Pediatric Disaster Preparedness


Recent natural disasters and terrorist actions have generated a recognized need for nation- and community-wide emergency preparedness. 

With regard to pediatric health concerns, appropriate planning is essential to ensure that children receive the necessary care once disaster – whether natural or man made – strikes.  Children are not simply small adults; due to their size, physiology, and cognitive development, they have a unique set of responses upon exposure to the infectious organisms associated with public health epidemics or the chemical, radiological, and biological agents of terrorist attacks.  They also have certain psychological vulnerabilities that require special attention. 

Consequently, the Emergency Medical Services for Children (EMSC) Program encourages its grantees to become actively involved in state and local disaster preparedness planning efforts to guarantee that children have access to the right services and support before, during, and after disaster events.

HEALTHCARE PROVIDER RESOURCES

Emergency Medical Services for Children (EMSC) National Resource Center

  • Disaster Volunteer Opportunities by State. This interactive map is designed to provide healthcare professionals – including those focusing on pediatric care – a resource to identify disaster volunteer agencies in their state.  As the user clicks on individual states, agencies recruiting volunteers are listed in alphabetical order along with the type of healthcare volunteers needed and any required training or certifications.  Volunteer applications for each agency are also provided. (January 2010)

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EXAMPLE PRACTICES

Florida Emergency Medical Services for Children (EMSC)

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FAMILY AND CAREGIVER RESOURCES


EMSC National Resource Center

More details about this and other family and caregiver resources

HEALTHCARE PROVIDER RESOURCES

EMSC National Resource Center

American Academy of Pediatrics

  • Children and Disasters. This section of the American Academy of Pediatrics’ (AAP) website includes information about disaster preparedness for children, families, health care providers, teachers, and others and offers a wide variety of resources including policy statements, online planning tools, fact sheets, and journal articles.  (Accessed February 2010)

    • The Resources component of the Children and Disasters site includes extensive links to preparedness materials organized by audience, topic, and title. (Accessed February 2010)

  • CHILDisaster Network.  The Academy has developed the Child Health International Large Scale (CHIL) Disaster Network – a network of pediatric professionals available to accompany organizations responding to disasters on short-term notice. This website describes this endeavor and the application process. (Accessed February 2010)

  • The Pediatrician and Disaster Preparedness.  This policy statement and related technical report address the challenges of dealing with the threat of terrorism, natural disasters, and public health emergencies.  It further considers the role of the pediatrician in: answering concerns of patients or families, knowing when to recognize signs of possible exposure to a weapon of terror, understanding first-line response to such attacks, and participating in disaster planning. (February 2006)

  • Psychosocial Implications of Disaster or Terrorism on Children: A Guide for the Pediatrician.  This clinical report describes children's responses to disaster situations, risk factors for adverse reactions, and strategies that can be taken by pediatricians to lessen the effects of disaster on children. (September 2005)

American Medical Association

  • Improving Health System Preparedness for Terrorism and Mass Casualty Events.  The American Medical Association (AMA), in partnership with the American Public Health Association (APHA), convened multidisciplinary summit meetings involving medicine, dentistry, nursing, hospital, emergency medical services (EMS), and public health leaders to assess health system preparedness for terrorism and other potential mass casualty events and to develop action-oriented recommendations (inclusive of children’s needs and consistent with the Institute of Medicine’s guidance in Emergency Care for Children: Growing Pains, 2006) to improve and sustain health system preparedness.  This publication is the result of the proceedings. (July 2007)

Association of Maternal and Child Health Programs

  • State Emergency Planning and Preparedness Recommendations for Maternal and Child Health Populations.  This publication provides an overview of disaster preparedness.  It presents key concepts that need to be considered in disaster scenarios, including: the impact of emergencies on the different maternal and child health (MCH) populations, the preparedness needs of state MCH programs, current efforts to enhance MCH preparedness, and state accomplishments in integrating the needs of the MCH population into emergency plans. (November 2007)

Center for Pediatric Emergency Medicine

Children’s National Medical Center’s International Center to Heal Our Children

  • Handbook of Frequently Asked Questions Following Traumatic Events: Violence, Disasters, and Terrorism.  This publication is designed to support schools, children's hospitals, community centers, ambulance services, rural hospitals, EMS services, mental health professionals, and parents with information about how to recognize normal child reactions to stress; recognize and understand the stages of grief in children and adolescents; identify children who need help and are at risk for long-term stress related conditions; and provide guidelines to answer common questions children and adults ask following acts of violence, disasters, and terrorism. (2005)

Illinois EMSC Program

  • Pediatric Disaster Preparedness Guidelines.  This product offers guidelines to serve as a resource in addressing the needs of children during disaster planning.  It is available as a downloadable document through the NRC website. (August 2005)

