Transcript How to Get Involved - JumpSTART Pediatric MCI Triage Tool

Disaster Preparedness and
Response for the Pediatrician:
How to Get Involved
Session S1082
Lou Romig MD, FAAP
Michele R. McKee MD, FAAP
Photo courtesy of www.photolibrary.fema.gov
Disclosure: Michele McKee
Faculty Disclosure Information

In the past 12 months, I have no relevant
financial relationships with the manufacturer(s)
of any commercial product(s) and/or
provider(s) of commercial services discussed
in this CME activity.

I do not intend to discuss an
unapproved/investigative use of a commercial
product/device in my presentation.
Disclosure: Lou Romig
 I have no relevant financial
relationship with the manufacturers
of any commercial product and/or
providers of commercial services
discussed in this CME activity.
 I do not intend to discuss an
unapproved/investigative use of a
commercial product or device.
Disclaimer: Lou Romig
 I am a federal intermittent disaster
employee under government salary
only when deployed to a federallydeclared disaster.
 Opinions expressed in this session
are strictly personal and shall not be
construed as representing the
opinion of any federal agency or
other federal personnel.
Objectives
 Learn about federal disaster
planning programs
 Learn about disaster planning and
preparedness issues for children
and families
 Learn how to get involved in disaster
planning and response
Session presentation available at
www.jumpstarttriage.com
“More lectures” page
Federal Disaster Planning and
Response
Photos courtesy of www.photolibrary.fema.gov
National Response Framework
• All hazards response
• Local through federal
levels
• Includes common
terminology through
NIMS
• Scalability
• Flexibility
• Adaptability
www.fema.gov/nrf
National Planning Scenarios

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





Improvised Nuclear
Device
Aerosol Anthrax
Pandemic Influenza
Plague
Blister Agent
Toxic Industrial
Chemicals
Nerve Agent
Chlorine Tank
Explosion
 Major Earthquake
 Major Hurricane
 Radiological




Dispersal Device
Improvised
Explosive Device
Food Contamination
Foreign Animal
Disease
Cyber Attack
Disasters are local events
Disaster
Occurs
Local
County
First
Alert Executive
Responders
Requests Governor
Aid From
Informs FEMA
Regional
Director
Field
Operations
THE National
RESPONSE
15
Emergency
Support
Functions
(ESFs)
Declares
Disaster
Advises
Requests
Assistance
FEMA
Director
Contacts
Framework
President
Provides
Emergency
Response
Team
Sets Up
Disaster
Field
Office
Federal
CoordinatingAppoints
Officer
Joins
State
Coordinating
Officer
National Response Framework
EMERGENCY SUPPORT FUNCTIONS
DOE
USDA
DOT
Energy
Food
EPA
NCS
Hazardous
Materials
11 12 1
10
Urban Search
FEMA and Rescue
2
ESF
9
8
Health and
Medical
Communication
3
Public Works
(USACE)
4
7
6 5
Firefighting
HHS
Resource
Support
Information
Mass Care & Planning
GSA
FEMA
ARC
Opportunities for involvement
DOD
USDA
& FS
National Response Framework
EMERGENCY SUPPORT FUNCTIONS
 ESF 13: Public Safety and Security
(DOJ)
 ESF 14: Long-Term Community
Recovery (FEMA)
 ESF 15: External Affairs (DHS)
NOTE
Photo from www.photolibrary.fema.gov
There is no agency
charged with
assuring the welfare
of children and
families during and
after disasters.
ESF - 8
We’re from the Feds, and we’re here to help…
Photos from www.photolibrary.fema.gov
Lead Agency for ESF-8
Office of the Assistant
Secretary for Preparedness
and Response (ASPR)
Office of Preparedness and
Emergency Operations (OPEO)
Roles of Emergency Support Function #8
 Assessment of Health and Medical Needs
 Health Surveillance
 Medical Care Personnel
 Health/Medical Equipment and Supplies
 Patient Evacuation
 In-Hospital Care
 Food/Drug/Medical Device Safety
 Worker Health/Safety
Roles of Emergency Support Function #8
 Radiological, Chemical, and Biological Hazards
 Mental Health
 Public Health Information
 Vector Control
 Potable Water/Wastewater & Solid Waste
Disposal
 Victim Identification/Mortuary Services
 Veterinary Services
NDMS is a public/private sector partnership
Federal partners - HHS, DOD, VA, DHS/FEMA
NDMS Resource Teams
 DMATs – Disaster Medical Assistance
Teams
 DMORTs – Disaster Mortuary Teams
 NVRTs – National Veterinary Response
Teams
 NNRTs – National Nurse Response
Teams
 NPRTs – National Pharmacy Response
Teams
So who’s watching out for kids
and families?
Photo from www.photolibrary.fema.gov
Federal agencies with advisory roles
 National Institute of Child Health and
Human Development (NICHD)

