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Christy Johnson, CCLS, MSW MD Heckle, Emergency Management Childrens Hospital & Research Center Oakland.

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Presentation on theme: "Christy Johnson, CCLS, MSW MD Heckle, Emergency Management Childrens Hospital & Research Center Oakland."— Presentation transcript:

1 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management Childrens Hospital & Research Center Oakland

2 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management Childrens Hospital & Research Center Oakland How Prepared Are YOU? Safety Information You came into this room -did you size up? Exit Points, Fire Extinguishers,1st Aid and Defibrillators locations, and Assembly Area Do you sponsor a culture resiliency?

3 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management CERT: Children in Disaster OUTLINE Presentation and discussion format Case study and interactive tabletop

4 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management CERT: Children in Disaster Why do the training? Initiativethank you! Take it a step further (CERT: Pediatric Triage August; CERT: Pediatric Patient Packaging and MovementSeptember) Focus on social-emotional development of young children Opportunity to reflect and learn from others

5 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management Triage System RED: Immediate YELLOW: Delayed GREEN: Minor Expectant/ Morgue Treatment Leader Medical Branch Director Medical Supply Coordinator Perimeter ENTRY Control Point EXIT Control Point Transportation Unit Group

6 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management CERT: Children in Disaster HYGEINE Wash hands frequently (40-60 seconds) –Or use alcohol-based hand sanitizer (20-30 seconds) Wear non-latex exam gloves Wear N95 mask and goggles Keep dressings sterile Avoid contact with body fluids –If it is warm, wet, and not yours, dont touch it!

7 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management CERT: Children in Disaster Carry Types Single carry Pack-strap carry Double carry Blanket carry

8 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management CERT: Children in Disaster Pack-strap carry

9 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management CERT: Children in Disaster Blanket carry

10 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management CERT: Children in Disaster Pedi Transport Send/Receive info Reassure/Review Car seats Keep warm ZERO rx No feeding Transport in position of comfort

11 Child Life Suggestions for Pain Management/Relaxation Techniques Deep breathing- -Smelling flower, blowing bubble -Count 1-4 Distraction for pain/discomfort- - Calm steady voice -Soft touch -Singing -Comfort Item -Conversation Christy Johnson, CCLS, MSW MD Heckle, Emergency Management Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

12 CERT: Children in Disaster OBJECTIVES Develop a clear definition for traumatic events. Recognize the stages of grief. Common reactions children experience when dealing with trauma. Working with Children Expand resources for helping children after a traumatic event.

13 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management CERT: Children in Disaster Pair Share 9/11 Loma Prieta Oakland Hills Fire Newtown School Emotional adjectives

14 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management CERT: Children in Disaster Traumatic vs. Stressful Events Points to consider: Types of care Types of events Impacts on mental health of child Impacts on CERT team members

15 CERT: Children in Disaster GRIEF, TRAUMA and LOSS Four Myths of Grief An active child is not a grieving child Infants & Toddlers are too young to grieve Children need to get over their grief Children are better off not attending funerals

16 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management CERT: Children in Disaster

17 Stress & Brain Development Stress can impact a childs brain development & chemistry. Early childhood trauma has been associated with reduced size of the brain cortex, impaired ability to regulate emotions, & intelligence. Many factors affect a childs development! Please note!!! No credible scientific evidence that supports the conclusion that young children who have been exposed to significant early stresses will always develop stress-related disorders. National Scientific Council on the Developing Child (2005). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3. Retrieved from Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

18 Need 2 Volunteers to participate in demonstration!!! Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

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20 For the Purpose of rest of this Presentation…. Children will be referred to as pediatric population of 0-18years old Provides generalized overview Special Populations & Teens Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

21 CERT Team Can provide emotional support to children/families Psychological First Aid Pfefferbaum, B., Shaw, J. & AACAP, & CQI. (2013). Practive Parameter on Disaster Preparedness. Journal of the American Academy of Chlid & Adolescent Psychiatry, 52(11), Mental Health Professionals May use different types of Triage/Rapid Assessment Ex) PsySTART Rapid Mental Health Triage Center for Disaster Medical Science- Univeristy of California. The PsychSTART Mental Health Triage & Incident Management System. Accessed December8, Accessed December8, 2013http://www.cdms.uci.edu/PDF/PsySTART-cdms pdf Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

