1. The Program for Pediatric Preparedness National Center for Disaster Preparedness Model Pediatric Component for State Disaster Plans and Additional Resources David Markenson, MD Director, The Program for Pediatric Preparedness Deputy Director, National Center for Disaster Preparedness Mailman School of Public Health, Columbia University

2. The Program for Pediatric Preparedness National Center for Disaster Preparedness Model Pediatric Component for State Disaster Plans Goal I – Build a coalition of experts from the fields of pediatrics, disaster planning, emergency medicine, emergency response, trauma, and mental health.Goal I – Build a coalition of experts from the fields of pediatrics, disaster planning, emergency medicine, emergency response, trauma, and mental health. Goal II – Utilizing the expertise of the coalition, build a consensus as to the appropriate methodology for the development of a model assessment method of both state disaster plans and recent disaster incidents, inclusive of the specific needs of children in disaster planning, preparation and response. This should include specific attention to the needs of special populations, such as culturally diverse groups, the homeless or transitional, children of substance abusers, and children with special health care needs.Goal II – Utilizing the expertise of the coalition, build a consensus as to the appropriate methodology for the development of a model assessment method of both state disaster plans and recent disaster incidents, inclusive of the specific needs of children in disaster planning, preparation and response. This should include specific attention to the needs of special populations, such as culturally diverse groups, the homeless or transitional, children of substance abusers, and children with special health care needs. Goal III – Use information gained via the assessment models, to develop a Model Pediatric Component (MPC) for use in state disaster planning.Goal III – Use information gained via the assessment models, to develop a Model Pediatric Component (MPC) for use in state disaster planning.

3. The Program for Pediatric Preparedness National Center for Disaster Preparedness Model Pediatric Component Key PrinciplesKey Principles Based on Federal Response PlanBased on Federal Response Plan Structured usingStructured using Emergency Support FunctionsEmergency Support Functions Existing and NewExisting and New AnnexesAnnexes

4. The Program for Pediatric Preparedness National Center for Disaster Preparedness Model State Pediatric Disaster Plans ESF #1 - Transportation ESF #2 - Telecommunications and Information Technology ESF #3 - Public Works and Engineering ESF #4 - Firefighting ESF #5 - Emergency Management ESF #6 - Mass Care, Housing, and Human Services ESF #7 - Resource Support ESF #8 - Public Health and Medical Services ESF #9 - Urban Search and Rescue ESF #10 - Oil and Hazardous Materials2 Response ESF #11 - Agriculture and Natural Resources ESF #12 - Energy ESF #13 - Public Safety and Security ESF #14 - Community Recovery, Mitigation, and Economic Stabilization ESF #15 - Emergency Public Information and External Communications

5. The Program for Pediatric Preparedness National Center for Disaster Preparedness Incident Annexes Biological Incident Annex Catastrophic Incident Annex Cyber Incident Annex Food and Agriculture Incident Annex Nuclear/Radiological Incident Annex Oil and Hazardous Materials Incident Annex Terrorism Law Enforcement and Investigation Annex

6. The Program for Pediatric Preparedness National Center for Disaster Preparedness Support Annexes Financial Management Insular Affairs International Coordination Logistics Management Private Sector Coordination Public Affairs Science and Technology Tribal Relations Volunteer and Donations Management Worker Safety and Health

7. The Program for Pediatric Preparedness National Center for Disaster Preparedness Additional Pediatric Specific Plans EMSEMS Mental HealthMental Health SchoolsSchools Schools, Day Care, Summer Camps, etc…Schools, Day Care, Summer Camps, etc… DMATDMAT NDMS, DMAT, MMRSNDMS, DMAT, MMRS HospitalHospital

8. The Program for Pediatric Preparedness National Center for Disaster Preparedness Model State Pediatric Disaster Plans FormatFormat Two VersionsTwo Versions Complete ESF or Annex with Pediatric AdditionsComplete ESF or Annex with Pediatric Additions Pediatric Additions OnlyPediatric Additions Only Additional ResourcesAdditional Resources Specific Guidelines and RecommendationsSpecific Guidelines and Recommendations Template GuidesTemplate Guides Detailed benchmarksDetailed benchmarks

9. The Program for Pediatric Preparedness National Center for Disaster Preparedness Model State Pediatric Disaster Plans Based on revised federal response plan and documentsBased on revised federal response plan and documents FRP Revised 6/30/04FRP Revised 6/30/04 New National Response PlanNew National Response Plan New National Incident Management SystemNew National Incident Management System Draft for review Winter/Spring 2005Draft for review Winter/Spring 2005 Final product available Summer 2005Final product available Summer 2005

10. The Program for Pediatric Preparedness National Center for Disaster Preparedness Coordination with Federal Pediatric Efforts National Advisory CommitteeNational Advisory Committee Strategic National StockpileStrategic National Stockpile Food & Drug AdministrationFood & Drug Administration CDC/HRSA Cooperative AgreementsCDC/HRSA Cooperative Agreements Pediatric Advisory GroupPediatric Advisory Group

11. The Program for Pediatric Preparedness National Center for Disaster Preparedness

12. The Program for Pediatric Preparedness National Center for Disaster Preparedness Objective A of the NACCT: The preparedness of the healthcare system to respond to terrorism as it relates to children. 1.Federal Responsibilities 2.Schools and Other Child Congregate Care Settings 3.Mental Health and Psychosocial Support 4.Primary Care Pediatric Providers 5.Pre-Hospital and Hospital Care 6.Community Involvement 7.Training 8.Health Intelligence 9.Risk Communication and Public Education

13. The Program for Pediatric Preparedness National Center for Disaster Preparedness Objective B of the NACCT: Needed changes to the healthcare and emergency medical service systems and emergency medical services protocols to meet the special needs of children 10. Emergency Medical Service Systems and Protocols