Obstetric and Pediatric Section for
Biodefense Activity

Best Pharmaceuticals for Children
Act of 2002 and 2007

Chemical, biological,
radiological/nuclear weaponry
Federal agencies with advisory roles
 Centers for Disease Control

The Coordinating Office for
Terrorism Preparedness &
Emergency Response (COTPER)

Represented on most federal-level
advisory committees, including
those with family/pediatric focus

Grant dollars
www.emergency.cdc.gov
Federal agencies with advisory roles
 National Biodefense Science Board

Established under the Pandemic and
All-Hazards Preparedness Act, 2007

Guidance to HHS

One voting member is pediatric ID
specialist (Dr Andrew Pavia)

Working groups may have pediatric
specialists
 http://www.dhhs.gov/aspr/omsph/nb
sb/index.html
Federal commissions with
advisory roles
 National Advisory Committee on
Children and Terrorism

Public Health Security and Bioterrorism
Preparedness and Response Act of 2002

Established 2003 by Sen. Clinton

Hosted by CDC

34 broad recommendations to the
Secretary of HHS
 http://www.bt.cdc.gov/children/PDF/
working/Recommend.pdf
Federal commissions with
advisory roles
 National Commission on Children
and Disasters

H.R. 3495: Kids in Disasters Wellbeing, Safety, and Health Act of
2007 (WiSH Act)

Still pending in the Senate

Focuses on evaluating existing law
and policy and incorporating lessons
learned into new law and policy.
Federal commissions with
advisory roles
 National Commission on Children
and Disasters

Establishes a national resource
center on children and disasters

Report to Congress and the
President
http://www.govtrack.us/congress/bill.
xpd?bill=h110-3495&tab=summary
http://www.ncdp.mailman.columbia.edu/index.html
AAP
 Disaster Preparedness Advisory
Council

3-5 yr strategic action plan for AAP

Oversee/support AAP initiatives

Strengthen AAP advocacy efforts
http://www.aap.org/disasters/dpac.cfm
The bottom line:
 Significant engagement at
federal/national level
 No oversight
 Little accountability
Disaster preparedness must
start at home.
If not us, who?
Incident Command for the Community
and
Family Centered Planning

Hierarchy/Roles

Response


Ground Zero Family
Planning
Special Needs
Populations

Child and Family
Focused Needs

Advocacy Roles

Community Advisory
Boards

State Involvement

Regional Response
Teams
Family Focused Planning
Family
Pediatrician
Local
State
Federal
Incident Command for the
Community

Roles
Family
Pediatrician
Local
State
Federal
Incident Command for the
Community

Roles
Federal Level Agency

Set requirements

Provide:
Family
Pediatrician
guidance
response capability (NDMS)
Local
recovery resources (FEMA)
financial resources to State and
Local communities

Support research

Stockpiling and distribution of
medical countermeasures,
equipment
State
Federal
Incident Command for the
Community

