1. Pediatric and Family Disaster Planning: Considerations for Emergency Managers Lou Romig MD, FAAP, FACEP Miami Children’s Hospital FL-5 DMAT/MSRT South

2. No excuses! Children are involved directly or indirectly in the great majority of disasters and multicasualty incidents

3. Small problems become big problems when they involve our children

4. “When in danger, when in doubt, run in circles, scream and shout.”

5. "Where in the hell is the cavalry on this one?'' Kate Hale, 8/27/92, Dade County Emergency Manager

6. Y.O.Y.O

7. You’re On Your Own The majority of disasters generate fewer than 50 injuries. Most of those are not critical. The cavalry will not be coming! Even if the feds are coming, it’s going to take time.

8. Key Concept Pediatric disaster planning at all levels and for all hazards must be family-centered

9. Who are emergency managers? YOU ARE!

10. Emergency Managers: Goals Facilitate family preparedness and independence Reunite and keep families together Assure the provision of appropriate sheltering and care before, during, and after an incident Meet the needs of families with special healthcare challenges Work with other community agencies and organizations to prepare for family care

11. Facilitating Family Preparedness Provide a realistic and honest community risk assessment Publicize and furnish family preparedness tools via internet, brochures, health fairs, media, etc. Work with school systems to distribute education and information Work with healthcare agencies and resource suppliers to assist families with CSHCN in their disaster planning

12. Keeping families together Work with school systems on reunification plans (shelter in place?) Emphasize need for reunification planning at a family level Plan shelters so that families can stay together, especially those with special medical needs Work with medical facilities and EMS/Law Enforcement to promote information sharing for locating victims

13. Adequate Care and Sheltering

14. Special needs sheltering Shelter staff training and resources Safety Nutrition Waste disposal Infectious diseases Child care Stress management Adequate Care and Sheltering

15. Special Needs Sheltering Keep families together! Community shelters or hospitals? Mix children with adults? Expanded definition of special needs Pediatric-specific medical and nutritional supplies Pediatric protocols/training for professional caregivers

16. Staff Training and Resources Who will staff regular and special needs shelters? Who can or should be turned away from regular shelters? Pediatric training? What level? Pediatric protocols for care or medical referral Reference materials Resources for phone or other advice Shelter sick call?

17. Shelter Safety Childproof your shelters (hazmats, trip hazards, etc.) Protect frail elderly or others from rambunctious children Attempt to assure security of all medications Smoking, weapons, alcohol, drug policies

18. Nutrition/Waste Disposal Assure provision of age-appropriate food and drinks and availability of snacks Watch choking hazards! Disposal of diapers, wipes,etc. Biohazard disposal (diabetic needles and lancets, wound dressings, etc.)

19. Infectious Diseases Screening at time of shelter entry How to handle new onset illnesses Medical isolation/segregation within the shelter When to involve Public Health Assessment of at-risk populations (elderly, potentially immuno- compromised occupants) Need for passive immunization (ex: VZIG)

20. Child Care

21. Stress Management Mental health professionals with child/family training Information, information, information Provide energy outlets for kids Provide parents with time away from kids Provide best possible sleep environment Therapeutic play (drawing, role play)

22. Jonathan, age 6, Hurricane Lili Scared Jonathan Rain Tree breaking

23. Emergency Managers: Goals Facilitate family preparedness and independence Reunite and keep families together Assure the provision of appropriate sheltering and care before, during, and after an incident Meet the needs of families with special healthcare challenges Work with other community agencies and organizations to prepare for family care

24. Families with CSHCN Who’s out there? (families, daycare and residential facilities) Liaison with EMS (Emergency Information Form from AAP/ACEP) Assist families and facilities with disaster planning Family-centered sheltering Emergency supply resources

25. Planning Partnerships

26. Planning Partners Emergency managers/planners Emergency responders Community response organizations School and childcare systems Medical facilities and practitioners, including mental health professionals Families and family organizations

27. Emergency Responders Work to assure that local responders can deal with the daily emergency needs of children and families. Disaster work is the same as everyday work, just more intense, more chaotic, more stressful and just plain more…

