Disaster Preparedness

Disaster Preparedness Lisa Heeg M.D., PGY-1 Educator Advocacy Presentation October 18, 2012

What am I advocating for? • Physician awareness about disaster preparedness • Physicians need to prepare their own disaster plan. • Physicians becoming involved in community/hospital disaster preparedness efforts • Pediatricians advocatingfor the unique needs of children in disaster preparedness • UNSOM Pediatric residents participating in simulated disaster training • Teaching our patients and their families about the importance of disaster preparedness and how to do it

Presentation Objectives Which disasters might occur in your community. What makes children “special” in disasters? What is our role as a pediatrician in disasters? What is our role in educating our patients/families about disaster preparedness? What community resources are available?

Japan Earthquake and TsunamiMarch 11, 2011 • http://abcnews.go.com/GMA/video/what-about-japans-children-13130803

Effect of Tsunami on Children The earthquake and tsunami, which are so far known to have killed at least 2,700 people, struck in the mid-afternoon when many children were at school or kindergarten. The organization believes around a fifth of the 500,000 thousand people displaced by the disaster are children. Children who have been caught up in disasters can develop behavioral and mental health problems.

J. McCurry. Japan earthquake: 100,000 children displaced, says charity: Save the Children warns of psychological strain and behavioral problems facing Japanese children living in makeshift shelters. The Guardian, 15 March 2011

After seeing the devastating consequences of cascading disasters in Japan, we have to be asking ourselves: Is Las Vegas ready for such a catastrophic event? What is our role as pediatricians? What is the role of physicians in educating families about disaster preparedness?

Disasters in Las Vegas • Earthquakes • The Nevada Earthquake Safety Council says: • Nevada is ranked 5thnationally in estimated losses on an annualized basis due to earthquakes • 3rdbehind Alaska and California for being at risk from large magnitude seismic activity. • Toxic spill • August 2007- a tank car loaded with chlorine gas escaped the Arden train yard near Blue Diamond Road, rolling downhill through a densely populated area for 20 miles, 16 minutes before braking to a stop in North Las Vegas, after Union Pacific workers hopped aboard as it was slowing down • May 4, 1988- PEPCON plant in Henderson produced ammonium perchlorate, an oxidizer used by NASA and missile programs caused a series of explosions. The blasts killed 2 employees and injured more than 300. http://www.youtube.com/watch?v=NMofeKl4hpY&feature=related

Disasters in Las Vegas • Flash flood • Lives have been lost and property damaged on the Flamingo Wash near Boulder Highway • Blackout • Part of the system that if damaged by earthquake, rock slide, flash flood or wildfire would create havoc to supplying power to Southern Nevada. • Disease Threats • Meningitis, E.Coli • Terrorist attack • As one of the premiere tourism destinations in the world, Las Vegas is a terrorist target. • Home to a military base also draws attention • Chemical, biological and nuclear attacks.

Why Children Are “Special”? • Children are considered as a population among “at risk,” “vulnerable” or “special needs” populations • Children under the age of 18 comprise nearly 25 % of the U.S. population • Have important and often complex planning and emergency response needs

Children have unique needs that must be addressed in emergency preparedness: • Children require different dosages of medications and specialized equipment. • Children’s developmental and cognitive levels may impede their ability to escape danger, evacuate and self-identify. • Children may experience increased psychological effects. • Critically sick or injured children may have specialized transportation needs.

As pediatricians, what can we do? Pediatricians need to be able to: answer concerns of patients or families know when to recognize signs of possible exposure to a weapon of terror understand first-line response to such attacks sufficiently participate in disaster planning to ensure that the unique needs of children are addressed satisfactorily in the overall process.

For the community • Become aware of disasters that might happen in your community or state. • www.fema.gov • www.ready.gov • Participate in state planning activities. • Work with AAP Chapters to connect to or initiate state pediatric preparedness advisory councils. • Join the AAP Disaster Preparedness Contact Network to receive quarterly updates on relevant AAP activities, resources, and opportunities. • Help local child care programs and schools develop disaster plans. • Take part in community and hospital disaster planning, exercises, and drills. • Investigate opportunities to sign-up to volunteer in advance, provide guidance to medical volunteer programs, and promote hospital preparedness. • Community Emergency Response Team (CERT) • Medical Reserve Corp (MRV) • Advocate for the needs of children in federal, state, and local planning.

For the hospital During a disaster, the physician’s role will be predicated by the disaster plan, hencefamiliarity with the plan is paramount. • Important questions to ask: • (1) Where should the pediatrician go during the disaster? • (2) How should pediatricians be notified that they are needed to respond to the disaster? • (3) How should hospital physicians be identified and notified to go to the scene to attend to victims of the disaster? • (4) How should transfers of pediatric patients in the hospital and discharges be handled? • Resources: • Emergency Preparedness Coordinator at UMC • Contact Wendy at 702-207-8822 • Email: Wendy.pagen@umcsn.com • Emergency Operative Plan • Found on Intranet under Emergency Preparedness

For your practices • Equipment • Computer equipment, diagnostic instruments, and lab tests are usually among the most expensive items in a pediatric office. • Patient information • Office and patient files are often irreplaceable and thus should be moved. • All EMR files should be backed up. • Vaccines deserve special consideration, as they represent a significant financial investment, requiring special storage. • Some regional facilities—such as a local hospital or health department— may agree to store vaccines for pediatricians. • Pediatricians evacuating the area may prefer to take the vaccines with them, in insulated shipping boxes or coolers. • Vaccine manufacturers may offer credit or partial credit for spoiled vaccines after a major disaster.

