Pediatric Pandemics and Disasters - A Summary.

Children make up approximately 25% of the population in the United States and are particularly vulnerable to the impact of disasters. The creation of federally-funded programs and advisory committees has had a positive impact on addressing the needs of children and families in disasters by identifying best practices, disseminating information, identifying gaps, and providing information with future investments that will contribute to expanding disaster science for children and their families.

A Pediatric-Focused Self-Assessment Tool on Vulnerabilities to Aid Regional Disaster Planning.

OBJECTIVE: A significant number of disaster and emergency victims are children. Yet, many hospitals are ill-prepared to care for these patients during disasters, as identified by the National Pediatric Readiness Project's survey of hospital pediatric disaster plans. The Region V for Kids Center of Excellence created a self-assessment tool to help regions identify vulnerabilities and ways to enhance care for vulnerable children and families. METHODS: Region V for Kids identified 9 key domains (eg, infrastructures and support mechanisms) that are important to safeguard children's and families' care during disasters. A self-assessment tool to assess these domains was distributed to 24 regional health care coalitions along with a 9-question usefulness survey. The self-assessment tool addressed 3 of the original domains, which have regional or national open-source databases and datapoints that health care coalitions can access for their responses. RESULTS: The survey received a 50% response rate. Approximately 40% of respondents indicated they were "somewhat likely" to make changes based on data gathered by the tool. The original self-assessment tool was revised to create an expanded web-based version. CONCLUSIONS: Health care coalitions and localities can use this tool to evaluate pediatric preparedness, identify needed improvements, and improve outcomes for children, families, and communities.

Disaster Preparedness Medical School Elective: Bridging the Gap Between Volunteer Eagerness and Readiness.

OBJECTIVE: Eager medical students may not be prepared for unanticipated complexities of disaster response. This study aimed to answer 2 questions: does an online disaster preparedness curriculum create a convenient method to educate medical students and motivate them to be better prepared to volunteer? METHODS: An online disaster preparedness elective was created for medical students. Four modules were created using Softchalk and hosted on the Blackboard Learning Management System. Students completed embedded pre-elective, post-lesson, and post-elective surveys. RESULTS: Fifty-five students completed the elective. When posed with the statement, "I feel prepared for an emergency at the University or the immediate area," 70% stated that they disagreed or strongly disagreed before the elective. Subsequently, only 11% claimed to disagree after the elective. At the conclusion of the elective, 13% of students had prepared a personal emergency kit and 28% had prepared a family communication plan for reunification. Students were surveyed on the statement "I would like to be involved in a community disaster response while continuing my medical training." Ninety-four percent claimed to agree or strongly agree before the elective, and 93% stated the same after elective completion. CONCLUSIONS: This disaster preparedness elective was envisioned to be a resource for students. Advantages of online availability are ease of student access and minimal demand on faculty resources. A voluntary, self-paced online elective in disaster preparedness has shown to create a stronger interest in disaster participation in medical students. Student readiness to volunteer improved; however, willingness remained stagnant.

National survey of institutional pediatric disaster preparedness.

OBJECTIVE: Describe institutional disaster preparations focusing upon the strategies to address pediatric patients in disaster preparedness. DESIGN: Descriptive study using survey methodology. SETTING: Hospitals that provide emergency care to pediatric patients throughout the United States. PARTICIPANTS: Survey responses were solicited from hospital personnel that are familiar with the disaster preparedness plan at their institution. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Describe how pediatric patients are included in institutional disaster preparedness plans. The presence of a pediatric-specific lead, policies and procedures, and geographic/demographic patterns are also a focus. RESULTS: The survey was distributed to 120 hospitals throughout the United States and responses were received from 29 states. Overall response rate was 58 percent, with 53 percent of the surveys fully completed. Sixty-three percent of hospitals had an individual responsible for pediatric-specific disaster planning and 78 percent specifically addressed the care of pediatric patients (<16 yo) in their disaster plan. The hospitals with an individual designated for pediatric disaster planning were more likely to have a disaster plan that specifically addresses the care of pediatric patients (90 percent vs 56 percent; p = 0.015), to represent children with special healthcare needs as simulated patients in disaster exercises (73 percent vs 22 percent; p = 0.003), and to include pediatric decontamination procedures in disaster exercises (78 percent vs 35 percent; p = 0.008) than hospitals without a designated pediatric disaster planner. CONCLUSION: The majority of hospitals surveyed incorporate pediatric patients into their disaster preparedness plan. Those hospitals with an individual designated for pediatric disaster planning were more likely to specifically address the care of pediatric patients in their institutional disaster plan.

Essentials of PEM Fellowship Part 2: The Profession in Entrustable Professional Activities.

This article is the second in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine (PEM) fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article describes the development of PEM entrustable professional activities (EPAs) and the relationship of these EPAs with existing taxonomies of assessment and learning within PEM fellowship. It summarizes the field in concepts that can be taught and assessed, packaging the PEM subspecialty into EPAs.

Going viral: adapting to pediatric surge during the H1N1 pandemic.

OBJECTIVES: The objective of this study was to assess hospital and emergency department (ED) pediatric surge strategies utilized during the 2009 H1N1 influenza pandemic as well as compliance with national guidelines. METHODS: Electronic survey was sent to a convenience sample of emergency physicians and nurses from US EDs with a pediatric volume of more than 10,000 annually. Survey questions assessed the participant's hospital baseline pandemic and surge preparedness, as well as strategies for ED surge and compliance with Centers for Disease Control and Prevention (CDC) guidelines for health care personal protection, patient testing, and treatment. RESULTS: The response rate was 54% (53/99). Preexisting pandemic influenza plans were absent in 44% of hospitals; however, 91% developed an influenza plan as a result of the pandemic. Twenty-four percent reported having a preexisting ED pandemic staffing model, and 36% had a preexisting alternate care site plan. Creation and/or modifications of existing plans for ED pandemic staffing (82%) and alternate care site plan (68%) were reported. Seventy-nine percent of institutions initially followed CDC guidelines for personal protection (use of N95 masks), of which 82% later revised their practices. Complete compliance with CDC guidelines was 60% for patient testing and 68% for patient treatment. CONCLUSIONS: Before the H1N1 pandemic, greater than 40% of the hospitals in our study did not have an influenza pandemic preparedness plan. Many had to modify their existing plans during the surge. Not all institutions fully complied with CDC guidelines. Data from this multicenter survey should assist clinical leaders to create more robust surge plans for children.