capacity and healthcare system capability abound Pre-hospital to In-patient critical care Pre-hospital to In-patient critical care

ASSESSMENT: Over 2/3rd of pediatric medications currently being used are administered “off-label”Over 2/3rd of pediatric medications currently being used are administered “off-label” SNS is devoid of adequate pediatric MCMs compared to that of the adultSNS is devoid of adequate pediatric MCMs compared to that of the adult

“BOOTS ON THE GROUND”, DATA & FACTS

Emergency department (ED) overcrowding is a critical issue on the national agenda Further exacerbated by H1N1 pandemic The science of ED surge remains relatively undeveloped Nager AL, Khanna K. Emergency department surge: models and practical implications. J Trauma. 2009;67(2 Suppl):S96-99

Daily Influenza-like illness (ILI) and Emergency Department (ED) volume Fall’09 H1N1. Solid line represents ED baseline volume. H1N1 Impact on Children’s National Emergency Department Patient Volume

A Rapid Medical Screening Process Improved Emergency Department Patient Flow during Surge Associated with Novel H1N1 Influenza Virus Daniel B. Fagbuyi Kathleen Brown, David Mathison, Jennifer Kingsnorth, Sephora Morrison, Mohsen Saidinejad, Jeffrey Greenberg, Michael Knapp, James Chamberlain Children’s National Medical Center The George Washington University School of Medicine

AAP in partnership with Children’s Health Fund conducted a public opinion poll on the use of resources related to disaster planning and response specific to children’s issues. Findings 76% of Americans agree that if resources are limited, children should be given a higher priority for life-saving treatments 75% believe that if tough decisions must be made, life-saving treatments should be provided to children rather than adults with the same medical condition 92% agree that if there were a terrorist attack, our country should have the same medical treatments readily available for children as are now available for adults Public Opinion on Children and Disasters

RECOMMENDATIONS: Reauthorization of PAHPAReauthorization of PAHPA Distinguish children as a separate population from the broader “at-risk” individuals’ category Ensure federal public health preparedness programs, grants and planning include performance measures for children

RECOMMENDATIONS: Ensure stockpile MCMs, equipment, and supplies are appropriate for childrenEnsure stockpile MCMs, equipment, and supplies are appropriate for children Achieve parity between medical countermeasures developed and included in the Strategic National Stockpile for children and those for adults Achieve parity between medical countermeasures developed and included in the Strategic National Stockpile for children and those for adults Address Emergency Use Authorization barriers and consider a pre-EUA process Address Emergency Use Authorization barriers and consider a pre-EUA process

RECOMMENDATIONS: Involve pediatrics experts at all levels of planning and responseInvolve pediatrics experts at all levels of planning and response Expand pediatric subject matter expertise in federal preparedness planning efforts e.g. Federal Advisory Committees and Boards Expand pediatric subject matter expertise in federal preparedness planning efforts e.g. Federal Advisory Committees and Boards

RECOMMENDATIONS: Ensure state and local planning includes the needs of children and familiesEnsure state and local planning includes the needs of children and families Ensure EMS agencies and hospitals are prepared and can care for childrenEnsure EMS agencies and hospitals are prepared and can care for children Improve and ensure pediatric education and training for all respondersImprove and ensure pediatric education and training for all responders

RECOMMENDATIONS: Augment and foster the linkage between all preparedness agencies and pediatric expertsAugment and foster the linkage between all preparedness agencies and pediatric experts Encourage and improve individual preparedness, including families and children with special healthcare needsEncourage and improve individual preparedness, including families and children with special healthcare needs

RECOMMENDATIONS: Ensure funding for preparedness and response are tied to addressing the pediatric gaps identifiedEnsure funding for preparedness and response are tied to addressing the pediatric gaps identified Improve strategic communications/messaging to parents/public, health professionals, decision makers, and the mediaImprove strategic communications/messaging to parents/public, health professionals, decision makers, and the media

RECOMMENDATIONS: Implement the recommendations from the work of the National Commission on Children and Disasters (October 2006)Implement the recommendations from the work of the National Commission on Children and Disasters (October 2006) Address the need for real-time data collection during public health emergenciesAddress the need for real-time data collection during public health emergencies

Take Home Points Children differ from adults in many aspects Failure to account for these differences will result in increase morbidity and mortality Cost-benefit analysis should consider life-years-saved vs. lives-saved

Take Home Points Remember the end-user and public accountability

With Questions, Please Contact: American Academy of Pediatrics Washington Office 202/ Tamar Haro: Betsy Dunford: Please visit:

Protecting the Public’s Health from Disease, Disasters, and Bioterrorism: Where are the Children? Daniel B. Fagbuyi, MD, FAAP Medical Director, Disaster Preparedness and Emergency Management Children’s National Medical Center, Washington, DC Assistant Professor, Pediatrics and Emergency Medicine The George Washington University School of Medicine, Washington, DC