1 / 69

Pediatric Disaster Life Support

Pediatric Disaster Life Support. Core Content Lecture 2 Practical Issues in Pediatric Disaster Medicine and Preparedness Andrew L. Garrett, MD. Goals of this Section. Apply the concepts learned in the first section with a focus on the vulnerabilities of children in disaster

rembert
Download Presentation

Pediatric Disaster Life Support

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Pediatric Disaster Life Support Core Content Lecture 2 Practical Issues in Pediatric Disaster Medicine and Preparedness Andrew L. Garrett, MD

  2. Goals of this Section • Apply the concepts learned in the first section with a focus on the vulnerabilities of children in disaster • To teach specific information which will enhance the practical application of this information

  3. Goals of this Section • To further develop the bio-psycho-social model’s applicability to pediatric disaster medicine and preparedness Social Biological Care of the Child During Disaster Psychological

  4. Pediatric Triage

  5. Pediatric Triage • Triage is the sorting of patients • During a disaster, the number of patients may exceed the amount of medical resources • It is important to allocate the limited resources to those who will most benefit from them

  6. Pediatric Triage • In other words: To do the most good for the most patients

  7. Pediatric Triage • Triage may occur at several points during a disaster • The scene of destruction • Mass casualty incident • At a casualty collection point or field hospital • At a receiving hospital • Mass casualty receiving

  8. Pediatric Triage • Triage of children and adults is typically done simultaneously during a disaster • It is important to remember that although the injury process may be the same, a child’s vulnerability to that injury may be very different • Specifically, their response to airway obstruction

  9. Pediatric Triage • The standard adult triage tools do not take into account the specific vulnerability that children have to dying from airway obstruction • Children may have a reversible period of respiratory arrest from which they may recover if treated promptly

  10. Pediatric Triage • Due to this, a specific pediatric triage tool was developed and tested • JumpSTART • Builds from the concepts of triage taught in START triage, which is commonly utilized

  11. START Triage (adults)

  12. Confused? • If you remember the specific vulnerability children have to airway compromise, this makes sense • The “Jumpstart” term refers to the extra chance we give a child to breathe before we declare them a BLACK TAG

  13. Examples • Awake 8 yr old child brought in 3 days after earthquake with 20 others • Can not walk • Responds to voice • Respiratory Rate 50 • No obvious injuries IMMEDIATE

  14. Examples • Unconscious 4 year old hit in head by debris moments ago • In a room full of injured children • Not breathing • Obvious head injury

  15. Examples • What do you do? • How do you classify this child if he breathes? • How do you classify this child if he does not breathe immediately? IMMEDIATE DECEASED

  16. Examples • You are receiving multiple casualties on a hospital ship • Young child found breathing but sleepy • Brought in by military helicopter with IV running

  17. Examples • What do you want to assess? • Respiratory Rate 30 • Has a palpable pulse • Arouses to touch and loud voice DELAYED

  18. Pediatric Triage • Focus on integration of children in to the triage system • Once a child is classified as a color, quickly move them to a treatment area in order of severity • RED first, then YELLOW, then GREEN

  19. Children with Special Health Care Needs

  20. Children with Special Health Care Needs (CSHCN) • Children with special medical or physical needs • Wheelchair or crutches • Learning disability • Vision, hearing, or language impaired • Technology dependent • Ventilator • Dialysis

  21. Children with Special Health Care Needs (CSHCN)

  22. Children with Special Health Care Needs (CSHCN)

  23. Prevalence of CSHCN • Based on a national survey • 1 in 5 households self identify as having a CSHCN • Approximately 1 in 8 children are identified by parents as being CSHCN • Care of these children must be integrated in to the care of all children during a disaster

  24. Special Challenges for CSHCN • Sheltering • Controversy: Together or separately? • Controversy: Should CSHCN be considered medical patients if they are not injured or ill? • Decontamination • What is the best way to decontaminate medical hardware such as a wheelchair? • How do we decontaminate technology, such as a ventilator?

  25. Special Challenges for CSHCN • Transportation • Take equipment with or leave behind during evacuation? • For all of these topics, special advance planning is required to be successful in taking care of all children

  26. Sheltering for Children • Hurricane Katrina taught us many harsh lessons about how important shelter planning is

  27. Sheltering Issues • Hygiene • Children pose a special risk to maintaining hygiene in a shelter operation • Basic supplies such as wipes and diapers frequently overlooked • Children are at a special risk of acquiring gastrointestinal and respiratory diseases • Children are exceptionally good at spreading these diseases • Must plan for handwashing/sanitizing

  28. Sheltering Issues • Safety and Supervision • Shelters are dangerous environments • Rarely childproofed • Children move quickly throughout environment • Easy to get lost • Possible criminal element

  29. Sheltering Issues • Health Maintenance • Clean water and healthy food a challenge • Children require something to do • Consider a recreational therapy group • Children require more sleep • Shelters are frequently loud • Pediatric Health Screening important • Prevention of disease • Maintaining primary care for extended stays

  30. Decontamination

  31. Decontamination of Children • Special issues must be accounted for before undertaking decontamination of children • Advance planning will make the difference • Goal is to integrate care of children with that of the general population

  32. Decontamination of Children • Parents • After a disaster or major emergency, most parents will not separate from their children • Decontamination patient flow must account for this • Takes longer than expected to decontaminate parent and child

  33. Decontamination of Children • Temperature Extremes • Decontamination water must not be ice cold for young children • Risk of hypothermia, especially in winter • Children must be covered immediately • Risk of injury if too hot or chemicals used • Do not use bleach in decon water • Do not use rough scrubbing devices

  34. Decontamination of Children • Special Equipment • Have a plan for special equipment on children or adults • Wheelchairs • Electronic equipment • Firearms

  35. Decontamination of Children • Special Issues • How long does it take a child to take a shower or bath normally? • Children may not be cooperative • Children will likely be frightened with protective suits • How do you track a non-verbal, naked child after decontamination?

  36. Chemical and Biologic Agents

  37. Chem/Bio Response • Frequently lumped together • Each will present to a different group and on a different timeline

  38. Timeline Chemical Attack First responders arrive DECON Presentation Of Symptoms Few Secondary Cases Seconds to Minutes

  39. Timeline Biological Attack Sick people present to hospitals/clinics/EMS People may not know about exposure Presentation Of Symptoms Incubation time Delay of hours to days Secondary Exposures?

  40. Biological Agents

  41. Biological Agents • Most Cat. A agents are detectable in their full-blown form • Characteristic symptoms, X-rays, or progression • Lab evaluation not typically rapid

  42. Widened Mediastinum of Anthrax

  43. Skin Lesion in Anthrax Infant patient

  44. Pneumonia of Plague + hemoptysis & fever

  45. Exanthem of Smallpox • Synchronous development of lesions • Cetrifugal pattern

  46. Paralysis ofBotulism

  47. Chemical Terrorism:Which Agents? • “Military Grade” Agents • Nerve Agents • “Blister Agents” (Vesicants) • “Blood Agents” (Cyanides) • “Choking Agents” (Phosgene, Chlorine) • Weapons of Opportunity • Toxic Industrial Chemicals

  48. Chemical Terrorism:Which Agents? • “Military Grade” Agents • Nerve Agents • “Blister Agents” (Vesicants) • “Blood Agents” (Cyanides) • “Choking Agents” (Phosgene, Chlorine) • Weapons of Opportunity • Toxic Industrial Chemicals

More Related