This article is part of a collaborative effort by experts in the field of emergency preparedness to complete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future directions in pediatric disaster readiness. This particular article, "The Role of Pediatric Health Care Providers," will illustrate the important role of pediatric care experts at all levels of disaster planning, and as a vital resource for pediatric emergency preparedness in the community.
The pediatric health care provider plays an integral part in disaster response and preparedness. Pediatricians are needed at all levels of disaster planning so that children's unique needs are recognized, addressed, and incorporated into comprehensive community-focused disaster plans.1, 2 In addition to pediatricians, pediatric subspecialists in emergency medicine, surgery, infectious diseases, and other areas are critical to all phases of emergency preparedness. In the following sections, we will outline the roles that pediatricians may play in preparing their communities for all hazards.1, 3, 4, 5 We encourage readers to explore the additional resources compiled by experts in the field of disaster medicine that are available in this compilation. We also point pediatricians to additional online resources such as the American Academy of Pediatrics (www.aap.org/disasters/pediatricians.cfm), American College of Emergency Physicians (www.acep.org), Emergency Medical Services for Children (www.childrensnational.org/EMSC/PubRes/EMSC_Toolbox.aspx),1 and the Center for Disease Control and Prevention (www.cdc.gov).
Serve as a Community Resource
Pediatric health care providers are important resources in community (eg, school6 and daycare, hospital associations, and clinics), state, or federal level efforts for establishing comprehensive response plans.1, 2, 3, 4, 5, 6, 7, 8 Pediatricians who are involved and “at the table” making decisions for emergency responses will undoubtedly help to recognize and close the gaps in often overlooked pediatric needs and resource considerations. The pediatric expert's influence ranges from selecting the appropriate antidote dosing to advocating for mental health plans that are developmentally appropriate.
Assist in Developing Protocols for Offices and Medical Treatment Facilities
The pediatric health care provider should assist with the development of plans for office emergencies1 evacuation, storage of temperature-sensitive vaccines and medications, and preidentified alternative office care sites. It is desirable that the office disaster plan be congruent with local community and hospital disaster plans. In addition, office personnel should be trained in basic first aid and cardiopulmonary resuscitation.1, 8 If there are no pediatric hospitals in the local community or region, then it is especially important for pediatricians to engage local hospitals in a dialogue about how children will be handled during and after a catastrophic event. Because all health care facilities must be prepared for a pediatric surge, this activity is important even in those communities with a children's hospital. One simple maneuver may be to organize a telephone tree of pediatric specialists in the area and share it with the hospital disaster planning group. Pediatricians may also serve as liaisons between local community hospitals or health care clinics and the regional pediatric hospital or a professional organization. In the face of a crisis, it may not be about what you know but who you know to call. Communication plans are key to disaster planning efforts.
Accept Key Role of Identifying Sentinel Cases of Illness
Office-based pediatricians or pediatric emergency physicians may be the first to evaluate and identify a patient (or patients) with a unique or suspicious case. It is the responsibility of the pediatric provider to report such information to public health authorities or the local department of health. To execute this duty to report, the provider must be able to identify the signs and symptoms of a chemical-biologic-radiologic-nuclear event. The Center for Disease Control and Prevention Web site previously mentioned is an excellent resource for chemical-biologic-radiologic-nuclear event information.7
Education and disaster training
The pediatrician should educate colleagues, trainees, emergency medical technicians, emergency managers, and policy makers on pediatric issues that may impact disaster management and response. Pediatric disaster experts can provide self-directed learning modules, disseminate critical information to colleagues, and assist with disaster drills. These activities raise awareness among fellow health care providers about pediatric patient–specific disaster preparedness concepts and reinforce pragmatic approaches to problem solving during a disaster.1, 3, 7
Provide Anticipatory Guidance to Families
Parents expect pediatricians to know about disasters7 and their effect on children. Pediatricians should recognize the natural progression of a disaster-related illness and be prepared to respond to parental questions. This is not easy because there are many potential hazards, but it is key to know where to find the answers to these questions. Furthermore, pediatricians should encourage parents to develop a family emergency plan7 and should establish the ground rules for interacting with the clinician's office if a catastrophic event occurs. Pediatric providers should pay particular attention to families with special needs or technology-dependent children in planning for catastrophic events. Recommendations may include updated emergency information forms,4, 8 notification of utility companies, extra supply of chronic medications, and supplies.4, 8
Summary
This section on the role of pediatric health care providers is not intended to be a complete compendium of didactic content, but rather a focused and abridged overview of how pediatricians and other health care professionals can lend their service and expertise to augment disaster preparedness from the local to national level and, perhaps, beyond. Candidly, we aim to get the pediatrician thinking and moving before the next disaster occurs. Some of the roles a pediatrician can play have been enumerated here and in other references, but without the drive, action, and multidisciplinary collaboration, such efforts are futile.
References
1. 1Dolan M, Krug S. Pediatric disaster preparedness in the wake of Katrina: lessons to be learned. Clin Pediatr Emerg Med. 2006;7:59–66.
4. 4American Academy of Pediatrics Committee on Pediatric Emergency Medicine . Emergency preparedness for children with special health care needs. Pediatrics. 1999;104:e53.
5. 5Schonfeld DJ. In times of crisis, what's a pediatrician to do?. Pediatrics. 2002;110(1 Pt 1):165.
6. 6American Academy of Pediatrics Council on School Health . Medical emergencies occurring at school. Pediatrics. 2008;122:887–894.
7. 7Markenson D, Reynolds S, American Academy of Pediatrics Committee on Pediatric Emergency Medicine . The pediatrician and disaster preparedness. Pediatrics. 2006;117:e340–e362.
8. 8American Academy of Pediatrics Committee on Pediatric Emergency Medicine . Preparation for emergencies in the offices of pediatricians and pediatric primary care providers. Pediatrics. 2007;120:200–212.
⁎Pediatrics and Emergency Medicine, The George Washington University School of Medicine, Children's National Medical Center, Washington DC
†Pediatric Disaster Resource and Training Center, University of Southern California, Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, CA
Reprint request and correspondence: Pediatrics and Emergency Medicine, The George Washington University School of Medicine, Children's National Medical Center, Washington DC.
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