28. Emergency Responders Disaster Training Pediatric threat-specific risks Pediatric assessment Pediatric MCI triage Pediatric treatment Pediatric decontamination

29. Emergency Responders Disaster Training (con’t) Appropriate transport modes and destinations Communication skills Stress management Reference resources

30. Emergency Responders Pediatric specific equipment Protocols Pediatric drug preparations and delivery systems (Atropen, CWIK tool) www.cwikresponse.com

31. Emergency Responders Special attention to CSHCN Medicolegal aspects (children without guardians) Disaster documentation Awareness of local family reunification schemes

32. Community Responders Help to assure that local volunteer responders (such as CERT members) receive pediatric training Monitor NGO plans for inclusion of consideration of family issues

33. School and Childcare Systems Work with public and private school systems in their disaster planning Help schools integrate with local response systems Provide risk assessments to schools and childcare facilities Establish minimum standards for disaster/disaster planning training for all licensed childcare workers and school systems?

34. Medical Facilities and Practitioners Increase practitioner awareness of the need for personal, family and office/facility disaster planning. Encourage medical practitioners to assist their patients with family disaster planning. Encourage practitioners to become disaster responders (Citizen Corps, Medical Reserve Corps)

35. Medical Facilities and Practitioners Help to assure that pediatric issues are addressed in all fixed medical facility disaster plans and drills Help hospitals integrate into community disaster response plans (incident management structure, communications, field response, responsibility for care of unusual pediatric patient loads)

36. IS 700 - National Incident Management System (NIMS), An Introduction IS 700 - National Incident Management System (NIMS), An Introduction US Fire Academy Emergency Management Institute http://training.fema.gov/EMIWEB/IS/is700.asp

37. Mental Health Professionals Key players in emergency planning and response Help to anticipate community reactions and behaviors Assist with proactive education to mitigate mental health complications after disasters Provide individual and system-level guidance after a disaster Must include pediatric and family considerations

38. Families and Family Organizations Incorporate family representatives and advocates in the community planning process Encourage family advocates to champion family disaster preparedness Listen and learn from families

39. Emergency Managers: Goals Facilitate family preparedness and independence Reunite and keep families together Assure the provision of appropriate sheltering and care before, during, and after an incident Meet the needs of families with special healthcare challenges Work with other community agencies and organizations to prepare for family care

40. Feeling a little overwhelmed?

41. Planning for Kids and Terrorism

42. Kids and Terrorism It has happened. It will happen again. Children are soft targets for hard- core terrorists. Very few are really ready to protect and care for children in a hazmat incident, much less a WMD setting.

43. Kids and Terrorism Assess your communities for terrorist risk, with a special eye toward large family-oriented gathering places and venues where large numbers of children are usually found. Look at the community composition around major potential target sites. Are there residential areas, schools, hospitals nearby?

44. Kids and Terrorism Help families assess their own risks of being involved in a terrorist incident: As victims, direct or indirect As responders Help them plan accordingly.

45. Kids and Terrorism Provide information in the form of facts, not speculation. Don’t ignore the issue of terrorism and disaster preparedness in community outreach programs and schools. Information is power.

46. Kids and Terrorism Monitor the “expert” sources for new information and products addressing the needs of children and families in the WMD setting. Pediatric Preparedness for Disasters and Terrorism: A National Consensus Conference, Executive Summary http://www.bt.cdc.gov/children/pdf/working/ execsumm03.pdf

47. Additional Resources American Academy of Pediatrics http://www.aap.org/terrorism/index.html American Academy of Child and Adolescent Psychiatry http://www.aacap.org/publications/Disas terResponse/index.htm EMSC website www.ems-c.org

48. Conclusions The cavalry may not come. Plan! We are all emergency planners and managers. Children are small but they can present their own big issues in disaster preparedness. Children and families need advocates at all levels of disaster planning. Planning should be family-centered, all hazards based.

49. Final thought Our ability to care for children in disasters will never be better than our ability to care for them on a daily basis.

50. Thank you! Questions? Louromig@bellsouth.net Louromig@jumpstarttriage.com Download lectures at: www.jumpstarttriage.com