Roles
State Level

Set Requirements

Provide:
Pass through for funding
Family
Pediatrician
Local
resources to local communities
response and surge capacity
(National Guard, MRC’s)
resources and guidance for
recovery

Governor can request Federal aid
State
Federal
Incident Command for the
Community

Roles
Emerging Concept
Local communities, intrastate
regions, private sector, states
forming linkages/partnerships
for preparedness and response
activities
Family
Pediatrician
Local
State
Federal
Emerging Concepts
Family
Pediatrician
Federal
Local: private and public sectors
State: single and intrastate
Emerging Concepts
Family
Pediatrician
What is my role?
How can I prepare my patients?
Federal
Local: private and public sectors
State: single and intrastate
The Pediatrician:
Pre-Event Planning
 Have I provided my patients with a
tool to plan for their survival and well
being?
 Are my special needs patients part
of the global plan?
 Do I have a role within my local
community?

Do I have a role in an Incident
Command System?
Tools for Families
 Multiple internet resources available,
personalize the plan
 Real time communication regarding
clinic availability
Internet Available Plans:
US Department of Homeland Security
http://www.ready.gov/kids/sesame/index.html
Let’s Get Ready!
http://www.sesameworkshop.org/initiatives/emotion/re
ady
Download: Parent or Caregiver Magazine, ©2008 Sesame
Workshop
Contents:
TALK ABOUT IT
IT’S A PLAN!
OUR FAMILY’S HEALTH AND CONTACT
INFORMATION
Make an Emergency Plan With Your
Family
Help Your Child Learn and Practice
Personal Information
Create a Family Emergency Kit
LET’S GET PERSONAL
OUR FAMILY’S EMERGENCY KIT
TOGETHER, WE CAN BE READY!
Internet Available Plans: AAP
http://www.aap.org/family/frk/frkit.htm
http://www.aap.org/family/frk/aapfrkfull.pdf
Overview Booklet, 2nd Edition
Four Focus Areas:
1. Understanding Disasters
2. Families As The First Resource
For Preparation, Protection and
Recovery
3. Making Your Neighborhood
Disaster Ready
4. Community and National
Resources
Emergency
Information
Form
http://www.aap.org/advo
cacy/blankform.pdf
Emergency
Information
Form
http://www.aap.org/advoc
acy/blankform.pdf
Prepare Your Patients and Your
Practice
http://www.aap.org/disasters/pediatricians.cfm
Clinic Availability
 Telephone triage
 Clinic hours and services
 Signs for those presenting to clinic
The Pediatrician:
Pre-Event Planning
 Have I provided my patients with a
tool to plan for their survival and well
being?
 Are my special needs patients part
of the global plan?
 Do I have a role within my local
community?

Do I have a role in an Incident
Command System?
Special Needs Patients
 Definition of “special needs
population” in the National
Response Framework
“Before, during and after an incident, members
of the special-needs population may have
additional needs in one or more of the following
functional areas: maintaining
independence, communication,
transportation, supervision and
medical care”
Special Needs Patients
 Category Definition
Elderly
Children
Pregnant women
Disabled
Hearing/sight impaired
People with Chronic Illnesses
Low socio-economic status
Home-bound
Low English proficiency
Tourists
Pandemic and All Hazards
Preparedness Act (S. 3678)
“The term ‘at-risk individual’ means
children, pregnant women, senior
citizens and other individuals who have
special needs in the event of a public
health emergency as determined by the
Secretary.”
Federal Maternal and Child
Health Bureau Definition
Children with special health care needs are
those who have or are at increased risk for a
chronic physical, developmental, behavioral,
or emotional condition and who also require
health and related services of a type or
amount beyond that required by children
generally.
Mc Pherson M, Arango P, et al. A New Definition of Children With
Special Health Care Needs. Pediatrics 1998;102;137-139
Pediatric Special Needs
 20 million children with special
healthcare needs
 Excluding Asthma: 12 million
children with special health care
needs
 Are the needs due to physical
handicaps, maturational or cognitive
level of functioning, technology
needs (ventilator, oxygen), chronic
medications
The Pediatrician:
Pre-Event Planning
 Have I provided my patients with a
tool to plan for their survival and well
being?
 Are my high risk or special needs
patients part of the global plan?
 Do I have a role within my local
community?