  • Disaster Preparedness Exercises Addressing the Pediatric Population.  This document, prepared by the Illinois EMSC program, contains scenarios and exercises primarily involving children to better prepare EMS, fire department/law enforcement, emergency department, hospital and long-term care facilities for a disaster situation. Along with the exercises, a check list is provided to help better assist the emergency situations. (December 2006)

Massachusetts Department of Public Health

  • Developing an Emergency Response Plan for Your School. These guidelines were developed by a statewide group of school nurses and paramedics to assist schools in preparing for emergencies. They include suggestions for developing an emergency response team in the school, recommendations for equipment and supplies to stock, and guidelines for training staff and students in bystander response (February 2000)

Missouri Department of Mental Health

  • Disaster Communications Guidebook.This guide provides preparedness strategies that improve resilience and foster greater coping skills in disaster events. By integrating this information into disaster readiness campaigns and programs, organizations can help minimize fear and improve emotional well-being in the face of terrorist acts or catastrophic disasters. (August 2006)

National Association of Child Care Resource and Referral Agencies

  • Disaster Planning and Recovery Basics. This section of the National Association of Child Care Resource and Referral Agencies’ website includes downloadable resources related to disaster policy recommendations for national, state, and local policymakers. (Accessed February 2012)

National Association of School Nurses

National Center for Disaster Preparedness: Columbia University Mailman School of Public Health

  • Executive Summary from a National Consensus Conference on Pediatric Preparedness for Disasters and Terrorism.  Funded by the Agency for Healthcare Research and Quality (AHRQ) and the federal EMSC Program, this document provides pediatric emergency preparedness guidelines and treatment recommendations. The report also includes guidance for prehospital and hospital care, recommendations on training, and specific guidance regarding appropriate pediatric equipment, providers, dosages, and treatment protocols across the range of possible public health emergencies. (2003)

National Children's Advocacy Center

New York City Department of Health and Mental Hygiene

Tennessee EMSC Program

  • Pediatric Disaster Online Courses.  These online educational courses are designed to help improve disaster response in the state. The courses are for healthcare providers and other professionals who may be expected to respond in the event of large-scale disasters.  They include modules dedicated to: (1) disaster preparedness for schools, (2) children with special healthcare needs, (3) explosion and blast injuries, (4) bioterrorism, (5) chemical incidents, and (6) radiation disasters. (2009)

University of New Mexico Health Sciences Center, Division of Pediatric Emergency Medicine

  • Virtual School Nurse and EMS Learning Project.  This streaming online video series, from the University of New Mexico Health Sciences Center with funding from the federal EMSC program, provides education and training opportunities related to school nurse preparedness.  Approved by the New Mexico Nurse Association, the 15 training modules address such topics as: emergency preparedness program planning, patient assessment and triage, and emergency care of the airway, spine, and musculoskeletal system (2008)

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality

Centers for Disease Control and Prevention

  • Emergency Preparedness and Response Site.  The purpose of this website is to increase the nation’s ability to prepare for and respond to public health emergencies including bioterrorism, chemical, radiation, mass casualty, and natural disasters and severe weather. Pediatric-specific information, such as Children and Anthrax, is also available to assist healthcare providers. (Accessed February 2010)

Food and Drug Administration

Substance Abuse and Mental Health Services Administration

  • Disaster Technical Assistance Center.  This section of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) website offers a variety of resources and toolkits to support health care providers in addressing children’s mental and behavioral health concerns resulting from disaster encounters. (Accessed February 2010)

EXAMPLE PRACTICES

Florida Emergency Medical Services for Children (EMSC)

The Florida Bureau of Emergency Medical Services, which houses the state’s EMSC program, has compiled a number of Disaster Response Resources online.  This website provides tools designed to help members of the EMS community prepare, respond, and recover in the face of hazard.  Resources available through the site include EMS Provider Pan Flu Guidelines, prescribing information and model protocol examples, statewide emergency response plans, and Multicasualty Incident (MCI) field triage guides.

