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PDLS 2.0 Outline

PDLS 2.0 Outline. Draft 21 December 2019. Course Introduction. Pediatric Disaster Life Support is designed to give emergency personnel a foundation of knowledge and skills to allow them to more effectively respond to a disaster involving children

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PDLS 2.0 Outline

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  1. PDLS 2.0 Outline Draft 21 December 2019

  2. Course Introduction • Pediatric Disaster Life Support is designed to give emergency personnel a foundation of knowledge and skills to allow them to more effectively respond to a disaster involving children • The structure and timeline of the course can fit in as little as 1 day or be expanded to 2 days for those requesting additional practice

  3. Prerequisite Training • This course builds on the fundamental pediatric assessment and resuscitation skills that are the backbone of courses such as: • Pediatric Advanced Life Support (PALS) • Advanced Pediatric Life Support (APLS) • Pediatric Emergency for the Prehospital Provider (PEPP) • One of these courses is prerequisite • Or equivalent professional experience

  4. Concurrent PALS Training • It is the goal that the PDLS training course described here will be paired with an opportunity to obtain PALS certification as well • The day prior to PDLS training would be the “skills and examination day” for PALS • Attendees wishing to obtain PALS certification will have completed the new on-line PALS course to prepare for the “skills and examination day”

  5. On-line PALS Day 1: Pediatric Skills (PALS Testing) Day 2: Pediatric Disaster Life Support course Day 3: Optional Additional Modules for PDLS

  6. PDLS Syllabus • Registration • Introduction • Fundamental Concepts in Pediatric Disaster Medicine (didactic) • Case Study Exercise • Practical Issues in Pediatric Disaster Medicine (didactic) • Field Training Practical Exercise • Debriefing and Test

  7. PDLS Syllabus • Optional Additional Modules: • Practical Disaster Scenarios • Expanded WMD/biohazard didactic training

  8. Introduction • Beginning Lecture • “Children as victims of disasters and terrorism” • Introduce statistics • Examples of disasters affecting children • Establish that children have unique needs • Concept of children “not fitting the mold” for standard preparedness dogma • Caring for children more difficult for providers • Introduce new paradigm • Children as intentional victims of terrorism • Purpose of PDLS • Teach basic concepts to allow for children to have to same chance as adults to to survive disaster

  9. Fundamental Concepts • Purpose • Establish a framework of pediatric-specific knowledge pertinent to disaster medicine • Build on general concepts in pediatric assessment and resuscitation such as those taught in Pediatric Advanced Life Support (PALS)

  10. Fundamental Concepts • “Children don’t fit the mold” • Most disaster medicine concepts have grown from adult and military model • Specific needs demand specific planning • Focus on vulnerabilities of children to tailor disaster response options already in place

  11. Biological Psychological Social Fundamental Concepts • A “Bio-Psycho-Social” approach • Recognizes that effective preparedness and response requires integration of three realms

  12. Biological Fundamental Concepts • BIOLOGICAL • Anatomy and Physiology unique to children • Focus on vulnerabilities of children, not on resuscitation • Discuss relationship to: • Environmental exposure (heat, cold, entrapment) • Decontamination • Susceptibility to Chemicals, Toxins • Behaviors that increase risk • Immature immune systems • Lack of verbal skills • Lack of self-preservation skills

  13. Fundamental Concepts • PSYCHOLOGICAL • Emotional Response to Disaster • Focus on general concepts, not by age group • What to expect & scope of problem • Behavior changes, aggression, regression • Post traumatic stress and anxiety • Latest research from disaster setting • How to anticipate and recognize problems • How to help • How long do these disorders last? • Where is help available? • Integrating these concepts into disaster prepared- ness and response plans Psychological

