1. University of Massachusetts Medical School Andrew Garrett MD, MPH, FAAP Richard Aghababian MD, FACEP University of Massachusetts Medical School Andrew Garrett MD, MPH, FAAP Richard Aghababian MD, FACEP Pediatric Disaster Life Support © Edition 2.0

2. Introduction Andrew Garrett MD Introduction Andrew Garrett MD Pediatric Disaster Life Support

3. Welcome  PDLS is designed to give emergency personnel a foundation of knowledge and skills to more effectively prepare for and respond to disasters involving children

4. Intent of PDLS  PDLS builds on the fundamental pediatric patient care skills learned in basic pediatric resuscitation courses  Such as PALS, PEPP, APLS  PDLS builds on the fundamental pediatric patient care skills learned in basic pediatric resuscitation courses  Such as PALS, PEPP, APLS

5. What is a disaster?  Many definitions exist  For this purposes of this course  An exceptional event that disrupts community functioning, causes human suffering or fatalities, and/or creates needs that the victims can not alleviate without assistance  Says nothing about the cause  Many definitions exist  For this purposes of this course  An exceptional event that disrupts community functioning, causes human suffering or fatalities, and/or creates needs that the victims can not alleviate without assistance  Says nothing about the cause

6. Why PDLS?  Disasters by our definition affect communities  “Community” in public health means any collection of people sharing an environment where they have something in common  Most communities contain infants, children, and adolescents  Towns, cities, states, nations  Schools, camps, daycare facilities  Disasters by our definition affect communities  “Community” in public health means any collection of people sharing an environment where they have something in common  Most communities contain infants, children, and adolescents  Towns, cities, states, nations  Schools, camps, daycare facilities

7. Care for the Entire Community  To take care of a community means to take care of the children contained within it  As a new specialty area, Disaster Medicine (along with Prehospital Care/EMS) was initially based on taking care of adult patients  Why is this?  Much of the science grew out of military research and military operations  These focus was on young, healthy adults  To take care of a community means to take care of the children contained within it  As a new specialty area, Disaster Medicine (along with Prehospital Care/EMS) was initially based on taking care of adult patients  Why is this?  Much of the science grew out of military research and military operations  These focus was on young, healthy adults

9. Children as a Special Population  For years, pediatric patients were underemphasized in Disaster Medicine  In the last decade, there has been increased interest in how to better care for children before they get to the hospital  This can be difficult, since “children are not just little adults” and they do not fit the traditional mold of preparing for and treating children in a disaster  For years, pediatric patients were underemphasized in Disaster Medicine  In the last decade, there has been increased interest in how to better care for children before they get to the hospital  This can be difficult, since “children are not just little adults” and they do not fit the traditional mold of preparing for and treating children in a disaster

10. Children as a Special Population  A major focus of PDLS is the difference between children and adults  Children have unique medical and psychological needs that must be taken into account during disaster preparedness and response planning  We will focus on the special vulnerabilities of children during disaster  A major focus of PDLS is the difference between children and adults  Children have unique medical and psychological needs that must be taken into account during disaster preparedness and response planning  We will focus on the special vulnerabilities of children during disaster

11. The Science Advances  PDLS reflects the advancements in the science of pediatric care during disasters  Incorporates the information that we have learned during the past decade, such as:  Oklahoma City bombing (1995)  9/11 terrorist attacks (2001)  Anthrax attacks (2001)  Beslan School seige (2004)  Indian Ocean tsunami (2004)  Hurricane Katrina (2005)  PDLS reflects the advancements in the science of pediatric care during disasters  Incorporates the information that we have learned during the past decade, such as:  Oklahoma City bombing (1995)  9/11 terrorist attacks (2001)  Anthrax attacks (2001)  Beslan School seige (2004)  Indian Ocean tsunami (2004)  Hurricane Katrina (2005)

12. Alfred P. Murrah Federal Building

13. An Unfortunate Reality  Children as an intentional target of terrorism increases the need for PDLS  Oklahoma City bombing daycare center  Tel Aviv Dolphinarium disco bombing  School Mass Murders:  Columbine, Red Lake, Ma’alot  Dubrovka Theater Seige  Beslan School hostage crisis  Children as an intentional target of terrorism increases the need for PDLS  Oklahoma City bombing daycare center  Tel Aviv Dolphinarium disco bombing  School Mass Murders:  Columbine, Red Lake, Ma’alot  Dubrovka Theater Seige  Beslan School hostage crisis

14. Beslan, Russia 9/1/04  Over 1000 children taken as hostages in a politically-motivated seige at a Beslan school  Seige lasted one week  Unmeetable demands made  Children packed into gymnasium rigged with explosives  Over 1000 children taken as hostages in a politically-motivated seige at a Beslan school  Seige lasted one week  Unmeetable demands made  Children packed into gymnasium rigged with explosives

15. Beslan, Russia 9/1/04  Day 3- terrorists suddenly begin shooting hostages and set off explosions in gymnasium  Rescuers storm school  Hundreds injured or killed  Resources limited due to remote location and prolonged event  Day 3- terrorists suddenly begin shooting hostages and set off explosions in gymnasium  Rescuers storm school  Hundreds injured or killed  Resources limited due to remote location and prolonged event

16. The Rescue Attempt Begins

17. A Sudden Influx of Patients

21. Beslan, Russia 9/1/04  Who should receive the efforts of a limited number of providers and medical facilities?  Does this meet our definition of disaster?  An exceptional event that disrupts community functioning, causes human suffering or fatalities, and/or creates needs that the victims can not alleviate without assistance  Who should receive the efforts of a limited number of providers and medical facilities?  Does this meet our definition of disaster?  An exceptional event that disrupts community functioning, causes human suffering or fatalities, and/or creates needs that the victims can not alleviate without assistance

22. Mass Casualty Incidents  MCI’s may or may not represent disasters to a community, based on the level of preparedness in the community  Why is that?  Many of the same priorities, knowledge and tools in PDLS still apply when responding to an MCI  MCI’s may or may not represent disasters to a community, based on the level of preparedness in the community  Why is that?  Many of the same priorities, knowledge and tools in PDLS still apply when responding to an MCI

23. Natural Disasters  As if terrorism was not enough…  Some experts think that the numbers of natural disasters are increasing  Increased numbers at risk due to globalization and development of at-risk areas  As if terrorism was not enough…  Some experts think that the numbers of natural disasters are increasing  Increased numbers at risk due to globalization and development of at-risk areas

24. Earthquakes and Tsunami

25. Nias, Indonesia 4/05

26. Hurricanes

27. Tornadoes

28. Floods

29. Volcanoes, Mudslides, Lahars

30. The Risk Exists  No community is exempt from the risk of a disaster  As healthcare providers we have a responsibility to prepare for the care of children and adults- the whole community  PDLS is a starting point  No community is exempt from the risk of a disaster  As healthcare providers we have a responsibility to prepare for the care of children and adults- the whole community  PDLS is a starting point

31. Outline  PDLS has two core lectures:  Fundamental Concepts in Pediatric Disaster Medicine  Practical Issues in Pediatric Disaster Medicine  Followed by a field training exercise that will give you an opportunity to practice some of the skills presented in PDLS  PDLS has two core lectures:  Fundamental Concepts in Pediatric Disaster Medicine  Practical Issues in Pediatric Disaster Medicine  Followed by a field training exercise that will give you an opportunity to practice some of the skills presented in PDLS