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HomeMy WebLinkAboutpediatric-surge-readiness-checklist-2016Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 1 Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 2 Children have unique, often complex physiological, psychosocial and psychological needs that differ from adults, especially during disaster situ- ations; and unfortunately children are often involved when disasters occur. This Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies is intended as a tool to help hospital administrators and leadership incorporate essential pediatric considerations into existing hospital disaster policies. • What it is designed to do: This tool was designed to complement and augment existing disaster resources, both pediatric-specific and gen- eral, rather than to serve solely as a stand-alone document. Users may find the entire checklist useful or may focus on specific domains, depending on their unique needs and resources. The relative importance assigned to any given consideration is unique to each facility based on their specific risk assessments. • What it is not designed to do: This is not a step-by-step guide to implementing policies. Instead, resources are provided for each domain to provide more details and help implement the considerations. . It is the consensus of national subject matter experts that the pediatric domains and considerations in this checklist be well integrated into existing all-hazards hospital disaster preparedness policies or guidelines. For example, this checklist can be used to supplement the eight healthcare pre- paredness capabilities so that the pediatric domains are addressed by healthcare coalitions funded by the Hospital Preparedness Program (http:// www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf). Furthermore, hospital disaster plans are unique to each facility and community; hence hospital administrators and managers are encouraged to work closely with their local, regional, and state healthcare systems and healthcare and/or disaster coalitions, national disaster partners, and their corresponding local chapters to adapt recommendations to their lo- cal needs, strategies, and resource availability. References to specific resources are included at the end of the document to assist users in finding relevant literature and best practices. Additionally, a comprehensive compendium of pediatric disaster resources and searchable databases is now available from the National Library of Medicine Disaster Information Management Research Center’s Health Resources About Children in Disaster and Emergencies at http://disaster.nlm.nih.gov/dimrc/children.html. Questions about or feedback on this checklist are greatly appreciated. To provide us your comments, please complete the Online Feedback Form at https://form.jotform.com/42574809725161. Introduction The Checklist of Essential Pediatric Domains and Considerations for Every Hospital Disaster Preparedness Policies is funded by a grant through the Health Resources and Services Administration, Maternal and Child Health Bureau, Emergency Medical Services for Children (EMSC) Program. Cooperative agree- ment number # U07MC09174-05-02: EMSC National Resource Center at Children’s National Health System, Washington, D.C. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 3 Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Background 4 Domain 1: Staff coordinator to champion pediatric disaster coordination and response - roles and responsibilities 6 Domain 2: Partnership building to facilitate surge capacity 7 Domain 3: Essential resources necessary for building pediatric surge capacity 8 Domain 4: Triage, infection control, and decontamination 9 Domain 5: Family tracking, security, support, and reunification 10 Domain 6: Legal/ethical issues 11 Domain 7: Behavioral health 12 Domain 8: Children with special health care needs 13 Domain 9: Staffing, exercises, drills, and training 14 Domain 10: Recovery and resiliency 15 References and Resources By Domain 16 Acknowledgements 26 Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 4 Children comprise 27% of the U.S. population1 and account for about 20% of all hospital emergency department visits.2 In 2006, the Institute of Medicine’s (IOM) Future of Emergency Care series reported that medical care for pediatric patients in the emergency setting continues to be uneven. The report noted deficiencies in the availability of pediatric equipment, supplies and medications, training for medical staff, and policies incorporating the unique needs of children. Furthermore, in the wake of Hurricane Katrina, the report noted that such deficiencies in everyday op- erational readiness are exacerbated during a disaster, calling the nation’s emergency care system “poorly prepared for disasters.”3 While there have been marked improvements in many areas of pediatric emergency care over the past decade,4 in 2010 the National Commission on Children and Disasters reported persistent deficiencies in every functional area of pediatric disaster preparedness.5 This report was followed in 2013 by the Preparedness, Response, and Recovery Considerations for Children and Families, a workshop convened by the IOM Forum on Medi- cal and Public Health Preparedness for Catastrophic Events. Opening statements posited that “current state and local disaster plans often do not include specific considerations for children and families.”6 The workshop highlighted nine major events that occurred during a seven-month period from October 24, 2012 and