  14. Fundamental Concepts • SOCIAL • Kids are irreversibly integrated into our society • If children are not accounted for, parents will not comply with officials • Adapting to the concept that children may be intentional targets of terrorism • Role of parents in disaster • Role of media in disaster, a double edged sword • Role of schools, where children spend the bulk of their time away from home • Children routinely cause increased stress in emergency providers Social

  15. Case Study • Hypothetical Hurricane Fiona (2010) • Same track as Hurricane Katrina 2005 • Role play from 3 perspectives/phases: • Planning • Response • Recovery • Students will assume leadership roles and open forum discussion will occur • Goal is to apply material from Fundamental Concepts session and discuss how children will be accounted for in all three phases of a major event

  16. Practical Issues • Goal of this section: • To apply the vulnerability concepts learned in the Fundamental Concepts session • Teach specific information which will enhance the application of this information in pediatric disaster planning, response, and recovery • Further develop the Bio-Psycho-Social model’s applicability to disaster medicine

  17. Practical Issues • Pediatric Triage: JumpSTART tool • What exactly is triage, how and where is it used? • Why develop triage tools in the first place? • Mass casualty incident • Mass casualty receiving • Re-evaluation • Review adult START triage • Why modify adult triage? • Review anatomy/phys • Handout protocol

  18. Practical Issues • Focus on integration, rather than separation, of pediatric triage concepts • Mini simulated drill with poll-the-audience response • Show video/slides of 10 adults and children requiring triage at both MCI scene and a casualty receiving point

  19. Practical Issues • Children with Special Health Care Needs: • Introduce scope of issue with statistics • Examples from Indonesia and Katrina • What may be affected? • Mobility • Communication (Visual/Verbal/Hearing) • May be technology-dependent (examples) • Resources required • Emphasize the integration, rather than separation of CSHCN • How will this affect the following two topics • Sheltering • Decontamination

  20. Practical Issues • Sheltering • What aspects of shelter management may not work well for children as they exist now? • Identify and plan for specific needs in advance: • Security • Safety (childproofing, etc.) • Hygiene • Nutrition • Health Screening • Sleep schedule • CSHCN • Recreation • Should CSHCN be sheltered separately or integrated?

  21. Practical Issues • Decontamination • What aspects of on scene and hospital decon need to be addressed for children? • Patient flow (need to keep with parents) and timing • Prevention of heat and cold injuries • Chemical decontamination dangerous to kids (e.g. bleach) • Clothing for children after decon • CSHCN durable medical equipment/hardware • Responding to surge capacity • Ensuring responder safety • Tracking non-verbal naked children • What do you do with exposed children before decon occurs? • Utilize concepts from BCH Pediatric Decon DVD

  22. Practical Issues • Chem/Bio/Rad • Issues facing children during these incidents • Review why children may be at higher risk during an exposure based on behavior and biology • Utilize Cieslak/Henretig material • Specific topics: • Personal Protection • Diagnosing exposures in children • Role of Primary Care • Immunization • Prophylaxis challenges • Treatment challenges

  23. Field Exercise • Purpose • Give students a focused, practical experience to apply the skills learned in PDLS • Review key concepts: • JumpSTART Triage • Resource Allocation • Need for proper decontamination • Recognizing suspicious pattern of illnesses • Same scenario approached from two angles • “secure” mass casualty incident requiring triage • Mass casualty receiving and decon at the closest emergency department • Course director will choose scenario based on audience

  24. Field Exercise 1 Schoolbus Triage on scene Chemical Tanker Triage at hospital 1 driver 1 escort 14 children 1 child in wheelchair 1 deaf child Decon Hospital

  25. Field Exercise 2 School Shooting 1 teacher 1 principal 20 children 1 child in wheelchair 1 visually impaired child Triage on scene Triage at hospital Hospital

  26. Field Exercise 3 2 pilots 20 children 1 child in wheelchair 1 visually impaired child Triage at hospital Hospital Triage on scene

  27. Debriefing and Test • Discussion of scenarios • Short examination • Evaluation • Train the trainer comments

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