14. The Program for Pediatric Preparedness National Center for Disaster Preparedness Objective C of the NACCT: Changes, if necessary, to the National Strategic Stockpile under Section 121 of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 to meet the emergency health security of children 11. Strategic National Stockpile

15. The Program for Pediatric Preparedness National Center for Disaster Preparedness Strategic National Stockpile Pediatric representationPediatric representation Ciprofloxacin suspensionCiprofloxacin suspension Doxycycline suspensionDoxycycline suspension Pediatric airways, NG tubes, oxygen masksPediatric airways, NG tubes, oxygen masks Pediatric Atropine auto-injectorsPediatric Atropine auto-injectors Ventilators with Pediatric CapabilityVentilators with Pediatric Capability

16. The Program for Pediatric Preparedness National Center for Disaster Preparedness HRSA Guidance Clear Focus on PediatricsClear Focus on Pediatrics Majority of critical benchmarks specify inclusion of childrenMajority of critical benchmarks specify inclusion of children Most quantifiable benchmarks include childrenMost quantifiable benchmarks include children

17. The Program for Pediatric Preparedness National Center for Disaster Preparedness HRSA Guidance Critical Benchmark #2-2: Surge Capacity: Isolation Capacity In addition, the awardee must identify at least one regional healthcare facility in each awardee hospital preparedness region as defined by the awardees FY 2003 work plan that is able to support the initial evaluation and treatment of at least 10 adult and pediatric patients at a time in negative pressure isolation.Critical Benchmark #2-2: Surge Capacity: Isolation Capacity In addition, the awardee must identify at least one regional healthcare facility in each awardee hospital preparedness region as defined by the awardees FY 2003 work plan that is able to support the initial evaluation and treatment of at least 10 adult and pediatric patients at a time in negative pressure isolation.

18. The Program for Pediatric Preparedness National Center for Disaster Preparedness FDA Expedited review and licensingExpedited review and licensing Pediatric testing not requiredPediatric testing not required If not tested for pediatric considered off label usageIf not tested for pediatric considered off label usage

19. The Program for Pediatric Preparedness National Center for Disaster Preparedness Additional Resources to be Included

20. The Program for Pediatric Preparedness National Center for Disaster Preparedness Pediatric Disaster and Terrorism Preparedness A National Consensus Conference and The Pediatric Expert Advisory Panel

21. The Program for Pediatric Preparedness National Center for Disaster Preparedness Recommendations PriorityPriority Preparedness and TreatmentsPreparedness and Treatments BiologicBiologic ChemicalChemical RadiologicRadiologic NPSNPS DecontaminationDecontamination Natural DisastersNatural Disasters Hospital PreparednessHospital Preparedness Mental Health Schools Primary Care Providers Displaced Children National Disaster Medical System Training Drills and Simulations

22. The Program for Pediatric Preparedness National Center for Disaster Preparedness Second Consensus Conference PediatricsPediatrics Update of previous guidelinesUpdate of previous guidelines Expanded focusExpanded focus Schools and congregate facilitiesSchools and congregate facilities Community Healthcare AssetsCommunity Healthcare Assets DecontaminationDecontamination NewNew SurgeSurge EvacuationEvacuation

23. The Program for Pediatric Preparedness National Center for Disaster Preparedness Second Consensus Conference Persons with DisabilitiesPersons with Disabilities Disability PerspectiveDisability Perspective Emergency Preparedness Function PerspectiveEmergency Preparedness Function Perspective

24. The Program for Pediatric Preparedness National Center for Disaster Preparedness Pediatric Expert Advisory Panel The purpose of the Pediatric Expert Advisory Panel (PEAP) is to:The purpose of the Pediatric Expert Advisory Panel (PEAP) is to: Discuss and analyze current issuesDiscuss and analyze current issues Multi-disciplinaryMulti-disciplinary Governmental and non-governmental bridgeGovernmental and non-governmental bridge On-going programOn-going program Ability for rapid analysisAbility for rapid analysis Dissemination of findingsDissemination of findings WebWeb InfoBriefInfoBrief Conference or SymposiaConference or Symposia

25. The Program for Pediatric Preparedness National Center for Disaster Preparedness AtroPen Infobrief Key Points AtroPen® is only ½ of a Mark-I KitAtroPen® is only ½ of a Mark-I Kit Does not include pralidoxime.Does not include pralidoxime. Pralidoxime should be added for appropriate treatment of nerve agent exposure.Pralidoxime should be added for appropriate treatment of nerve agent exposure. Complete treatment will require the usage of anticonvulsantsComplete treatment will require the usage of anticonvulsants

26. The Program for Pediatric Preparedness National Center for Disaster Preparedness AtroPen Infobrief Recommendation The Mark 1 Kit should remain as the preferred emergency treatment for children of any age. This recommendation includes using the Mark 1 Kit in children younger than 3 years old after bona fide nerve agent exposure.

27. The Program for Pediatric Preparedness National Center for Disaster Preparedness Future InfoBriefs Pediatric DecontaminationPediatric Decontamination Pediatric Surge CapacityPediatric Surge Capacity

28. The Program for Pediatric Preparedness National Center for Disaster Preparedness NYC BOE 9/11 Report Evaluation of NYC BOE response to 9/11Evaluation of NYC BOE response to 9/11 Critical assessmentsCritical assessments Lessons learnedLessons learned

29. The Program for Pediatric Preparedness National Center for Disaster Preparedness

30. The Program for Pediatric Preparedness National Center for Disaster Preparedness Questions

31. The Program for Pediatric Preparedness National Center for Disaster Preparedness David Markenson, MD National Center for Disaster Preparedness www.ncdp.columbia.edu212-342-0408dsm2002@columbia.edu