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Prehospital Care of Children in Disasters

By Sally Greene,2014-11-22 01:52
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Prehospital Care of Children in Disasters

    STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY ARNOLD SCHWARZENEGGER, Governor EMERGENCY MEDICAL SERVICES AUTHORITY th1930 9 STREET

    SACRAMENTO, CA 95811-7043 (916) 322-4336 FAX (916) 324-2875

    EMSC PEDIATRIC

    DISASTER PREPAREDNESS

    GUIDELINES: LEMSAs

    EMSA #197

    March 24, 2010

    EMSC PEDIATRIC DISASTER PREPAREDNESS GUIDELINES: LEMSAS

    Prepared by:

    The Pediatric Disaster Preparedness Subcommittee

    Bonnie Sinz, RN

    EMS Systems Division Chief

    California EMS Authority

    ~

    Donna Westlake

    EMS for Children Coordinator

    California EMS Authority

    ~

    R. Steven Tharratt, MD, MPVM

    Director

    California EMS Authority

    Kim Belshé

    Secretary

    California Health and Human Services Agency

    Arnold Schwarzenegger

    Governor

    Acknowledgements

    EMS for Children Technical Advisory Committee

    Judith Brill MD Patrice Christensen PHN Art Andres EMT-P Director PICU Mattel Childrens Injury Prevention Program Paramedic Hospital Coordinator Ontario Fire Department UCLA Medical Center San Mateo County EMS Agency Bernard Dannenberg MD Ron Dieckmann MD Robert Dimand MD Director, Pediatric Emergency Director, Pediatric Emergency Chief of Pediatrics

    Medicine Medicine Children's Hospital Central

    Lucile Packard Children's San Francisco General Hospital California

    Hospital

     Jan Fredrickson MSN Les Gardina RN Erin Dorsey BSN, PHN CPNP EMSC/Trauma System School Nurse California State Emergency Coordinator Long Beach USD Nurses Assoc. San Diego County EMS Agency Marianne Gausche-Hill MD Jim Harley MD Donna Black Director, EMS & Pediatric Emergency Medicine EMSC Representative

    Emergency Medicine Children's Specialists of San State of CA Office of Traffic

    Harbor UCLA Medical Center Diego Safety

    Ramon Johnson MD Nancy McGrath PNP Maureen McNeil Director, Pediatric Emergency Pediatric Liaison Nurse EMSC Technical Advisor Medicine Harbor UCLA Medical Center Emergency Medicine Associates

    Allen Morini DO Michael Osur Barbara Pletz EMDAC Representative Deputy Director, Public Health EMS Administrator Riverside County EMS Agency San Mateo County EMS

    Nicholas Saenz MD Debby Rogers MSN Sandy Salaber Pediatric Surgeon Vice President, QI & EMS EMS Systems Program Analyst Rady Children's Hospital California Hospital Association California EMS Authority (Trauma Center)

    Bonnie Sinz RN Debra Smades-Henes R. Steven Tharratt, MD, MPVM Chief, EMS Systems Division EMSC Family Representative Director California EMS Authority California EMS Authority

    Scott Vahradian Richard Watson Donna Westlake EMS Integration Authority EMSC Technical Advisor EMSC Program Coordinator Santa Cruz Co. Fire Department EMS for Children Program California EMS Authority

    Pediatric Disaster Subcommittee

    Solomon Behar MD Ron Dieckmann MD Ramon Johnson MD Department of Emergency Director, Pediatric Emergency Director, Pediatric Emergency

    Medicine Medicine Medicine Children's Hospital of Los San Francisco General Hospital Emergency Medicine Associates

    Angeles

    Erin Dorsey BSN, PHN Calvin Freeman Deborah Henderson

    School Nurse Vice President EMSC Coordinator

    Long Beach USD Global Vision Consortium Harbor UCLA Medical Center

    Alan Nager MD Amy Kaji MD John Michelini

    Director, Emergency & Transport Medical Director, Disaster Division Chief, Special

    Medicine Resource Center Operations

    Children's Hospital, Los Angeles Harbor UCLA Medical Center Coummes Fire Department

    Michael Osur Mary Jo Quintero CCRN Bonnie Sinz RN

    Deputy Director, Public Health Prehospital Liaison Nurse Chief, EMS Systems Division

    Riverside County EMS Agency ED, Children's Hospital Central California EMS Authority

     California

    Donna Westlake R. Steven Tharratt, MD, MPVM Richard Watson EMSC Program Coordinator Director EMSC Technical Advisor California EMS Authority California EMS Authority EMS for Children Program

