Pediatric Surge Pocket Guide

State: CA Type: Model Practice Year: 2011

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"The unique developmental, psychological and physiological attributes of children make them one of the most vulnerable populations in the event of a disaster or terrorist attack. Developmentally, children often lack motor skills to escape from the site of a chemical, biological or other terrorist incident. Children also lack cognitive decision-making skills to figure out how to flee from danger or to follow directions from others. Physiologically, they are especially at risk.

In the event of an aerosolized attack, children breathe more times per minute than adults and would inhale larger doses in the same period of time. Children are more at risk to the effects of agents or diseases that produce vomiting and/or diarrhea because they have less fluid reserve than adults and can become dehydrated faster. They are more vulnerable to agents that act on the skin because their skin is thinner, and they have a larger surface area-to-mass ratio than adults. Children also have smaller circulating blood volumes than adults so if treatment is not immediate, relatively small amounts of blood/fluid loss can lead to irreversible shock or death; and their condition can shift from stable to life-threatening quite rapidly because of less blood and fluid reserves, increased sensitivity to changes in body temperature, and a faster metabolism. And as demonstrated during pandemic H1N1, children are particularly susceptible to infectious diseases like influenza—children are immunologically naïve and even healthy children are vulnerable to more severe outcomes from infection.

In Los Angeles County, pediatric disaster is planning a priority. LA is home to more than 3 million residents under the age of 18, with 2.7 million aged 14 and younger. However, our pediatric emergency care and hospital capacity are declining—the likelihood that a crisis event would overwhelm our already taxed system is inevitable. Similarly, mobility constraints that might be caused by large-scale crisis event or a natural disaster (like an earthquake—a serious threat in LA County) further require that non-pediatric hospitals prepare for a likely influx of pediatric patients.

To prepare for a surge in patients that may occur during a pandemic or terrorist event, the Los Angeles County Department of Public Health began a series of hospital surge planning conferences in 2005. As a natural progression and based on recommendations that arose during the trainings and meetings, a pediatric surge planning conference was held in June 2009. The Pediatric Surge Pocket Guide was developed to both supplement the training and to also serve as an effective stand-alone resource. The pediatric surge planning conference united over 60 key hospitals, healthcare, and student health administrators from across LA County. During the workshop, the Guide was tested as participants used the tool to resolve hypothetical crisis scenarios all involving an in-flux of pediatric patients. The participants nearly unanimously rated the Guide as a valuable tool they will use and recommend to others long after the workshop was over. While the Guide was provided to participants in its intended format (a small, pocket-sized flip book) it is also available for download and reproduction at: www.publichealth.lacounty.gov/eprp/plans.htm.

The Pediatric Surge Pocket Guide has proven to be a simple, practical, yet effective resource that provides comprehensive pediatric specific recommendations on: 1) normal values (i.e., vital signs, fluid and electrolyte requirements); 2) triage and assessment; 3) treatment and medications; 4) equipment; 5) decontamination; 6) mental health; and, 7) pediatric safety and security considerations. The Guide is quick, easy-to-use and a ready resource that requires no training, technology or electricity to operate. In addition, because the Guide is not specific to LA or any particular jurisdiction, it has been requested by and has proven to be very useful to hospitals and healthcare centers.