For your patients • Talk to parents about the need to develop a family disaster plan. • Provide families with information on how to create a family emergency plan, discussing this plan with their children, and practicing the plan. • Support emergency preparedness for individual children by coordinating completion of appropriate Emergency Health Forms.

For your family • Practice what you preach! • Prepare and regularly update a preparedness plan for your home and family. • Relatives, friends or colleagues out of the disaster area should be contacted beforehand to serve as “safe houses” for your family. • Have a “disaster kit” ready with essentials. • Recommend a smaller “go kit” for your car

Evacuation • Pediatricians have a responsibility to the medical needs of the community. • If the pediatrician’s hospital will be evacuated and closed, the pediatrician must ensure the safety of his or her patients before leaving, by arranging appropriate discharge or transfer. • Hospitals that intend to remain functional through a disaster will usually need a pediatrician in-house; coverage arrangements should be worked out ahead of time. • Pediatricians at liberty to leave must balance what is best for themselves, their families, and their communities.

Medical Equipment • stethoscope • otoscope/ophthalmoscope (and specula) • Spare bulbs, charger or batteries • tongue blades • tape measure • alcohol wipes, gloves • reference books, calculator • thermometer • syringes and needles for administering medicines and vaccines • sharps container for safe disposal • fitted respirator masks, such as a N95 mask, for airborne illnesses, mold and other biohazard exposure • Consider taking small “goodies” for children, such as stickers, small books or toys.

Medical Supplies • Acetaminophen/ibuprofen • Diphenhydramine • Antibiotic ointment (Neosporin or mupirocin) • Oral antibiotics that do not require refrigeration (Omnicefand Zithromax) • Injectable antibiotics (ceftriaxone) • Steroids syrup (e.g., Orapred) pills (prednisone) injection (dexamethasone) • Portable battery-powered or DC-powered nebulizers • MDI or spacer • Pre-mixed vials of albuterol

How prepared are our patients and their families?

Specific tactics which are targeted towards those in the two different stages of non-action • Precontemplation • Represent the largest and most challenging audience • May feel a sense of immunity to the issue • Will likely require an approach which facilitates an engagement of the topic using a tailored and indirect method. • Contemplation • More likely to be encouraged to act • To motivate this group to change their behavior may require another specially tailored approach which acknowledges and addresses the ambivalence they likely feel towards preparedness.

How do we start the conversation? • Ask parents about their child’s awareness of natural disasters, their degree of exposure and their reaction. • An opportunity to advise parents about how best to have the discussion with their children. • Be honest • Use age appropriate language • Talk with their children about a specific plan. • The goal of these discussions should be to help the child to feel in control of a threatening situation.

Preparing for an Emergency:What should parents know? • Do you know how you would contact all members of your family and where you will all go to be safe? • In addition to putting together an emergency supply kit, it is important to create a family emergency plan, with information like: • a neighborhood meeting place • an out-of-town meeting place • names and locations where each family member can typically be found • emergency contacts • important medical history • You should also make sure you child's school and other places he spends time has an emergency plan.

What about children with special needs? • Pediatricians should provide guidance to families of children with special health care needs regarding: • notification of utility companies to provide emergency support during a disaster • maintenance of medications and equipment should supply be disrupted during a disaster • knowledge of how to obtain additional medications and equipment during times of disaster • training for family members to assume the role of in-home health care providers, who may not be available during a disaster • keeping an up-to-date emergency information form to provide health care workers with the patient’s medical information should the regular care provider be unavailable.

Community Resources • www.fema.gov • www.ready.gov • http://www2.aap.org/disasters/ • http://www.usfa.fema.gov/kids/flash.shtm • http://www.southernnevadahealthdistrict.org/php/index.php • http://www.redcrosslasvegas.org/Disaster_Services.php

What are my goals from this advocacy presentation: • Be aware:You’ve already started by listening to this presentation • Prepare:100% Pediatric resident physicians to have prepared a personal disaster kit by the end of the academic year • Get involved:Lied and KHC to have comprehensive medical disaster preparedness kits and a designated person to maintain it by the end of the academic year • Advocate:AAP Class representatives bring up Disaster Preparedness at the next AAP Chapter meeting • Participate: UNSOM Pediatric residents to participate in at least one UMC Simulated Disaster Drill in a year with 50% resident attendance • Teach our patients:Add to anticipatory guidance of the 2 month visit and school aged children. Make use of resources.

References • http://www.unep.org/tsunami • J. McCurry. Japan earthquake: 100,000 children displaced, says charity: Save the Children warns of psychological strain and behavioural problems facing Japanese children living in makeshift shelters. The Guardian, 15 March 2011 • http://www.fema.gov • http://www.ready.gov/kids • www.childrenanddisasters.acf.hhs.gov. • http://www.fema.gov/pdf/about/divisions/npd/CPG_101_V2.pdf • http://pediatrics.aappublications.org/content/117/2/560.full.html • http://www.aap.org/en-us/professional-resources/practice-support/Pages/A-Disaster-Preparedness-Plan-for-Pediatricians.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token • http://www.savethechildren.org/publications/emergencies/Children-in- Emergencies-Planning-Guide.pdf • http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response/management-public-health.page? • Andrew Garrett MD, MPH David Abramson PhD, MPH Irwin Redlener, MD . Selling Disaster Preparedness to the Public: Why Are They Not Buying?

Disaster Preparedness