May 31, 2013 in which there were 176 fatalities, including 46 children (26%), and discussed the numerous near-misses that could have further increased pediatric casualties. In 2013, the American Academy of Pediatrics, the American College of Emergency Physicians, the Emergency Nurses Association, and the EMSC Program collaborated jointly on a quality improvement initiative, the National Pediatric Readiness Project. The project initiated an assessment of more than 5,000 U.S. emergency departments and more than 4,100 facilities responded (83%).4 Preliminary results illustrated that less than half of all U.S. hospitals reported having written disaster plans addressing issues specific to the care of children. Based on these findings, the Na- tional Pediatric Readiness Project stakeholder group recommended convening a multidisciplinary workgroup to develop a tool to assist hospitals to assure pediatric considerations are included in existing or future disaster plans. The primary goal of the workgroup was to build on existing resources, with a particular focus on best practice guidelines and checklists from local geographic regions, to come to consensus on essential domains of pediatric considerations that should be incorporated into disaster policies for all hospital types in the United States. While this checklist takes an all-hazards approach to pediatric hospital preparedness, it is designed primar- ily to identify the personnel, resources, equipment, and supplies that will be useful for rapid onset pediatric surge planning, as well as for disaster response involving pediatric patients. Specific references and links to more robust resources for disaster and pandemic events for each domain are provided at the end of the document. Background Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 5 Contributors to this checklist are acknowledged at the end of the document. 1 United States Census Bureau: Age and Sex, Table 1: Population by Age and Sex 2012. Accessed April 11, 2014 from http://www.census.gov/population/age/data/2012comp.html. 2 Centers for Disease Control and Prevention, Ambulatory and Hospital Care Statistics Branch. National Hospital Ambulatory Medical Care Survey:2010. Accessed April 10, 2014 from http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf. 3 Institute of Medicine, Committee of the Future of Emergency Care in the United States Health System. Emergency Care for Children: Growing Pains. Washington, DC: National Acad- emies Press. 2007. 4 National Pediatric Readiness Project. National Results. Revised March 21, 2014. Accessed April 10, 2014 from http://www.pediatricreadiness.org/results-and-findings/national-results. 5 National Commission on Children and Disasters. 2010 Report to the President and Congress. Agency for Healthcare Research and Quality Publication No. 10-M037. Rockville, MD: Agency for Healthcare Research and Quality. October 2010. 6 Institute of Medicine, Forum on Medial and Public Health Preparedness for Catastrophic Events. Disaster Preparedness, Response, and Recovery Considerations for Children and Families: Workshop Summary. Washington, DC: National Academies Press. 2013. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 6 Domain 1: Staff coordinator to champion pediatric disaster coordination and response - roles and responsibilities Pediatric Specfics to Consider/Discuss YES/NO Notes/Implementation Plan Professionals with pediatric training in medical content and disaster response, or willing to learn about disaster re- sponse (e.g., Incident Command System courses) Yes No Non-pediatric professionals who could advocate for and integrate the needs of children in planning and impact pediatric disaster response (e.g. neurosurgeon, trauma surgeon, other surgical subspecialists, infectious disease, adult emergency medicine physicians, etc.) Yes No Formal designation of advocates with defined roles/respon- sibilities/authority, including: • Incorporates pediatric-specific considerations within the hazard vulnerability analysis and planning goals • Plans and coordinates disaster drills that include pediatric patients • Serves as liaison for pediatric patients/concerns on hos- pital committees (e.g., medical, trauma, disaster, etc.) • Assures pediatric considerations and priorities are included in all staff disaster education and training • Assures pediatric considerations and priorities are in- cluded in disaster education for prehospital providers • Assists with development and review of the hospital disaster policies, ensuring that pediatric needs are addressed • Serves as liaison representing children to regional facilities, EMS agencies, healthcare coalitions, and organizations to promote community disaster pre- paredness inclusive of children • Collaborates with disaster program manager • Promotes pediatric disaster awareness in the community Yes No Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 7 Domain 2: Partnership building to facilitate surge capacity Pediatric Specfics to Consider/Discuss YES/NO Notes/Implementation Plan Coalition-building and relationships (pact among hospitals and other healthcare facilities) with hospital and non- hospital stakeholders (e.g. primary care, churches, medical homes, EMS, schools, daycare centers, Red Cross, etc.) to support pediatric care and families Yes No Process/plan to measure, prioritize, and expand pediatric surge capacity and capabilities based on resource availability Yes No Process to facilitate the triage of patients including children for transport from the prehospital setting to the