Pediatric Surge: But We Dont DO Peds! Marilyn J. Chapman, RNC, MSN June 20, 2012

Objectives Describe a method to recruit pediatric volunteers to serve as victims during an emergency preparedness drill Describe a method to recruit pediatric volunteers to serve as victims during an emergency preparedness drill Describe resources that can be used to expand capabilities during a pediatric medical surge event Describe resources that can be used to expand capabilities during a pediatric medical surge event Describe ways to expand abilities to respond to a pediatric patient surge Describe ways to expand abilities to respond to a pediatric patient surge

Scenario Charleston, MO: The USGS confirmed that a catastrophic earthquake with a magnitude of 8.0 occurred virtually in the center of the New Madrid Seismic Zone (NMSZ), with an epicenter at Charleston, MO. Mt. Carmel, IL: A second large earthquake with a magnitude of 7.0 occurred a short time later on the Wabash Valley Seismic Zone (WVSZ).

Scenario Midwest, U.S.: Catastrophic structural damage is reported across the central portion of the Midwest. Injuries are in the thousands and hundreds have died. Small quakes and aftershocks are predicted over the next 72 hours. Illinois: Thousands of buildings (to include many hospitals) have suffered significant damage; though catastrophic damage and outright destruction is less significant in central and northern Illinois

Scenario Assumptions 3,000 serious patients; 6,000 non-serious patients – est. state capacity in 1 st 24 hrs = 1,000 pts. More than 15,000 injured requiring care. 3,000 serious patients; 6,000 non-serious patients – est. state capacity in 1 st 24 hrs = 1,000 pts. More than 15,000 injured requiring care. Limited air-med-evacuation assets for the 500 patients with head, crush, and multi-trauma. Limited air-med-evacuation assets for the 500 patients with head, crush, and multi-trauma. Thousands of pediatric patients requiring hospitalization, blood transfusions, respiratory support, and other medical supplies. Thousands of pediatric patients requiring hospitalization, blood transfusions, respiratory support, and other medical supplies.

Obtaining Volunteers Reviewed patient list sent by exercise planners – 24 patients, ages 4 months – 13 years Reviewed patient list sent by exercise planners – 24 patients, ages 4 months – 13 years Put out a call to entire hospital staff requesting parents and children between the ages of 7 and 12 years of age to participate Put out a call to entire hospital staff requesting parents and children between the ages of 7 and 12 years of age to participate Offered documentation of service hours for participation Offered documentation of service hours for participation

Using Volunteers Received 15 child volunteers from 9 families Received 15 child volunteers from 9 families Volunteers were 7 – 17 years of age Volunteers were 7 – 17 years of age Matched ages and sex to patient profile list – the remainder of patients were simulated by dolls Matched ages and sex to patient profile list – the remainder of patients were simulated by dolls Used the 17 year old as the mother of the 4 month old represented by one of the dolls Used the 17 year old as the mother of the 4 month old represented by one of the dolls

Using Volunteers Children were asked to come in casual clothes and if dirty from playing outside that was okay Children were asked to come in casual clothes and if dirty from playing outside that was okay Each child was given a lanyard with the victim age and patient profile along with any pertinent clinical information received with the profile Each child was given a lanyard with the victim age and patient profile along with any pertinent clinical information received with the profile The youngest children were accompanied by their parent throughout the victim process The youngest children were accompanied by their parent throughout the victim process

Using Volunteers Every parent signed a consent for participation for their child Every parent signed a consent for participation for their child An observer assigned roles, distributed lanyards to the victims, and coordinated movement of victims into and through the ED An observer assigned roles, distributed lanyards to the victims, and coordinated movement of victims into and through the ED Once a victim was cleared for transfer to a patient room, the observer gathered the volunteers, gave them lunch and released them for the day Once a victim was cleared for transfer to a patient room, the observer gathered the volunteers, gave them lunch and released them for the day

Using Volunteers After the exercise letters were written for each child confirming the service hours After the exercise letters were written for each child confirming the service hours Letters were delivered to the parents along with a t-shirt or bag for each volunteer Letters were delivered to the parents along with a t-shirt or bag for each volunteer Parents and children commented that this was a good experience for them and they learned a lot Parents and children commented that this was a good experience for them and they learned a lot No one said they were afraid during the exercise No one said they were afraid during the exercise

Pediatric Surge Mercy absorbed 62 pediatric patients (budgeted Average Daily Census = 2.5) 15 in the initial surge – all went to the Pediatric Unit 15 in the initial surge – all went to the Pediatric Unit 4 from a school collapse – 1 to ICU, 3 to Pediatric Unit 4 from a school collapse – 1 to ICU, 3 to Pediatric Unit 4 from the pediatric hospital evacuation – 3 to ICU/CCU, 1 to Pediatric Unit 4 from the pediatric hospital evacuation – 3 to ICU/CCU, 1 to Pediatric Unit

Pediatric Surge 20 from a pediatric mental health facility – 20 from a pediatric mental health facility – placed on Behavioral Health Unit placed on Behavioral Health Unit 4 Russian speaking children without parents – 4 Russian speaking children without parents – used Russian-speaking Respiratory Therapist, used Russian-speaking Respiratory Therapist, eventually sent to Pediatric Unit eventually sent to Pediatric Unit