Do I have a role in an Incident
Command System?
Incident Command System
 A standardized management
protocol
 Meant to provide a common
framework for all entities to respond
cohesively to an all-hazard event
 Objectives include

Reduce miscommunication

Avoid redundancy
Incident Command System:
5 major functions
Command staff, general staff
with branches and divisions.
Incident Command
Flexible to suit any given
incident.
Operations
Section
Planning
Section
Logistics
Section
Finance/
Administration
Section
Incident Command System:
5 major functions
For the community
physician
you will most likely be
absorbed
into the operations section.
Operations
Section
Incident Command
Planning
Section
Logistics
Section
Finance/
Administration
Section
Incident Command System
•
•
•
•
•
•
•
Where do I report?
Who is my supervisor?
What is my role?
Am I urgently or emergently
credentialed at this locale?
Are there generic computer accounts
provided for volunteers?
Pediatrics
Critical Care
Medicine
Operations
Section
In-patient
Casualty
Clinical Support
Staff/Victim Safety
Surgical
Nursing
Ambulatory
Care
OB
Family Centered Planning
 Provisions
 Identification and reunification
 Post-event recognition and
treatment
Provisions
 Routine

Age or developmental appropriate
food, hygiene, recreation, sleep
 For special needs or at-risk patients

Pre-identify and target during first
round of family readiness planning
during well or ill visits

Electrical or mechanical needs,
medications, special dietary needs,
transportation, communication
Identification and Reunification
 Developmentally immature
 Shelter in place vs. relocation
 Transportation and communication
 Picture boards or other identifiers

HIPAA compliant?

Withstand the test of time?
Identification and Reunification
 Facility plans

Childcare
http://www.naccrra.org/disaster/docs/Disaster_Guide_MEC
H.pdf

School

Group living structure

Foster care
• Who has medical and/or legal guardianship?
• Is there a special caveat during an acute
event even when there isn’t a life threatening
issue?
Post-Event Stress
 Sensitive to adult responses
 Long lasting response; may be
delayed
 How does it manifest

Depression, PTSD, Acting out,
Regression, Somatic complaints

School performance changes

Sleep disturbances
Post-Event Stress
 Screening

Augmentation of existing protocols,
staffing

At scene group screening
 Treatment
PostEvent
Stress
http://www.aap.
org/disasters/pd
f/psychosocialimplications.pdf
PostEvent
Stress
http://www.aap.
org/disasters/p
df/chem-bioterrorism.pdf
Anticipatory Guidance
 Family Readiness