    Millicent Wilson MD

     Disaster Training Specialist

    Los Angeles Co. EMS Agency

FOREWORD

    As in day-to-day medical emergencies, children face unique vulnerabilities during disasters. The events of Hurricane Katrina and the Southern California wildfires reinforced the need to provide pediatric-specific guidance to medical personnel responding to disasters in both the hospital and pre-hospital setting. Child-centric approaches are required for triage, treatment, and decontamination to achieve optimal outcomes for pediatric patients. Accordingly, the California EMS for Children Technical Advisory Committee appointed a Disaster Subcommittee to develop pediatric disaster medical guidelines for California’s Local EMS Agencies and hospitals (published as separate documents).

    The Disaster Subcommittee considers these guidelines to be minimum standards for large and small hospitals and Local EMS Agencies serving both urban and rural California communities. The guidelines include references that provide supporting evidence for the recommendations and tools for implementation. Additional information is available at the website of the EMS Authority (www.emsa.ca.gov).

    Finally, the EMS Authority views these guidelines as living documents to be expanded and modified as resources and new information become available.

    The EMSC Pediatric Disaster Preparedness Guidelines: LEMSAs are partially supported by a grant from the HRSA/MCHB and through the Preventive Health and Health Services Block Grant from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

    EMSC PEDIATRIC DISASTER PREPAREDNESS GUIDELINES: LEMSAS

    TABLE OF CONTENTS

PEDIATRIC PREHOSPITAL DISASTER PREPAREDNESS

    Introduction: Prehospital Care of Children in Disasters ................................................ 1

    General Local EMS Agency Checklist ........................................................................... 3

TRIAGE

     Introduction .................................................................................................................... 5

     Triage Checklist ........................................................................................................... 15

MEDICATIONS

     Introduction .................................................................................................................. 16

     Medications Checklist .................................................................................................. 19

DECONTAMINATION

     Introduction .................................................................................................................. 20

     Decontamination Checklist .......................................................................................... 22

MENTAL HEALTH ISSUES

     Introduction .................................................................................................................. 24

     Mental Health Checklist ............................................................................................... 26

SPECIAL NEEDS CHILDREN CONSIDERATIONS

     Introduction .................................................................................................................. 27

     Checklist for Pediatric Special Needs Populations ...................................................... 31

DISASTER DRILLS AND EXERCISES

     Introduction .................................................................................................................. 33

     Checklist ...................................................................................................................... 37

ACRONYMS .......................................................................................................................... 39

    1

    1

    PREHOSPITAL CARE OF CHILDREN IN DISASTERS

Introduction

    The care of children in disasters presents unique challenges for prehospital professionals. EMS agencies must have a thorough, well-rehearsed disaster response plan that addresses the needs of children. Planning for the care of children in disasters requires recognition that children are more vulnerable, physically and emotionally than adults. The following table summarizes the physiologic and psychological characteristics of children that place them at high risk during disasters.

    Pediatric Special Risk during Disaster

    Characteristic

    Respiratory Higher minute volume increases exposure to inhaled agents.

    Nuclear fallout and heavier gases settle lower to the ground

    and may affect children more severely.

    Gastrointestinal May be more at risk for dehydration from vomiting and diarrhea

    after exposure to contamination.

    Skin Higher body surface area increases risk of skin exposure. Skin

    is thinner and more susceptible to injury from burns, chemicals

    and absorbable toxins.

    Endocrine Increased risk of thyroid cancer from radiation exposure.

    Thermoregulation Less able to cope with temperature problems with higher risk

    of hypothermia.

    Developmental Less capability to escape environmental dangers or anticipate

    hazards.

    Psychological Prolonged stress from critical incidents. Susceptible to

    separation anxiety.

Other considerations include:

    ; An incident involving multiple pediatric casualties can rapidly overwhelm existing

    resources and capabilities for children in the local area.

    ; The presence of children in a disaster adds to the chaos and may rapidly deplete

    rescuers and resources physically and emotionally.

    ; Post-event Critical Incident Stress Management (CISM) should be included in

    disaster planning.

    ; Care of children in disasters must include plans for reuniting children with their

    families and keeping families together during triage, treatment, and transport.

    EMERGENCY MEDICAL SERVICES FOR CHILDREN California EMS Authority EMSC Pediatric Disaster Preparedness Guidelines: LEMSAs Page 1

    ; Field EMS providers in California have education consistent with the Department of

    Transportation Curriculum, but they may not have completed additional initial or on-

    going training specific to pediatric patients, including the care of pediatric patients in

    disasters.