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Los Angeles County Public Health Department
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Pediatric Surge Pocket Guide
"The unique developmental, psychological and physiological attributes of children make them one of the most vulnerable populations in the event of a disaster or terrorist attack. Developmentally, children often lack motor skills to escape from the site of a chemical, biological or other terrorist incident. Children also lack cognitive decision-making skills to figure out how to flee from danger or to follow directions from others. Physiologically, they are especially at risk. In the event of an aerosolized attack, children breathe more times per minute than adults and would inhale larger doses in the same period of time. Children are more at risk to the effects of agents or diseases that produce vomiting and/or diarrhea because they have less fluid reserve than adults and can become dehydrated faster. They are more vulnerable to agents that act on the skin because their skin is thinner, and they have a larger surface area-to-mass ratio than adults. Children also have smaller circulating blood volumes than adults so if treatment is not immediate, relatively small amounts of blood/fluid loss can lead to irreversible shock or death; and their condition can shift from stable to life-threatening quite rapidly because of less blood and fluid reserves, increased sensitivity to changes in body temperature, and a faster metabolism. And as demonstrated during pandemic H1N1, children are particularly susceptible to infectious diseases like influenza—children are immunologically naïve and even healthy children are vulnerable to more severe outcomes from infection. In Los Angeles County, pediatric disaster is planning a priority. LA is home to more than 3 million residents under the age of 18, with 2.7 million aged 14 and younger. However, our pediatric emergency care and hospital capacity are declining—the likelihood that a crisis event would overwhelm our already taxed system is inevitable. Similarly, mobility constraints that might be caused by large-scale crisis event or a natural disaster (like an earthquake—a serious threat in LA County) further require that non-pediatric hospitals prepare for a likely influx of pediatric patients. To prepare for a surge in patients that may occur during a pandemic or terrorist event, the Los Angeles County Department of Public Health began a series of hospital surge planning conferences in 2005. As a natural progression and based on recommendations that arose during the trainings and meetings, a pediatric surge planning conference was held in June 2009. The Pediatric Surge Pocket Guide was developed to both supplement the training and to also serve as an effective stand-alone resource. The pediatric surge planning conference united over 60 key hospitals, healthcare, and student health administrators from across LA County. During the workshop, the Guide was tested as participants used the tool to resolve hypothetical crisis scenarios all involving an in-flux of pediatric patients. The participants nearly unanimously rated the Guide as a valuable tool they will use and recommend to others long after the workshop was over. While the Guide was provided to participants in its intended format (a small, pocket-sized flip book) it is also available for download and reproduction at: www.publichealth.lacounty.gov/eprp/plans.htm. The Pediatric Surge Pocket Guide has proven to be a simple, practical, yet effective resource that provides comprehensive pediatric specific recommendations on: 1) normal values (i.e., vital signs, fluid and electrolyte requirements); 2) triage and assessment; 3) treatment and medications; 4) equipment; 5) decontamination; 6) mental health; and, 7) pediatric safety and security considerations. The Guide is quick, easy-to-use and a ready resource that requires no training, technology or electricity to operate. In addition, because the Guide is not specific to LA or any particular jurisdiction, it has been requested by and has proven to be very useful to hospitals and healthcare centers.
The Pediatric Surge Pocket Guide recognizes and addresses the critical need for all jurisdictions to plan for an inevitable surge in pediatric patients that can occur during a natural disaster, pandemic, or terrorist attack. Many incorrectly assume that young patients always will be transferred to pediatric hospitals or that every hospital or healthcare center can readily and routinely adapt their services to meet children’s unique needs—but that is not the case. During crisis events, especially those that might limit mobility (like an earthquake), an influx of pediatric patients is very likely and is an event that all hospitals should realize and prepare for. The unique developmental, psychological and physiological attributes of children make them one of our most vulnerable populations. Developmentally, children often lack motor skills and cognitive decision-making skills to identify and flee from harm or to follow directions. Physiologically, children breathe more times per minute than adults and would inhale larger doses of an aerosolized toxin. Children are more at risk to the effects of agents or diseases that produce vomiting and/or diarrhea because they have less fluid reserve than adults and can become dehydrated faster. They are more vulnerable to agents that act on the skin because their skin is thinner, and they have a larger surface area-to-mass ratio than adults. Children also have smaller circulating blood volumes than adults so if treatment is not immediate, relatively small amounts of blood/fluid loss can lead to irreversible shock or death; and their condition can shift from stable to life-threatening quite rapidly because of less blood and fluid reserves, increased sensitivity to changes in body temperature, and a faster metabolism. And as demonstrated during pandemic H1N1, children are particularly susceptible to infectious diseases like influenza—children are immunologically naïve and even healthy children are vulnerable to more severe outcomes. In LA County there are more than 3 million residents under the age of 18, with 2.7 million aged 14 and younger. However, our pediatric emergency care and hospital capacity are declining—the likelihood that a crisis event would overwhelm our already taxed system is inevitable.
