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Pediatric and Family Disaster Planning:
Considerations for Emergency Managers
Lou Romig MD, FAAP, FACEP
Miami Children’s Hospital
FL-5 DMAT/MSRT South
No excuses!
Children are
involved directly or
indirectly in the great
majority of disasters
and multicasualty
incidents
Small problems become big problems
when they involve our children
“When in danger,
when in doubt,
run in circles,
scream and shout.”
"Where in
the hell is
the cavalry
on this
one?''
Kate Hale, 8/27/92, Dade County Emergency Manager
Y.O.Y.O
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.
Key Concept
Pediatric disaster
planning at all levels and
for all hazards must be
family-centered
Who are emergency managers?
YOU ARE!
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
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
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
Adequate Care and Sheltering
Adequate Care and Sheltering
Special needs sheltering
Shelter staff training and resources
Safety
Nutrition
Waste disposal
Infectious diseases
Child care
Stress management
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
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?
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
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.)
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 immunocompromised occupants)
Need for passive immunization (ex:
VZIG)
Child Care
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)
Jonathan, age 6, Hurricane Lili
Tree breaking
Rain
Scared Jonathan
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
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
Planning Partnerships
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
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…
Emergency Responders
Disaster Training
Pediatric threat-specific risks
Pediatric assessment
Pediatric MCI triage
Pediatric treatment
Pediatric decontamination
Emergency Responders
Disaster Training (con’t)
Appropriate transport modes
and destinations
Communication skills
Stress management
Reference resources
Emergency Responders
Pediatric specific equipment
Protocols
Pediatric drug preparations and
delivery systems (Atropen,
CWIK tool)
www.cwikresponse.com
Emergency Responders
Special attention to CSHCN
Medicolegal aspects (children
without guardians)
Disaster documentation
Awareness of local family
reunification schemes
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
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?
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)
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)
IS 700 - National Incident Management
System (NIMS), An Introduction
US Fire Academy
Emergency Management Institute
http://training.fema.gov/EMIWEB/IS/is700.asp
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
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
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
Feeling a little overwhelmed?
Planning for
Kids and
Terrorism
Kids and Terrorism
It has happened. It will happen
again.
Children are soft targets for hardcore terrorists.
Very few are really ready to
protect and care for children in a
hazmat incident, much less a
WMD setting.
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?
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.
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.
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
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
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.
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.
Thank you! Questions?
[email protected]
[email protected]
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