    ; Responders rarely have experience in assessing the emotional states of a child and

    the child’s family. The mental health needs of children must be recognized in

    planning for disasters.

    ; Pediatric patients are not often included in disaster drills and exercises, so

    prehospital personnel may not have experience in triaging and treating pediatric

    patients in disaster scenarios.

    Because of the need to address these issues, this annex has been designed to assist EMS agencies in planning for the care of children in disasters, and includes checklists and resources for this purpose.

References

    American Academy of Pediatrics. The Youngest Victims: Disaster Preparedness to Meet Children’s Needs. www/aap.org/advocacy/releases/disaster_preparedness.htm

    Handrigan MT, Becker BM, Jagminas L, Becker TJ. Emergency medical services in the reconstruction phase following a major earthquake: a case study of the 1988 Armenia earthquake. Prehosp Disaster Med. 1998 Jan-Mar;13(1):35-40.

    Shirm S, Liggin R, Dick R, Graham J. Prehospital preparedness for pediatric mass-casualty events. Pediatrics. 2007 Oct; 120(4):e756-61.

    van Amerongen RH, Fine JS, Tunik MG, Young GM, Foltin GL. The Avianca plane crash: an emergency medical system's response to pediatric survivors of the disaster. Pediatrics. 1993 Jul; 92(1):105-10.

    EMERGENCY MEDICAL SERVICES FOR CHILDREN California EMS Authority EMSC Pediatric Disaster Preparedness Guidelines: LEMSAs Page 2

    LOCAL EMS AGENCY PEDIATRIC DISASTER PREPAREDNESS

    General Local EMS Agency Checklist

    Item Yes No In

    Process

    POLICIES

    1. Destination policies are in place for response to numerous children

    in a multi-casualty incident, including transport to higher levels of

    care for more seriously ill or injured children in a large-scale

    disaster.

    2. Agreements have been made with pediatric tertiary care centers

    and other facilities outside LEMSA jurisdiction for pediatric

    patients requiring higher levels of care or specialized care.

    3. Plans for disasters include means of obtaining additional pediatric

    equipment, supplies and medications.

    4. Disaster planning includes attention to children with special health

    care needs and pediatric mental health issues.

    PROTOCOLS

    1. Triage methods of pediatric patients such as the Pediatric

    Assessment Triangle, JumpSTART or other means of

    determining severity of injury or illness of pediatric patients is

    used.

    2. Triage plan includes method of identifying pediatric patients and

    their family members to aid in reuniting them.

    3. Rapid method of determining dosages for children, such as the

    Broselow tape or other length-based tool is available.

    4. Methods of decontaminating children in the field, including

    medically stable or unstable children and children with special

    needs are included in disaster plans.

EMERGENCY MEDICAL SERVICES FOR CHILDREN California EMS Authority

    EMSC Pediatric Disaster Preparedness Guidelines: LEMSAs Page 3

EDUCATION

    1. Agency regularly provides, supports or recommends special

    education in pediatrics for personnel, such as Pediatric

    Education for Prehospital Professionals (PEPP) and/or

    Pediatric Advanced Life Support (PALS) or pediatric

    education consistent with these courses.

    2. Interventions for biological, chemical, and radiologic disasters, with

    instructions specific to pediatric patients are included in training of

    prehospital providers.

    3. Children are routinely included in disaster drills and exercises.

    4. Pediatric expertise (pediatricians, pediatric intensivists, etc.) is

    included in planning drills/exercises, and other disaster-related

    activities.

    5. Public health agencies, schools, daycare facilities, health clinics,

    the American Red Cross, and other local and statewide agencies

    and organizations interested in pediatric care are included in

    planning for disasters, and in disaster exercises.

    6. Pediatric expertise is routinely included in debriefings/evaluations

    for disasters or disaster exercises.

There are many resources to aid in accomplishing these objectives. The following

    represents a partial list that provides an overview and some additional information:

Resources General articles/websites

http://www.aap.org/terrorism/index.html

http://pediatrics.aappublications.org/cgi/content/full/aap120/4/e756

http://www.fireengineering.com/articles/print.html?id=276789&bPool=FE.pennnet.com%

    2Farticle_tool_bar

http://www.bt.cdc.gov/children/pdf/working/execsumm03.pdf

http://www.ncdp.mailman.columbia.edu/program_pediatric.htm

EMERGENCY MEDICAL SERVICES FOR CHILDREN California EMS Authority

    EMSC Pediatric Disaster Preparedness Guidelines: LEMSAs Page 4

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