Pediatric Surge 11 ventilator dependent patients – placed in 11 ventilator dependent patients – placed in PACU, staff called in to care for patients PACU, staff called in to care for patients 4 neonates whose mothers delivered 4 neonates whose mothers delivered prematurely – infants placed in Special Care prematurely – infants placed in Special Care Nursery, mothers to Labor & Delivery for Nursery, mothers to Labor & Delivery for assessment and then to Mother/Baby Unit assessment and then to Mother/Baby Unit

Outcomes Every patient sent to Mercy during the drill was placed within the hospital and treated Every patient sent to Mercy during the drill was placed within the hospital and treated Alternate care locations were rapidly identified within the hospital and Mercy staff found to care for patients Alternate care locations were rapidly identified within the hospital and Mercy staff found to care for patients Used 2 senior charge nurses in the HICS role of Resources Unit Leader to determine patient placement, staffing requirements and equipment needs – they do this every day and are really good at it Used 2 senior charge nurses in the HICS role of Resources Unit Leader to determine patient placement, staffing requirements and equipment needs – they do this every day and are really good at it

Reunification American Red Cross Patient Connection American Red Cross Patient Connection system was activated system was activated Pictures were taken of incoming patients and parents Pictures were taken of incoming patients and parents Patients accompanied by parents were not separated from parents for any reason Patients accompanied by parents were not separated from parents for any reason

Reunification Do not cut off ID bands from transferring institutions – these can aid in reunification Do not cut off ID bands from transferring institutions – these can aid in reunification If these bands are cut off – If these bands are cut off – Have registrars record the information Have registrars record the information Place the actual band in the patient record Place the actual band in the patient record Take a photo and copy into the chart with other identifying photos Take a photo and copy into the chart with other identifying photos

Reunification Load camera software into system so that any printer may be used to print pictures Load camera software into system so that any printer may be used to print picturesOR Invest in a photo printer for each camera and issue printer with camera Invest in a photo printer for each camera and issue printer with camera Be sure you have photo paper available, the larger the better Be sure you have photo paper available, the larger the better Use personnel from the Labor Pool to deal with patient identification and photo printing while ED staff triage and treat patients Use personnel from the Labor Pool to deal with patient identification and photo printing while ED staff triage and treat patients

Reunification Have parent identify child from photo board Have parent identify child from photo board and have child identify parent from photo board and have child identify parent from photo board Have parent describe birthmarks, tattoos, Have parent describe birthmarks, tattoos, clothing, distinguishing marks, etc. before clothing, distinguishing marks, etc. before seeing child seeing child Place matching arm bands on parents and Place matching arm bands on parents and children children Think about other ways to prevent child Think about other ways to prevent child abduction during a chaotic situation abduction during a chaotic situation

Planning Create a plan clearly identifying holding locations for reunification Create a plan clearly identifying holding locations for reunification Conduct a safety survey of those areas as a part of your plan Conduct a safety survey of those areas as a part of your plan Create a checklist based on the safety survey to prepare the area for an influx of families Create a checklist based on the safety survey to prepare the area for an influx of families

Planning Create a staffing plan knowing that it will take more people than expected to deal with frightened children Create a staffing plan knowing that it will take more people than expected to deal with frightened children Extra staff will be needed to hold for procedures, watch unattended patients, prevent falls and wandering Extra staff will be needed to hold for procedures, watch unattended patients, prevent falls and wandering Consider using day care staffing ratios and use the labor pool Consider using day care staffing ratios and use the labor pool

Planning Remember that there are others who work in the hospital besides clinical caregivers – they can be included in the Labor Pool Remember that there are others who work in the hospital besides clinical caregivers – they can be included in the Labor Pool Some of those individuals will be parents and can help in caring for groups of children Some of those individuals will be parents and can help in caring for groups of children Think about the size of the child and not just the age in determining bed placement Think about the size of the child and not just the age in determining bed placement

Planning Think about staff members from local Pediatric medical practices Think about staff members from local Pediatric medical practices Think about individuals who work in Day Care facilities Think about individuals who work in Day Care facilities Think about using uninjured parents who accompany injured children as helpers Think about using uninjured parents who accompany injured children as helpers

Planning Insure that you have pediatric supplies on hand especially if you do not have a pediatric unit Diapers and formula Diapers and formula T-shirts in various sizes to serve as gowns – can also be used in decontamination situations T-shirts in various sizes to serve as gowns – can also be used in decontamination situations Pediatric masks Pediatric masks

Planning Insure that you have pediatric supplies on hand especially if you do not have a pediatric unit Small size needles and pediatric drip chambers if pumps are not available Small size needles and pediatric drip chambers if pumps are not available IV Pumps – can your current pumps be set for low doses IV Pumps – can your current pumps be set for low doses Ventilators – can your current equipment be set for low volumes, pressures, rates Ventilators – can your current equipment be set for low volumes, pressures, rates

Planning Create pediatric dosing charts in advance based on weight and age Create pediatric dosing charts in advance based on weight and age Create drip rate charts in advance for your IV tubing Create drip rate charts in advance for your IV tubing Purchase pediatric emergency equipment based on the Broselow Color Coded Emergency System and/or the EMSC Checklist for Care of Children in Emergency Department Purchase pediatric emergency equipment based on the Broselow Color Coded Emergency System and/or the EMSC Checklist for Care of Children in Emergency Department

Planning Study packet for Broselow Color Coded Emergency System Study packet for Broselow Color Coded Emergency System Use the resources available on-line to create plans specifically for pediatric patients Use the resources available on-line to create plans specifically for pediatric patients

Marilyn J. Chapman, RNC, MSN Director, Organizational Development Mercy Hospital and Medical Center Chicago, IL