Specific to pediatrics, the Florida EMSC program has sponsored a number of initiatives relating to children and disasters.  These include the:

  • Guidelines for Pediatric Equipment Inventories in EMS Disaster Response Trailers, a list of guidelines for essential pediatric equipment to be stocked in EMS Disaster Response trailers. (March 2004);

  • Hospital Pediatric Equipment Inventories for Disaster Response, a compilation of key pediatric equipment and supplies hospitals should stock to ensure adequate emergency disaster response resources for children. (March 2004)

  • JumpSTART Pediatric Multicasualty Triage Tool, an algorithm modeled after the mass casualty incident triage tool most commonly used in the United States that applies specifically to pediatric triage in the face of disasters and other large-scale events.  It is designed to optimize primary triage of injured children, enhance the effectiveness of resource allocation, and reduce the emotional burden on triage personnel faced with life-or-death decisions under pressure. (Revised December 2009); and

  • Kids in Disaster Kits (CD-ROM). This kit, often referred to as the K.I.D. Kit, provides child and family–centered materials addressing disaster triage, the Broselow-Luten principles of color-coding children, tools for responding to incidents involving agents of chemical warfare, and several other aspects of pediatric disaster planning and preparedness. Six presentations are narrated and self-contained; all presentations are also available in their original PowerPoint formats. A number of the presentations are available in Spanish. For those interested in teaching primary multi-casualty incident triage using START and JumpSTART, all the files you need have been included in the K.I.D. Kit. For a free copy of the CD-ROM, contact the NRC at emscinformation@childrensnational.org. (2008)

Illinois Emergency Medical Services for Children (EMSC)

Since the 1990s, Illinois’ EMSC Program has included disaster preparedness among its core mission areas.  Beginning in 1998, the Illinois Department of Health (IDPH) initiated a Pediatric Facility Recognition program to formally recognize hospitals for their Emergency Department preparedness.  This program requires hospitals to comply with defined pediatric standards and undergo a site visit every three to four years.  In 2002, the Pediatric Facility Recognition program expanded to include Pediatric Critical Care preparedness in hospitals. 

Next, in 2004, IDPH/EMSC added another component to the Pediatric Facility Recognition program and began to review hospital disaster plans during the site visits.  This provides an opportunity during the site survey process to identify any areas of need and offer recommendations on incorporating children into hospital disaster plans.  These hospital disaster plan reviews, which have been conducted throughout the state, have been highly assistive in identifying a number of common areas of need such as:

  • Decontamination process for infants/small children

  • Pediatric surge capacity

  • Identification process for unaccompanied children

  • Development of a designated holding area for children pending discharge/reunification

  • Reunification process for children with their parents/designated caretakers

  • Addressing the needs of Children with Special Health Care Needs

Illinois EMSC also maintains a specific webpage on Pediatric Disaster/Multicasualty Preparedness. Here, you will find links to a wide variety of useful pediatric disaster preparedness resources and tools including:

  • A Pediatric Disaster Preparedness Checklist for Hospitals;

  • Information on the Illinois Medical Emergency Response Pediatric Specialty Team;

  • Specifics on the activities of the Illinois Terrorism Task Force’s Bioterrorism Workgroup

  • A pediatric preparedness resource catalogue; and

  • A listing of web-based disaster preparedness resources.

Children’s Hospital Boston

The Center for Biopreparedness housed at Children’s Hospital Boston was created in June 2003 with the assistance of a contract from AHRQ to be a national Center of Excellence in all pediatric aspects of public health preparedness and consequence management after acts of terrorism and other disasters.

Over the past two years, the Center has: (1) trained personnel throughout the hospital on principles of terrorism, campus security and consequence management, (2) purchased and configured equipment for the management of mass casualty incidents, (3) developed pediatric surge capacity protocols, (4) purchased personal protective equipment and trained emergency personnel in the management of pediatric victims, (5) developed decontamination protocols for pediatric victims of chemical or radiation exposure, and (6) provided education to the Greater Boston medical community in pediatric aspects of homeland security/public health preparedness.

The Center also conducts original research that examines the efficacy of systems and protocols that have been developed through preparedness efforts. Since 2000, the Center scientists have published more than 20 research papers, examining issues such as the value of educational websites in enhancing physician knowledge of bioterrorism, the ability to identify infection clusters, using both temporal and geospatial data, and innovative methods of clinical decision analysis that assist in the prompt recognition of infectious outbreaks. These investigations and the resulting systems are currently being examined for their ability to rapidly identify emerging infections of all types, including West Nile virus and SARS. The Center's syndromic surveillance systems are among the most extensive and sensitive instruments currently available.