22 Childrens Experience & Coping In Disasters Biological & Developmental Age of ChildBiological & Developmental Age of Child Direct Exposure to EventDirect Exposure to Event Grief/LossGrief/Loss Ongoing Stress From Secondary Effects of DisasterOngoing Stress From Secondary Effects of Disaster Other Considerations:Other Considerations: Special Needs Cultural Differences Language Barriers (American Red Cross: Accessed December 8, ) Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

23 A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, Child Development, Possible Disaster Stressors, and Interventions Developmental Information from A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, 2013.www.childlife.org/files/CaregiverInterventions.pdf Infants (0- 12months) Gets Information through senses Development of trust Primary Caregiver Bond Minimal Language Meet basic physical needs Possible Disaster Stressors Sensory Experience / Injury Possible Separation from Caregiver Impaired basic needs Stranger anxiety Behaviors You May See (Coping Behaviors) Crying Hand & mouth activity Interventions Safety Talk before touch Singing/holding Decrease # of caregivers if possible Avoid hunger if possible Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

24 A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, Toddlers (1-3yrs) Developmental Information from A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, 2013.www.childlife.org/files/CaregiverInterventions.pdf Seeks independence Developing language Process of learning new skills (walking & toilet training) Routine is everything! Short attention span Possible Disaster Stressors Sensory Experience / Injury Separation from caregiver/ Fear of abandonment Stranger anxiety New Environment Loss of independence & mobility Changes in routine Back-laying position frightens toddlers Scared of sudden movements or loud noises Behaviors You May See (Coping Behaviors) Regression of recently learned skills Clinging to people Temper tantrums Interventions Safety Allow to move around as able Offer choices Expect treatment to be resisted Provide simple explanations Singing/encouraging statements, toys Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

25 A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, Preschoolers (3-5yrs) Developmental Information from A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, 2013.www.childlife.org/files/CaregiverInterventions.pdf Belief they are center of world Limited language skills Fantasy & magical thinking Fear of dark Limited concept of time May view disaster as punishment Learn best by doing Does not understand death as final Possible Disaster Stressors Sensory Experience / Injury Separation from caregiver Heightened fears (pain, strangers, etc) Loss of protection & sense of abandonment Confusion about events Confusion between fantasy vs. reality Behaviors You Might See (Coping behaviors) Regression (act younger than age) Temper tantrums Aggression/anger Guilt Fantasy Interventions Safety Give Choices & reinforce positive behavior Expression of feelings through play/verbalizing Child participation in care Be realistic & truthful Comfort Encouraging statements, singing Child coloring picture at Shelter in Haiti

26 A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, School age (6-12yrs) Developmental Information from A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, 2013.www.childlife.org/files/CaregiverInterventions.pdf Friendships are important Develops concrete thinking Active learners Increased participation in self care Continued language skills developed Concerns about body image Possible Disaster Stressors Sensory Experience/Injury Separation from caregiver Loss of bodily control Enforced dependence Loss of competence Fears body harm, pain, or death Behaviors You Might See (Coping behaviors) Guilt Acting out/regression/depression/withdrawal Separation Anxiety Mirror Caregiver/Adult response Interventions Safety Give Choices Teach coping strategies that teach mastery Encourage participation in their care Give child tasks to help Correct misconceptions Respect childs modesty Comfort, humor, encouragement, etc Children after Tornado destroyed school in Oklahoma (NY Daily News)

27 A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, Adolescent 13-18yrs Developmental Information from A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, 2013.www.childlife.org/files/CaregiverInterventions.pdf Socialization is important Changing body image Body image relates to self esteem Need for privacy Increasing independence & responsibility Struggle to develop self-identity Use of deductive reasoning & abstract thought Possible Disaster Stressors Sensory Experience / Injury Lack of trust Loss of independence & control Threat of change in body image/harm Restriction of physical activities Loss of peer acceptance & fear of rejection Threat of bodily competence or future Fear of death Behaviors You May See (Coping Behaviors) Defense mechanisms Intellectualizations Conformity Uncooperative behavior Interventions Safety Respect & maintain privacy Involve in care & decisions Peers Communicate honestly Discuss potential psych & physical changes Comfort Jokes, music, encouraging, deep breathing, imagery.