appropriate destination Yes No Defined pediatric transfer processes, i.e., agreements and guidelines to facilitate movement of children needing pediatric specialty facilities as well as those more stable children needing to be moved to increase surge capacity of specialty centers Yes No Telemedicine/telephone consultation agreements, process- es, and equipment to facilitate provision of pediatric care in facilities not typically caring for children Yes No Method to integrate facility disaster policy with community and regional disaster plans, including prehospital systems of care Yes No Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 8 Domain 3: Essential resources necessary for building pediatric surge capacity Pediatric Specfics to Consider/Discuss YES/NO Notes/Implementation Plan Plan for expanded and alternative space for pediatric surge for key services: • Alternative care sites (including sites for the provision of general inpatient and outpatient overflow and spe- cialty care, such as critical care, technology depen- dent care, surgery, etc.) • Decontamination showers and mass decon areas • Family staging/waiting Yes No Pediatric equipment (e.g. ventilators, isolettes; consider equipment and supplies to support children with special health care needs) No. in facility: ______________ No. in neighboring facilities: ___________ Memorandum of Understandings (MOUs) to obtain addi- tional equipment for surge Yes No Pharmaceutical needs and drug administration aides (pediatric appropriate drugs, dosing, and administration guidelines including specific pediatric antidote dosing requirements for exposure to chemical/biological agents, access to pharmaceutical caches and stockpiles, Broselow tapes, kilogram scales, etc.) Yes No Dietary needs: regular formula, special formula (non-dairy, lactose free), infant foods, and equipment (bottles, feeding tubes) to meet surge Yes No Supplies and accommodations (e.g. cribs, diapers, recliner for parents) No.in facility: ______________ No. in neighboring facilities: ___________ MOUs to obtain additional supplies for surge Yes No Needs for prolonged patient stays in your facility when transfer not immediately possible (shelter in place) Yes No Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 9 Domain 4: Triage, infection control, and decontamination Pediatric Specfics to Consider/Discuss YES/NO Notes/Implementation Plan Pediatric disaster triage processes that include defined process when infectious disease or exposure suspected Yes No Temperature- and pressure-regulated water controls for pediatric decontamination, especially for small children Yes No Process for keeping families together during decontamination Yes No Disposable pediatric-sized face masks Yes No Pediatric isolation capabilities (e.g., contact, airborne) Yes No Process for disinfection of communally available toys in the facility Yes No Shelter in place and evacuation procedures for children Yes No Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 10 Domain 5: Family tracking, security, support, and reunification Pediatric Specfics to Consider/Discuss YES/NO Notes/Implementation Plan Child identification (ID) forms and ID bands for all children arriving at the hospital listing information available from verbal children (name, age, parent name, address/phone, and possibly allergies) and identifying characteristics and intake source (where did they arrive from and who brought them in) of nonverbal children Yes No Central transfer/tracking tool with capacity to record chil- dren’s photos/ID information. This should include digital camera and photo printing capabilities Yes No Processes defined to support family togetherness and reunification during triage, care, and post disaster Yes No Procedures/staff/volunteers to care for unattended children brought in to the hospital Yes No Process for maintaining or increasing adequate security for existing pediatric patients in all areas of the hospital in ad- dition to the emergency department Yes No Specialized, separate spaces for injured/ill and non- injured/non-ill unaccompanied children with security guard and appropriate staff Yes No Defined security, support, and reunification processes for non-verbal children Yes No OB/GYN – the unique considerations of disasters on preg- nant women, delivery, breastfeeding, and care of newborns Yes No A plan to establish a Family Information and Support Center (which could include staffing by volunteers) Yes No Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 11 Domain 6: Legal/ethical issues Pediatric Specfics to Consider/Discuss YES/NO Notes/Implementation Plan Policies and education regarding assents/consents for pediatric assessment, testing, or treatment with or without a parent in a disaster situation Yes No Review and understand ability to require vaccination, testing, or treatment notwithstanding parental or other consent Yes No Coordinate with credentialing bodies for healthcare personnel and understand scope of practice for all healthcare providers Yes No Procedures/staff/volunteers to care for unattended children brought in to the hospital Yes No Process for rapid credential verification and privileges. Does the state participate in the volunteer license reciprocity programs? Yes No Reporting of pediatric adverse events, including maltreat- ment/violence Yes No Plan addressing allocation of scarce resources for children and adolescents (e.g., mechanical ventilators and pumps, etc.) Yes No Understand the process for obtaining and impact of a waiver of Emergency Medical Treatment and