Pediatric Disaster Planning

 Protocols for Managing Child Victims during a Disaster Surge

           

            In any disaster whether natural or man made, children may be part of the population of victims.  Further, children may makeup the largest portion of a surge if a school or day care center is affected by a natural disaster or if children are the express target of terrorist efforts.

            Children may present to the hospital with or without their parents or known adult.  Their parents may or may not require medical attention themselves.  The hospital has protocols in place to address the following:

·        Victims requiring medical intervention are triaged with the knowledge that because of their size and physiology children require more immediate attention and intervention than an adult with the same injury and/or exposure.

·        Children’s injuries and/or exposure elicit a greater sense of panic amongst parents, rescuers and care providers than similar injuries and/or exposure in an adult.

·        Parents’ sense of anxiety about their children requires they learn their child’s whereabouts and condition as a first priority and they are by their child as a second priority.

·        Children’s sense of anxiety requires they know their parents whereabouts as a first priority and have their parents with them as the second.

·        Children and parents who present to the hospital together may need to be separated for diagnosis or treatment.

·        Children who are brought to the hospital without their parents may not be in the company of a known adult and may require crisis intervention simultaneous to triage and medical intervention.  Crisis intervention may be necessary to gain the child’s cooperation with diagnosis and treatment.  This would be so especially if there were a group of children who required hazardous material decontamination.  

·        Children may present to the hospital without identification and may be unable to provide identifying information.

·        Children brought to the hospital may not require treatment but may require supervision until their parents arrive or their parents are treated.

 

To address these scenarios, the hospital has the following protocols for which the staff are trained and practiced through drills.

1. Security staff are trained to direct anxious families arriving at the Medical Center to the appropriate portal of entry for triage and treatment.
2. Security staff are trained to direct anxious family members seeking victim relatives to the Family Assistance Center.  Security staff have available direction to the Family Assistance Center written out in common foreign languages known to be present in the community.

3. Security staff are trained to get backup and to access the Mental Health Unit when they encounter surge situations that have not been responsive to direction.
4. Triage nurses and ED physicians keep themselves informed of the ages of incoming disaster victims so staff and material preparations can be made as quickly as possible and child victims can be triaged first, if warranted.
5. Children arriving with their parents are co-banded with their parents facilitating reunion if they need to be separated. 
6. If parents or children do not require treatment and must wait while the other is being treated, they will be cared for at the hospital’s Family Assistance Center, the assigned “pediatric safe area.”  The Family Assistance Center has the space, communications, material and trained Mental Health staff to attend to the needs of all family members.  Co-banding will facilitate children waiting in the Family Assistance Center being reunited with: a) parents who have undergone treatment or, b) other relatives who have arrived at the Family Assistance Center to be with or claim the child after proper identification and permission has been established.  Co-banding will facilitate the reunion of waiting parents with children who have been treated.
7. Children arriving without their parents will be registered as patients and if unable to provide a name, will have their physical description and any other identifying information appear on the patient tracking form.  This information will be available to the staff in the Family Assistance Center who will seek to identify the child’s relatives based on matching up that identifying information with the identifying information they have obtained from relatives using the Lost Patient Form.  The information on the Lost Patient Form will also be accessible by the Patient Tracking Officer and the Public Information Officer.