1. Addressing Pediatric and School-based Surge Capacity in a Mass Casualty Event Michael Shannon, M.D. Director The Center for Biopreparedness Division of Emergency Medicine Children’s Hospital Boston Harvard Medical School Boston, MA

2. Surge Capacity and Children: Key Issues Every type of disaster can occur Two scenarios to consider:  School is a target  Community disaster while school is in session

3. Key Challenges in Consequence Management EMS, fire and other public health agencies Decontamination teams Non-pediatric hospitals emergency departments Hospital response Hospital campus security Mental health response and recovery Mass distribution of antidotes, antibiotics, and vaccines Inclement weather

4. The Challenges of Mass Casualty Incidents Involving Children vs. Adults Biological – immature immune system  greater morbidity/mortality Chemical – difficult to assess, manage and keep warm during decontamination Radiological – significantly increased risk of cancer (e.g., thyroid)

5. Blast – difficult to stabilize during the “golden hour” Burns – greater likelihood of life-threatening fluid loss and susceptibility to infection The Challenges of Mass Casualty Incidents Involving Children vs. Adults

6. School Crisis Response Manual: Guiding Principles Guidelines are desperately needed General templates can be created but no one size fits all The main steps in creating a school plan are:  Interviews with principal  Interviews with school nurse  A walk through with the custodian  Include after-school programs

7. School Crisis Response Manual: Guiding Principles Steps in creating a school plan – cont’d  Integrate into the existing plans, e.g., evacuation (fire drills)  All plans take weather into account  New plans needed for sheltering-in and lockdown  Drills, including table-top exercises, are an important part of school readiness

8. Role of DMAT in Disasters Involving Children Currently limited because there are only 2 in the U.S. Compelling need to develop more Existing DMAT teams need ongoing training in pediatric response

9. Emergency Department Challenges in Disasters Involving Children Adequate number of pediatric supplies Pediatric decontamination equipment and protocols Effective response to large numbers of burn victims Assessing non-verbal children

10. Additional Emergency Department Challenges in Disasters Involving Children Treating children while wearing personal protective equipment Effective systems for identification, tracking, and reunification Use of alternate sites (e.g., schools, neighborhood health centers)

11. AHRQ-Sponsored Pediatric Protocols Under Development Completed  Training video: The Decontamination of Children Near-Complete  Pediatric Aspects of Surge Capacity Planning  The Role of DMAT in Pediatric Mass Casualty Incidents In Production  Effective School-based Response to Disasters and Other Public Health Emergencies