28 YOU make a difference!!! -SAFETY- Injuries, potential danger & harm -Calming emotions -Helping to decrease sensory stimulation -Basic needs YOU ARE CREATING A POWERFUL MEMORY OF STRENGTH & HELPING WITHIN THIS EVENT!!! Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

29 Working With Children Use age appropriate simple language.Use age appropriate simple language. Use childs name.Use childs name. Get down at the childs level.Get down at the childs level. Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

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31 Communication Encouragement & PraiseEncouragement & Praise Be direct. State what you want them to do (not what you dont want).Be direct. State what you want them to do (not what you dont want). Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

32 Avoid euphemisms!!! Use concrete terms.Avoid euphemisms!!! Use concrete terms. Letting them know their feelings are normal. It is ok to feel ________.Letting them know their feelings are normal. It is ok to feel ________. Crying is ok! (dont tell boys of any age to be tough or brave)Crying is ok! (dont tell boys of any age to be tough or brave) Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

33 Being honest about what happened & that they are safe.Being honest about what happened & that they are safe. Reassuring the child the event was not their fault.Reassuring the child the event was not their fault. Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

34 Avoid talking about children as if they are not there!!Avoid talking about children as if they are not there!! Children hear & understand more than we think.Children hear & understand more than we think. Misconceptions & fears may arise from fragments of information that were overheard & not explained.Misconceptions & fears may arise from fragments of information that were overheard & not explained. Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

35 Children react differently to stress. Some may not appear to react at all.Children react differently to stress. Some may not appear to react at all. Prepare children on what is happening or going to happen. (Ex: Going into a shelter or triage)Prepare children on what is happening or going to happen. (Ex: Going into a shelter or triage) If you do not know the answer to a childs question, it is ok to say that you do not know.If you do not know the answer to a childs question, it is ok to say that you do not know. Every Child is different! Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

36 After The Disaster After The Disaster. American Red Cross. Accessed December 8, Common Reactions to Disaster by Age Birth through 2 years.Birth through 2 years. Are pre-verbal but can retain sensory memoriesAre pre-verbal but can retain sensory memories May be irritable & wanting to be held more.May be irritable & wanting to be held more. Respond to caregivers copingRespond to caregivers coping Preschool - 3 through 6 years.Preschool - 3 through 6 years. Feelings of helplessness, fear, & insecure.Feelings of helplessness, fear, & insecure. Fear of separation from caregiverFear of separation from caregiver Does not understand that death is permanentDoes not understand that death is permanent May use repetitious play to reenact incidentMay use repetitious play to reenact incident School age - 7 through 10 years.School age - 7 through 10 years. May become preoccupied with event & want to talk about.May become preoccupied with event & want to talk about. Has ability to understand permanence of death/loss.Has ability to understand permanence of death/loss. Problems at school or concentration.Problems at school or concentration. May have variety of emotions related to disaster (fear it may happen again, anger it happened, guilt it was their fault)May have variety of emotions related to disaster (fear it may happen again, anger it happened, guilt it was their fault) Pre-adolescence to adolescence - 11 through 18 years.Pre-adolescence to adolescence - 11 through 18 years. May become involved in risk-taking behaviorsMay become involved in risk-taking behaviors May be fearful of leaving homeMay be fearful of leaving home May change world view (feel unsafe)May change world view (feel unsafe) May have variety of emotions related to disaster (yet may feel unable to discuss them with othersMay have variety of emotions related to disaster (yet may feel unable to discuss them with others Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

37 The National Child Traumatic Stress Network (NCTSN). Accessed December 8, What Adults Can Do To Help Children The National Child Traumatic Stress Network (NCTSN). Accessed December 8, 2013.www.nctsnet.org Help to role model positive coping skills. Monitor adult conversations. Limit media exposure. Reassure children that they are safe. Tell children about community recovery. Review the family preparedness plan. Maintain regular daily life & routines. Maintain expectations. Encourage children to help. Do not criticize your children for changes in behavior. Be extra patient as your children return to school. Give support at bedtime. Help with boredom. Keep things hopeful. Even in the most difficult situation, your positive outlook on the future will help your children see good things in the world around them, helping them through challenging times. Seek professional help if your child still has difficulties more than six weeks after the earthquake.