Refer to internet resources

Handouts
 Did the school/child care facility ask
for a plan?
 Does my county have its own plan?
Advocacy roles
for
pediatric and
family disaster
preparedness
Children and Disasters
http://www.aap.org/disasters/
AAP Strategic Plan for Disaster Preparedness
Activities
Advocacy
Appointments
Comments
Educational Presentations
Partnership for Children's Disaster
Preparedness
Publications
Representation at Meetings
Testimony
AAP Policies and Resources
http://www.aap.org/disasters/advocacy.cfm
Bioterrorism and Other Public
Health Emergencies
Pediatric Terrorism and Disaster
Preparedness
A Resource for Pediatricians
Report or Summary is available
Author: AAP for AHRQ
Community Advisory Boards
 Is there a physician on the board?
 Emergency
 School
 Home
Management
System
health care
 Is the board sensitive to the special
needs and issues children present?
Service
Opportunities:
Getting
involved as a
disaster
responder
Getting involved as a disaster
responder
 Responding outside of a disaster
area
 Responding inside a disaster area
Be a part of the system
 Pre-credentialing
 Resource-typing
 Training (including Incident
Command/NIMS)
 Liability/ Worker’s comp coverage
 Support of family, coworkers and
employers
Response Networks
 Medical Reserve Corps
 ESAR-VHP
 Disaster Medical AssistanceTeams
 CHILDisaster NETWORK
Medical Reserve Corps
 Part of US Citizen Corps
 Local initiatives with local/regional
responsibilities
 Options to respond outside of local
area (through state or federal
activation)
 Medical and non-medical personnel
Medical Reserve Corps
 > 500 MRC units, about 100,000
volunteers
 Often housed within Public Health
Departments
 Roles in public health initiatives and
emergencies as well as disasters
 Often support Red Cross missions
www.medicalreservecorps.gov
ESAR-VHP
 Emergency System for Advance
Registration of Volunteer Health
Professionals
 Federally subsidized, administered
by state government
 Federal program within DHHS
Health Resources and Services
Administration (HRSA)
ESAR-VHP
 Not a response team or program
 Acts as advance registration and
credentialing tool to facilitate use of
medical volunteers
 Feds are developing guidelines for
composition of state-level
standardized/specialty response
teams
MA System for Advance Registration
(MSAR)
http://www.massmed.org/AM/Template.cfm?Section=Preparedness&CON
TENTID=17715&TEMPLATE=/CM/ContentDisplay.cfm
MRC/ESAR-VHP
 Federally subsidized with oversight
by DHHS
 Standardize the volunteer process
 Replace previous volunteering
through professional organizations
 Reduce freelance volunteering
MRC/ESAR-VHP
 Not paid when deployed
 No federal employment protection
 Liability/Worker’s comp covered by
state law/regs unless federally
deployed
The NDMS
and
DHHS Disaster Medical Assistance
Teams
DMATs
 Oversight by DHHS Office of Emergency




Preparedness
Deployed to federally-declared disasters
and security events
Volunteers become temporary federal
employees when deployed
Workmen’s comp, liability, salary,
expenses covered while on deployment
No geographic restriction to practice when
deployed
The Legalities:
USERRA
 Deployment is voluntary for the individual
 An employer must let the employee
deploy if they choose to respond
 The employee should give their employer
as much advance notice as possible
except when urgency prevents timely
notice.
 The volunteer cannot be required to take
vacation or other leave time to deploy.
DMATs
 Have drills and training throughout
the year
 May have local and state
agreements for service in a
nonfederal disaster and for special
security or mass gathering events.
 Some states are sponsoring state-
level DMAT-equivalent teams
DMAT Missions

Field emergency care facility

Medical standby for mass gatherings

Disaster shelter sick call/clinics

Neighborhood outreach

Fill in hospital and EMS staff

Medical care for responders

Other federal missions (refugee health
screening and care, Points of Distribution)
What’s the down side of DMAT?
 Food and Shelter
 Environment/Hygiene
 Working hours
 Working outside your comfort zone
 Safety
 Uncertainty
 Isolation (The YOYO Principle)
 Hurry up and wait!
 The pay…
FL5 DMAT photos
http://www.hhs.gov/aspr/opeo/ndms/join/index.html
CHILDisaster NETWORK
 Alliance of the AAP, the Johnson
and Johnson Pediatric Institute and
the International Pediatric
Association
 Registry of medical professionals
with pediatric training and
experience who are willing to deploy
internationally
 Deploy at the request of other
agencies (NGOs)
CHILDisaster NETWORK
 Must complete a basic course in
complex humanitarian
emergencies
 Be willing to be on call and
deployable at 48hrs notice
 Must be able to deploy for at
least 2 weeks
http://www.aap.org/disaster/
Summary
 If we don’t do our part, children and
families may be overlooked
 Disasters are local
 Disaster preparedness is a personal
and professional responsibility
 There’s a job that matches your
desire to contribute
Join us!
[email protected]
www.jumpstarttriage.com
[email protected]