Agency Community RolesRepresentatives from the Los Angeles County Department of Public Health (LACDPH) served as project manager to facilitate the initiation, development, refinement, testing and maintenance of the Pediatric Surge Pocket Guide. The idea for the Guide was suggested as a response to a critical planning gap broached during LACDPH’s series of hospital surge pandemic preparedness meetings and workshops. Accordingly, LACDPH drafted, submitted and managed its funding. For this, LACDPH fleshed out the idea, designed the project objectives and outcomes, oversaw its production and distribution, and reviewed its effectiveness when tested during our pediatric surge workshop and subsequently as it continues to be used by our local hospitals and others. LACDPH also worked to unite the appropriate key representatives to serve as experts in the creation of the Guide’s design and content. LACDPH continues to maintain the Guide: an electronic version is posted on our website (www.publichealth.lacounty.gov/eprp/plans.htm), we field requests and questions about the Guide from other jurisdictions, and monitor ideas for potential new revisions. Costs and ExpendituresThe unique developmental, psychological and physiological attributes of children make them one of the most vulnerable populations in the event of a disaster or terrorist attack. Developmentally, children often lack motor skills to escape from the site of a chemical, biological or other terrorist incident. Children also lack cognitive decision-making skills to figure out how to flee from danger or to follow directions from others. Physiologically, they are especially at risk. In the event of an aerosolized attack, children breathe more times per minute than adults and would inhale larger doses in the same period of time. Children are more at risk to the effects of agents or diseases that produce vomiting and/or diarrhea because they have less fluid reserve than adults and can become dehydrated faster. They are more vulnerable to agents that act on the skin because their skin is thinner, and they have a larger surface area-to-mass ratio than adults. Children also have smaller circulating blood volumes than adults so if treatment is not immediate, relatively small amounts of blood/fluid loss can lead to irreversible shock or death; and their condition can shift from stable to life-threatening quite rapidly because of less blood and fluid reserves, increased sensitivity to changes in body temperature, and a faster metabolism. And as demonstrated during pandemic H1N1, children are particularly susceptible to infectious diseases like influenza—children are immunologically naïve and even healthy children are vulnerable to more severe outcomes from infection. In Los Angeles County, pediatric disaster is planning a priority. LA is home to more than 3 million residents under the age of 18, with 2.7 million aged 14 and younger. However, our pediatric emergency care and hospital capacity are declining—the likelihood that a crisis event would overwhelm our already taxed system is inevitable. Similarly, mobility constraints that might be caused by large-scale crisis event or a natural disaster (like an earthquake—a serious threat in LA County) further require that non-pediatric hospitals prepare for a likely influx of pediatric patients. To prepare for a surge in patients that may occur during a pandemic or terrorist event, the Los Angeles County Department of Public Health began a series of hospital surge planning conferences in 2005. As a natural progression and based on recommendations that arose during the trainings and meetings, a pediatric surge planning conference was held in June 2009.The Pediatric Surge Pocket Guide was developed to both supplement the training and to also serve as an effective stand-alone resource. The pediatric surge planning conference united over 60 key hospitals, healthcare, and student health administrators from across LA County. During the workshop, the Guide was tested as participants used the tool to resolve hypothetical crisis scenarios all involving an in-flux of pediatric patients. The participants nearly unanimously rated the Guide as a valuable tool they will use and recommend to others long after the workshop was over. While the Guide was provided to participants in its intended format (a small, pocket-sized flip book) it is also available for download and reproduction at: www.publichealth.lacounty.gov/eprp/plans.htm. The Pediatric Surge Pocket Guide has proven to be a simple, practical, yet effective resource that provides comprehensive pediatric specific recommendations on: 1) normal values (i.e., vital signs, fluid and electrolyte requirements); 2) triage and assessment; 3) treatment and medications; 4) equipment; 5) decontamination; 6) mental health; and, 7) pediatric safety and security considerations. The Guide is quick, easy-to-use and a ready resource that requires no training, technology or electricity to operate. In addition, because the Guide is not specific to LA or any particular jurisdiction, it has been requested by and has proven to be very useful to hospitals and healthcare ImplementationThe primary goal of the Pediatric Surge Pocket Guide is to provide a practical, effective, yet simple and ready resource for comprehensive pediatric specific recommendations that would be vital during a crisis situation such as pandemic or terrorist event. To meet this goal, the Guide was developed with convenient color-coded tabs highlighting seven key areas: 1) normal values (i.e., vital signs, fluid and electrolyte requirements); 2) triage and assessment; 3) treatment and medications; 4) equipment; 5) decontamination; 6) mental health; and, 7) pediatric safety and security considerations. In addition, the Guide was specifically designed to be a tangible, easy to use resource that requires no training, technology or electricity to operate. The Pediatric Surge Pocket Guide was developed as a supplement to the Los Angeles County Department of Public Health’s Pediatric Medical Surge Workshop held on June 2, 2009. The design and development of the Guide was the task of our workshop’s planning committee which was comprised of many key community stakeholders including representatives from: Los Angeles County Department of Health Services, Pasadena Public Health Department, Long Beach Department of Health and Human Services, Children’s Hospital Los Angeles, Hospital Association of Southern California, Huntington Hospital and Harbor-UCLA Medical Center. It was their