Emergency healthcare workers discuss caring for kids and infants during disasters

What would you do right now to prepare a children’s hospital or pediatric ward for an earthquake? This was the question posed by conference organizers to the health professionals and emergency center managers who attended the California Neonatal/Pediatric Disaster Coalition Conference in downtown Oakland last week to review strategies to improve emergency preparedness procedures for neonatal and pediatric patients.

Approximately 140 representatives from organizations such as Contra Costa Emergency Medical Services, Oakland’s Children’s Hospital and Research Center, the Alameda County Public Health Department and the California Hospital Association were invited to participate in the conference.

As conference attendees pointed out, during normal times injured or ill children are usually sent to pediatric specialty centers. These services will not necessarily be available to emergency teams during a disaster.

“When we have overwhelmed hospitals and health care systems, when we don’t have enough beds, neonatal intensive care units, pediatrics intensive care units, how are we going to take care of all the children?” asked Cynthia Frankel, co-chair of the Emergency Medical Services for Children and Pediatric Disaster Coalition.

The goal of the conference was to encourage attendees to have their institutions review equipment, facilities and personnel to identify methods that will allow them to be better prepared for disasters, as well as to discuss and evaluate the outcome of services provided to neonatal and pediatric patients during catastrophic events. Conference attendees also examined the emergency responses after Hurricane Katrina, the H1N1 flu pandemic and the earthquake in Japan to identify lessons that will help emergency responders in the future.

One of the presentations about the earthquake in Japan came from Kozue Shimabukuro, a critical-care pediatrician at Mattel Children’s Hospital UCLA who worked as part of the medical relief team in her native country, Japan. Her presentation highlighted some of the challenges faced by emergency service responders such as the loss of electronic communication and difficulty in securing transportation for rescue teams and patients.

Every hospital is a trauma center said Ramon Johnson, the Mission Hospital Regional Medical Center board chair, who also sits on the trauma advisory committee for the state, and the biggest issue among hospitals during disasters is the lack of communication among them and among physicians. A key component to improving services will be to link those facilities with databases to allow better coordination during a disaster, Johnson said. Recently hospitals have started to use computer programs to track the records of patients who are moved to trauma centers during an emergency, he said.

Because California is a state that experiences disasters often, and it is important to prepare for every kind of disaster that can be imagined, said Johnson. He said that a survey conducted a few years ago revealed that parents and other adults in the community want children treated as a priority in the event of a disaster. “Children are at risk, they are vulnerable, they don’t have very much representation,” Johnson said. “We really do need to provide leadership, to carry the banner not only at the federal level but at the state and local levels to make sure we have the backing that we need and the support that we need to get those federal dollars and put them in the right place, to not let them forget that children are our priority.”

Some of the attendees also discussed how local care providers can work together during an emergency to provide assistance to children from the entire region. Children’s Hospital and Research Center, Oakland has been at the center of many disasters including the 1989 Loma Prieta earthquake, said trauma center director Chris Newton, who attended the conference. “They have a mission to be the safety net hospital for kids. They take care of all the children in the Bay Area, paid insurance or not. That’s the mission of the hospital, whether it’s medical problems or trauma problems,” Newton said.

Pete Howes, the retired Contra Costa Emergency Medical Services division chief who has worked with the health department and fire department in San Francisco, said that coordinating between facilities in different Bay Area regions will be important in a disaster situation because it will allow everyone to know what resources are available. “If something is happening in the East Bay and there are resources in other areas that can assist and backup systems in place so teams do not become overwhelmed, it will allow everyone to receive adequate care,” Howes said.

Sandra Shields, the senior disaster analyst for the Los Angeles County Department of Health Services, also spoke about the need for further development of tools to assist in serving trauma patients. Her focus is on the integration of mental health preparedness into disaster preparedness plans. The American Red Cross has provided an effective model by creating a triage-driven system for managing mental health resources, Shields said, but other services providers are not as effective at providing this service during a disaster. “Research in past disasters shows that people who surge to the emergency room following a disaster are not people who are actually injured, but people who have some psychological concerns,” Shields said.

Shields describes this occurrence as “a surge of psychological casualties.” For example, she said, after the H1N1 flu pandemic there were people who needed follow-up treatment for the emotional trauma they experienced by the stress of living through the epidemic. “We have to acknowledge that mental health issues are really the most enduring,” Shields said. “We cannot afford to have mental health be the caboose on the train.”

This is the first year the California Neonatal Pediatric Disaster Coalition has included a presentation about mental health, said Judy Smith, who has been a trauma coordinator for 10 years at Contra Costa Emergency Medical Services Agency, and who was attending her third such conference. The conferences “get better every year,” Smith said. “The work they are doing is becoming more important and more people are beginning to realize that health care has not been adequately addressed for pediatric patients.”

Once the presentations were completed, the members of the conference moved into small groups to discuss the information they received during the presentations. Health care professionals in each group were asked to focus on one key issue such as mental health, the data system, more training and community involvement. The recommendations the groups made will be used to expand on the current state and hospital guidelines and create and share solutions for medical responses in disaster situations.

“There are a lot of different messages to pass on,” said Patricia Frost a co-chair of the Emergency Medical Services Neonatal/Pediatric Disaster Coalition Conference. “But the key message today is that this group is here to help support communities at all levels in health care.  We can start talking about what would we have to do differently for children, and what would we do differently for infants, if these situations occurred.”