38 Children may grieve in spurts & can re-grieve at new developmental stages as their understanding of death & perceptions of the world change.Children may grieve in spurts & can re-grieve at new developmental stages as their understanding of death & perceptions of the world change. The National Child Traumatic Stress Network (NCTSN). Accessed December 8, 2013.The National Child Traumatic Stress Network (NCTSN). Accessed December 8, 2013.www.nctsnet.org Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

39 Resources- Disaster Preparedness Federal Emergency Management Agency (FEMA). Accessed December 8, American Red Cross: Accessed December 8, Lets Get Ready. Sesame Street. parents/topicsandactivities/toolkits/ready Accessed December 8, parents/topicsandactivities/toolkits/readyhttp://www.sesamestreet.org/ parents/topicsandactivities/toolkits/ready The National Child Traumatic Stress Network (NCTSN). Accessed December 8, Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

40 After The Disaster After The Disaster. American Red Cross. Accessed December 8, Accessed December 8, Disaster Distress Hotline (Substance Abuse & Mental Health Services Administration-US Dept of Health & Human Services). Accessed December 8, 2013.Disaster Distress Hotline (Substance Abuse & Mental Health Services Administration-US Dept of Health & Human Services). Accessed December 8, (Hotlines supports Survivors, Disaster Workers)(Hotlines supports Survivors, Disaster Workers) Natural Disasters. The National Child Traumatic Stress Network. December 8, 2013.Natural Disasters. The National Child Traumatic Stress Network. Accessed December 8, (General Information, Online Training, Online Childrens book on Earthquakes) (General Information, Online Training, Online Childrens book on Earthquakes) Talking To Children After Disaster. Substance Abuse & Mental Health Services Adminstration- United States Department of Health & Human Services. Accessed December 8, 2013.Talking To Children After Disaster. Substance Abuse & Mental Health Services Adminstration- United States Department of Health & Human Services. pdf Accessed December 8, pdf Talking To Children About Disasters. American Academy of Pediatrics. Disasters/Pages/Talking-to-Children-About-Disasters.aspx Accessed December 8, 2013.Talking To Children About Disasters. American Academy of Pediatrics. Disasters/Pages/Talking-to-Children-About-Disasters.aspx Accessed December 8, Disasters/Pages/Talking-to-Children-About-Disasters.aspx Disasters/Pages/Talking-to-Children-About-Disasters.aspx

41 Other Resources A Guide for the caregiver of the Hospitalized Child. Childrens Hospital of Orange County. Accessed December 8, Center for Disaster Medical Science- Univeristy of California. The PsychSTART Mental Health Triage & Incident Management System. Accessed December Accessed Decemberhttp://www.cdms.uci.edu/PDF/PsySTART-cdms pdf 8, , 2013 National Child Life Council National Scientific Council on the Developing Child (2005). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3. Retrieved from Pfefferbaum, B., Shaw, J. & AACAP, & CQI. (2013). Practice Parameter on Disaster Preparedness. Journal of the American Academy of Child & Adolescent Psychiatry, 52(11), Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

42 Breathe….. (Smell the flower….blow the bubble) Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

43 Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. -Margaret Mead Christy Johnson, CCLS, MSW MD Heckle, Emergency Management

44 Childrens Hospital & Research Center at Oakland Additional References: Community Emergency Response Basic Training Powerpoints. FEMA. Web. 8 September https://www.fema.gov/media- library/assets/documents/27669?id=6191 Mass casualty triage: An evaluation of the data and development of a proposed national guideline. Disaster Med and Public Health Preparedness, 2008;2(Suppl 1):S25-S34. [PubMed Citation]Mass casualty triage: An evaluation of the data and development of a proposed national guideline SALT mass casualty triage: concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association. Disaster Med Public Health Prep Dec;2(4): [PubMed Citation]SALT mass casualty triage: concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association The Pediatric Assessment Triangle: Accuracy of Its Application by Nurses in the Triage of Children. Journal of Emergency Nursing March; Volume 39, Issue 2, Pages Timothy Horeczko, Brianna Enriquez, Nancy E. McGrath, Marianne Gausche-Hill, Roger J. Lewis Newton, C., Heckle, M. ( ). Mass Casualty Incidents: Pediatrics. Childrens Hospital & Research Center Grand Rounds. Lecture conducted from Childrens Hospital & Research Center at Oakland, Oakland, California.

45 Christy Johnson, CCLS, MSW MD Heckle, Emergency Management Questions? Michelle D. Heckle, CHEP Emergency ManagementEmergency Management Childrens Hospital & Research Center Oakland nd Street Oakland, CA Christy Johnson, CCLS, MSW James Betts, MD


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