input that served as the impetus for the creation of the Guide—recognizing its need to address a critical planning gap. They participated in the development of the Guide’s: design, layout, content, testing and dissemination; they assembled the information from multiple sources; reviewed the Guide for clarity and accuracy; and they continue to assist with the promotion and suggestions for revisiting this project. The application of the Guide was assessed during the June workshop. During that event, the participants used the Guide to resolve two hypothetical pediatric surge events. The participants nearly unanimously rated the Guide as a valuable tool they will use and recommend to others long after the workshop was over. The Pediatric Surge Pocket Guide recognizes and addresses the critical need for all jurisdictions to plan for an inevitable surge in pediatric patients that can occur during a natural disaster, pandemic, or terrorist attack. The Pediatric Surge Pocket Guide was the culmination of several years of pandemic and emergency preparedness. The Los Angeles County Department of Public Health (LACDPH), in collaboration with our many other emergency preparedness partners (Department of Health Services, Department of Emergency Medical Services, our over 100 local hospitals, etc.) have been actively preparing for a pandemic or other crisis health event for more than 6 years. A cornerstone of LACDPH’s preparedness activities has been hospital readiness which has included a series of hospital surge preparedness workshops. Through these workshops and related meetings, the need to include preparedness activities specific to pediatric patients was identified. Moreover, it was agreed that assistance should extend beyond a workshop—a tangible, stand-alone resource that needs no training or technology to implement would be vital. The development of the actual Guide began approximately 5 months prior to is application and assessment during our Pediatric Medical Surge Workshop held on June 2, 2009. Following that event, the electronic version has been available for free download from our website (www.publichealth.lacounty.gov/eprp/plans.htm) and requests for printer-ready versions are readily granted.
The Pediatric Surge Pocket Guide accomplished three primary goals. Foremost, the Guide continues to successfully provide an effective and ready resource for pediatric guidelines in accessible, easy-to-use format. The Guide details important information, across a wide breadth of topics, deemed essential to pediatric care including: 1) normal values (i.e., vital signs, fluid and electrolyte requirements); 2) triage and assessment; 3) treatment and medications; 4) equipment; 5) decontamination; 6) mental health; and, 7) pediatric safety and security considerations. The effectiveness of the Guide was proven during our pediatric surge planning conference and workshop held in June 2009. The conference united over 60 key hospital, healthcare, and student health administrators from across LA County. During the conference, the Guide was tested as participants used the tool to resolve hypothetical crisis scenarios all involving an in-flux of pediatric patients. The participants nearly unanimously rated the Guide as a valuable tool they will use and recommend to others long after the workshop was over. In addition, LACDPH continues to field requests and accolades for the Guide from other health departments and hospitals across the nation. In addition, the Guide successfully provides information that is useful for a wide range of issues. While the primary goal of the Guide was to provide assistance during a pandemic, disaster or terrorist attack, the Guide is also valuable for day-to-day reference and a broad range of needs. By expanding the content and making the Guide multipurpose tool, it makes it more likely to be used and furthers its sustainability. Similarly, the Guide was not made to be specific to Los Angeles County; again, by broadening its range we have increased it application and effectiveness. Finally, the Guide served to further strengthen our partnerships with our community stakeholders including representatives from our local hospitals, emergency care agencies and student health. The Guide provided tangible evidence that LACDPH strives to do more than just talk about issues—we are committed to providing practical, effective and concrete products that address the needs express by our community partners. The idea for the Guide arose from our alliances with our stakeholders; and the product and all of the steps to produce it (its content, design, testing, and refinement) was conducted with extensive involvement, discussion and consensus among our community partners.
The Pediatric Surge Pocket Guide is a stand-alone resource available for free download from our website (www.publichealth.lacounty.gov/eprp/plans.htm). While hard copies of the Guide are no longer available, requests for printer-ready versions are readily granted. The Los Angeles County Department of Public Health is committed to maintaining the posting of this document and also accepts suggestions for future improvements from those that use the Guide. The partnerships formed during the Pocket Guide’s development sowed the seeds for long term sustainable application via ongoing pediatric surge planning. It also laid the foundation for understanding pediatric related preparedness and response nuances, i.e. bed capacities, triage and treatment capacities, risk communication issues, etc. Its role continues with many stakeholders reconvening during the Mass Medical Care Operational Plan Conference held in southern California on September 8-10, 2010 and again on June 22-23, 2011 to continue to discuss and improve surge strategies. While the Guide was originally created to supplement our Pediatric Surge Training Workshop, the Guide was also designed to be a stand-alone resource that can provide effective and regular application well beyond the event and for our jurisdictions. To that end, the Guide has been posted on our website for free download and we have routinely provided electronic versions so that other jurisdictions can create their own hard copies into a handbook format. There has been uptake of the Guide throughout healthcare delivery sectors and facilities in other states as well as locally. We continue to reference it in our local plans and include it in our updated plans.
 
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