Challenges and solutions: pandemic 2009 H1N1 influenza A in a pediatric emergency department.

OBJECTIVE: The purpose of this study was to describe the impact of the 2009 H1N1 influenza pandemic on a pediatric emergency department (ED) at a freestanding children's hospital in the summer and fall of 2009. DESIGN: In July 2009, active prospective surveillance for influenza-like illness (ILI) was performed on a daily basis of patients presenting to the ED of Arkansas Children's Hospital. The Centers for Disease Control and Prevention definition of ILI was used. Records of daily ILI volume were kept. A retrospective review of admissions from the ED to the inpatient service was done for patients with ILI and non-ILI. In addition, comparisons of monthly patient census for the months involved were compared with historical census data. RESULTS: When public schools started in mid-August 2009, there was a rapid and dramatic increase in the number of patients with ILI seen in the pediatric ED. Within 3 weeks, as many as 120 patients with ILI per day were being seen in the ED. The month of September 2009 was the highest census month ever recorded in this ED. The admission rate of the patients with ILI was lower than patients with non-ILI between September and November 2009 (10.8 percent vs 14.8 percent). CONCLUSIONS: The 2009 H1N1 influenza pandemic resulted in unprecedented patient volumes in this pediatric ED; however, patient acuity (based on admission rate) for patients with ILI was lower than patients with non-ILI. Pandemic influenza can overwhelm emergency care resources, even when the overall severity of illness is relatively low.

A state survey of emergency department preparedness for the care of children in a mass casualty event.

OBJECTIVE: The Institute of Medicine has issued two reports over the past 10 years raising concerns about the care of children in the emergency medical care system of the United States. Given that children are involved in most mass casualty events and there are deficiencies in the day-to-day emergency care of children, this project was undertaken to document the preparedness of hospitals in AR for the care of children in mass casualty or disaster situations. DESIGN: Mailed survey to all emergency department medical directors in AR. Nonresponders received a second mailed survey and an attempt at survey via phone. PARTICIPANTS: Medical directors of the emergency departments of the 80 acute care hospitals in AR. RESULTS: Seventy-two of 80 directors responded (90 percent response rate). Only 13 percent of hospitals reported they have pediatric mass casualty protocols and in only 28 percent of hospitals the disaster plan includes pediatric-specific issues such as parental reunification. Most hospitals hold mass casualty training events (94 percent), at least annually, but only 64 percent report including pediatric patients in their disaster drills. Most hospitals include local fire (90 percent), police (82 percent), and emergency medical services (77 percent) in their drills, but only 23 percent report involving local schools in the disaster planning process. Eighty-three percent of hospitals responding reported their staff is trained in decontamination procedures. Thirty-five percent reported having warm water showers available for infant/children decontamination. Ninety-four percent of hospitals have a plan for calling in extra staff in a disaster situation, which most commonly involves a phone tree (43 percent). Ninety-three percent reported the availability of Ham Radios, walkie-talkie, or Arkansas Wireless Information Network (AWIN) units for communication in case of land line loss, but only 16 percent reported satellite phone or Tandberg units. Twelve percent reported reliance on cell phones in this situation. CONCLUSIONS: This survey demonstrated important deficiencies in the preparedness of hospitals in AR for the care of children in disaster. Although many hospitals are relatively well prepared for the care of adults in disaster situations, the needs of children are different and hospitals in AR are not as well prepared for pediatric disaster care.