Addressing Pediatric and School-based Surge Capacity in a Mass Casualty Event

1. Addressing Pediatric and School-based Surge Capacity in a Mass Casualty Event Michael Shannon, M.D. Director The Center for Biopreparedness Division of Emergency Medicine Children’s Hospital Boston Harvard Medical School Boston, MA

2. Surge Capacity and Children: Key Issues • Every type of disaster can occur • Two scenarios to consider: • School is a target • Community disaster while school is in session

3. Key Challenges in Consequence Management • EMS, fire and other public health agencies • Decontamination teams • Non-pediatric hospitals emergency departments • Hospital response • Hospital campus security • Mental health response and recovery • Mass distribution of antidotes, antibiotics, and vaccines • Inclement weather

4. The Challenges of Mass Casualty Incidents Involving Children vs. Adults • Biological – immature immune system  greater morbidity/mortality • Chemical – difficult to assess, manage and keep warm during decontamination • Radiological – significantly increased risk of cancer (e.g., thyroid)

5. The Challenges of Mass Casualty Incidents Involving Children vs. Adults • Blast – difficult to stabilize during the “golden hour” • Burns – greater likelihood of life-threatening fluid loss and susceptibility to infection

6. School Crisis Response Manual: Guiding Principles • Guidelines are desperately needed • General templates can be created but no one size fits all • The main steps in creating a school plan are: • Interviews with principal • Interviews with school nurse • A walk through with the custodian • Include after-school programs

7. School Crisis Response Manual: Guiding Principles • Steps in creating a school plan – cont’d • Integrate into the existing plans, e.g., evacuation (fire drills) • All plans take weather into account • New plans needed for sheltering-in and lockdown • Drills, including table-top exercises, are an important part of school readiness

8. Role of DMAT in Disasters Involving Children • Currently limited because there are only 2 in the U.S. • Compelling need to develop more • Existing DMAT teams need ongoing training in pediatric response

9. Emergency Department Challenges in Disasters Involving Children • Adequate number of pediatric supplies • Pediatric decontamination equipment and protocols • Effective response to large numbers of burn victims • Assessing non-verbal children

10. Additional Emergency Department Challenges in Disasters Involving Children • Treating children while wearing personal protective equipment • Effective systems for identification, tracking, and reunification • Use of alternate sites (e.g., schools, neighborhood health centers)

11. AHRQ-Sponsored Pediatric Protocols Under Development • Completed • Training video: The Decontamination of Children • Near-Complete • Pediatric Aspects of Surge Capacity Planning • The Role of DMAT in Pediatric Mass Casualty Incidents • In Production • Effective School-based Response to Disasters and Other Public Health Emergencies