FAMILY AND CAREGIVER RESOURCES

EMSC National Resource Center

  • Disaster Preparedness: Planning for Children and Youth with Special Health Care Needs (English) (Spanish) This fact sheet contains information on disaster preparedness for children with special health care needs.  It provides guidance on how families can prepare their child and/or youth, their home, and neighborhood.  The sheet also includes a list of useful resources. This fact sheet is also available in Spanish. (2006)

American Academy of Child and Adolescent Psychiatry

  • Disaster Resources for Families.  This section of the American Academy of Child and Adolescent Psychiatry’s website includes publications, online tip sheets, and links to other mental health resources focusing on natural and man-made disasters, communications, and children.  (Accessed February 2010) 

American Academy of Pediatrics

  • Family Readiness Kit: Preparing to Handle Disasters. This kit is for parents to use at home to help prepare for most kinds of disasters. It includes information on understanding disasters, steps to take to prepare for a disaster involving your family, family disaster supplies list, and disaster fact sheets addressing hurricanes, earthquakes, floods, tornadoes, tsunamis, winter storms, and terrorism. The overview booklet is also available in Spanish. (February 2010)

  • Children and Disasters. This section of AAP’s website includes information about disaster preparedness for children, families, teachers, and others and offers a wide variety of resources including planning kits and reference materials. (Accessed February 2010)

American Red Cross

  • Masters of Disaster.  This online resource is divided into educational areas for teachers and children and includes a family readiness kit, games, and other informational resources to assist children in learning how to prevent, prepare for, and respond to disasters.  (Accessed February 2010)

  • Preparedness Fast Facts.  Offering tips on man-made disaster preparedness and response for families, this web page provides guidance on creating emergency communications plans, establishing meeting places, and assembling emergency preparedness kits.  It also provides information on basic emergency medical care and what families might expect following acts of terrorism. (Accessed February 2010)

  • Talking to Children About Disasters.  This guide provides tips for families and caregivers on how to communicate with children during disasters, including advice on how to answer typical questions. (March 2007)

Florida Institute for Family Involvement

  • Disaster Preparedness for Families of Children with Special Needs.  This publication offers tips on preparing for and responding to disasters and is specifically designed for families of children with special healthcare needs.  It includes preparedness checklists as well as tips on creating disaster response plans and supply kits.  Links to other useful preparedness resources are also included. (Accessed February 2010)

National Association of Child Care Resource and Referral Agencies

National Association of Pediatric Nurse Practitioners

NYU Child Study Center

  • Bioterrorism: Talking with Kids About Threats They Can’t See.  This online resource answers a variety of questions parents might have regarding how to explain bioterrorism to children, including how children might react, what children are most worried about, how to make a family safety plan, and how to reassure children and help them deal with their worry and concern. (Accessed February 2010)

Texas Department of State Health Services

  • Emergency and Disaster Planning for Children with Special Health Care Needs.  The Children with Special Health Care Needs (CSHCN) Services Program of the Texas Department of State Health Services offers this bilingual (English/Spanish) booklet on disaster preparedness for CSHCN and their families.   It includes checklists, internet resources, and tips on supplies and first aid kits.  (March 2008)

US Department of Health and Human Services: Flu.gov

  • Individual and Family Planning.  As a component of flu.gov, an interagency online resource managed by the Department. of Health and Human Services, this website includes checklists, toolkits, and guidelines designed to assist individuals and families in planning specifically for an influenza pandemic. (Accessed February 2010)

National Institutes of Health

Substance Abuse and Mental Health Services Administration

US Department of Homeland Security: Federal Emergency Management Agency

  • Federal Emergency Management Agency (FEMA) for Kids. This website teaches children how to prepare for disasters and prevent disaster damage. Resources include information on what causes disasters, online educational games and stories, as well as materials for parents and teachers. (Accessed February 2010)

  • Are You Ready? An In-Depth Guide to Citizen Preparedness. This guide is designed to help individuals and families protect themselves against all types of hazards.  The focus is on how to develop, practice, and maintain emergency plans that reflect what must be done before, during, and after a disaster to protect people and their property.  (August 2004)

  • Ready.gov. This FEMA website provides individuals and families information through its Ready America campaign, which seeks to help citizens prepare for disasters.  The site contains links to detailed information on preparing disaster supply kits, creating emergency plans, and staying informed.  Additional Resources available include family emergency materials such as the Just in Case – Family Plan fill-in-the-blank worksheet, as well as links to state and local entities responsible for disaster preparedness. Listo.Gov is the Spanish language version of the site. (Accessed February 2010)

    • Ready Kids. A component of Ready.gov, this interactive website helps children work with their families to prepare for disasters. It includes guidance on how to create a disaster kit and make an emergency plan, and features detailed information on tornados, earthquakes, fire emergencies, flooding, tsunamis, hurricanes and terrorism. (Accessed February 2010)

    • Listen, Protect and Connect: Psychological First Aid for Children and Parents. Available for download from the Ready.gov site, this publication provides information to parents and caregivers on how to address the psychological vulnerabilities of children and youth after they experience a disaster.  (2006)

  • Helping Children Cope with Disaster. Developed in collaboration with the American Red Cross, this booklet offers parents, caregivers, and other adults suggestions on how to help children cope with the effects of disaster, as well as how to be prepared before a disaster strikes. (August 2004)