By Dennis Cooley, MD, FAAP
Are we prepared to provide the best possible care for our children in emergency and disaster situations? I have recently attended one meeting and one conference on emergency preparedness for children that shed some light on this question. I want to first give you some of the information that I learned followed by some thoughts on the current situation in our state and how we might improve it.
The meeting I attended was the state’s EMSC Annual Meeting held in Wichita. There was some good news, but also some worrisome information presented at this meeting concerning our emergency and disaster services for the children in our state. First the good news. The state’s EMS services did well in the areas of online medical direction and protocols for pediatric patients scoring above national averages in both. We had mixed results on the area of equipment. Our BLS vehicles averaged 91% of recommended equipment and the ALS vehicles averaged 93%. These numbers are very close to national averages. However, only 17.3% of BLS transporting vehicles and 15.8% of ALS vehicles had all of the recommended equipment to deal with pediatric emergency patients. Now for the really bad news. In the area of inter-facility transfers, only 50% of hospitals have transfer agreements for pediatric patients compared to the national average of 66%. And when looking at the eight components of EMSC transfer guidelines only 30% of our hospital fulfilled these.
The conference I attended was the National Pediatric Disaster Coalition Conference in Scottsdale, Arizona. Again some sobering facts came out. According to the Save the Children organization for every $10 spent in federal emergency preparedness grants less than 1 cent is spent toward activities targeting children’s safety. This is despite the fact that children make up 26% of the US population. Also, data shows that more than 1/2 of US families have been affected by disasters. Yet in a survey only 40% of families have an emergency plan. It was pointed out that only 21% of the recommandations made by the National Commission on Children and Disasters 10 years ago following Katrina had been met. Primary care physicians are an untapped source of expertise that is available during disaster and emergency situations. Finally, mental health problems developed in over 37% of children affect by Hurricane Katrina and this number is likely much lower than the actual number.
So what did I learn from this and other information presented at these meetings? Well as we all know, children tend to be forgotten, despite making up a large section of our population. (I am being politically correct saying forgotten rather than intentionally ignored but, I am not so sure the latter is not really the truth). Emergency preparedness is not a priority for adult patients but, they tend to get the majority of attention and money. People think disasters are huge events that occur in remote parts of the world. In truth, most disasters involve small numbers of patients that overwhelm the local system and can and do occur anywhere. (Remember the data that over 50% of families have been affected by disasters) Rural areas have a difficult time dealing with children in emergency situations for a number of reasons and solutions to remedy these are not forthcoming. Primary care providers are essentially left out of community disaster and emergency plans partly as a result of our own lack of interest (I was told this by a number of the hospital and emergency planners) but, also because of a reluctance of emergency managers and hospitals to enlist them (and I made sure to tell this to the hospital and emergency planners). We will see significant problems with transfers of pediatric patients as a result of a poorly formalized system for inter-hospital transfers. As pediatricians, we all know the importance of children receiving care in appropriate facilities and trying to arrange this in the middle of an emergency will result in delays and potentially inappropriate referrals that could result in loss of life. Lastly, mental health issues are significant and primary care providers will be on the front lines in dealing with these.
The first step we need to do to address these issues is to set up regional pediatric emergency /disaster coalitions in our state to better serve our children. These coalitions can facilitate appropriate and timely transfers of pediatric patients. In addition, coalitions may serve to help our rural counties by helping with supplies and medications and medical expertise. The logical group to initiate these coalitions is the EMSC program. Our EMSC program was well represented at the Conference and is very anxious to be a part of this effort. I am on the Advisory Board of the EMSC representing the Kansas Chapter and this will be a priority for us.
But we still need to get state and community planners to understand the importance of including children’s needs in planning and funding. As always, it is left to us and other child advocates to make noise and work to get more attention and funding targeting children in the planning of disasters and emergency situations. We may need to approach hospital administrators or the emergency management planners about incorporating pediatricians, be it primary care or specialists, into the plans.
We can educate parents on the importance of family emergency plans during our anticipatory guidance. I know this is just one more thing we as pediatricians are expected to do during preventative care visits but, if we can at least spend a few seconds encouraging parents to at least think about this it might help. (the AAP has a handout that addresses family disaster planning)
Finally, we need to get involved. It may be taking a psychologic first aid class. It may be joining your counties Medical Reserve Corps. But it most certainly is writing your own office disaster emergency plan. The Kansas Chapter has a template for your use in writing your plan, email firstname.lastname@example.org if you would like a copy. It is vitally important to your patients and to you that you are able to continue to practice in the immediate aftermath of these situations.
Remember most disasters are small and can affect all of us – and all of our patients. If I can be of help please feel free to contact me.
Dennis Cooley, MD, FAAP