Labor Act (EMTALA), State Children’s Health Insurance Program (SCHIP), or other federal or state laws during declared emergencies Yes No Legal requirements to plan and prepare for pediatric needs during emergencies Yes No Liability and protections related to the implementation of crisis standards of care during declared emergencies/ disasters Yes No Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 12 Domain 7: Behavioral health Pediatric Specfics to Consider/Discuss YES/NO Notes/Implementation Plan Pediatric psychological first aid protocols and training for all responders Yes No Waiting area and discharge information sheets with tips for pediatric mental health/stress responses and resources Yes No Mental health professionals incorporated into pediatric care-review process (PI/QI/AAR/CAP) Yes No Pediatric mental health screening procedures and staff education to identify at-risk individuals based on nature and degree of exposures potentially needing additional behavioral health services and follow-up (e.g., death of family member) Yes No Assessment and identification of pediatric mental health resource availability in the facility and the community Yes No Death notification and bereavement support Yes No Policies and processes to reduce unnecessary exposure of children (and caregivers) to television and other potentially sensitizing stimuli (e.g., curtains to reduce exposure to injured patients and other traumatic images) Yes No Rapid access to urgent evaluation and treatment services when indicated Yes No Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 13 Domain 8: Children with special health care needs Pediatric Specfics to Consider/Discuss YES/NO Notes/Implementation Plan Care considerations specific to neonates Yes No Care considerations specific to children with developmental disabilities and/or physical limitations and disability Yes No Specialized equipment (e.g., wheelchairs, ventilators, pediatric feeding tubes, pediatric suction catheters, trachs, portable source of electricity, etc.) or MOUs to obtain (See Domain 2: Resources) Yes No Medications and related dietary needs Yes No Process to estimate hospital surge demands for children with special health care needs (CSHCN). Consider: • An estimate of the number of CSHCN in commu- nity (may want to work with state to identify number and types of special needs in catchment area to assure they can be addressed in a disaster; for ex- ample: Supplemental Assistance Nutrition Program in Delaware) • Resource availability (e.g., special equipment, facilities) • Healthcare professionals and other potential caretak- ers with which to partner (e.g., prehospital personnel, home health, and parent support organizations, such as Family Voices) Yes No Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 14 Domain 9: Staffing, exercises, drills, and training Pediatric Specfics to Consider/Discuss YES/NO Notes/Implementation Plan Pediatric victims are incorporated into regular exercises that test the system’s ability to handle a surge in or evacuation of a variety of pediatric patients (e.g. infants, special needs). Lessons learned, after action reports, and improvement plans are incorporated into and drive improvement of hospital policy Yes No Staffing needs during disasters and identification/ prioritization of pediatric staff/expertise to care for children or pediatric champions within institution Yes No Triage protocols and training to identify patients to be considered for immediate transfer (critically ill/injured or those sufficiently stable to move to another care center) and transferring patients with appropriate pediatric specific equipment and personnel Yes No Pediatric care-review process (Process Improvement, Quality Improvement, After Action Report, Corrective Action Plans, etc.) Yes No Curriculums and training opportunities that address gaps and increase skills specific to pediatric patients Yes No Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 15 Domain 10: Recovery and resiliency Pediatric Specfics to Consider/Discuss YES/NO Notes/Implementation Plan Discharge disposition of children (including a tracking pro- cess and tool to assure that providers can readily commu- nicate when and where children have been discharged or transferred to other facilities) Yes No Short and long-term mental health assessment and conti- nuity of care for children’s behavioral health needs Yes No Culturally tailored and developmentally focused user- friendly parent information sheets Yes No Partnerships with primary care and community medical homes to promote pediatric resiliency Yes No Bereavement support Yes No Professional self-care Yes No Partnerships with community sites, such as child care centers, schools, preschools, etc., where services can be provided, including screening, primary prevention, and treatment Yes No Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 16 Domain 1: Staff coordinator to champion pediatric disaster coordination and response - roles and responsibilities American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Committee, and Emergency Nurses Association. Joint Policy Statement—Guidelines for Care of Children in the Emergency Department. Annals of Emergency Medicine, 54(4). October 2009 from http://download.journals.elsevierhealth.com/pdfs/journals/0196-0644/PIIS0196064409014358.pdf. Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene. Children in Disas- ters: Hospital Guidelines for Pediatric Preparedness, 3rd edition, August 2008. Accessed December 30, 2013 from http://home2.nyc.gov/html/doh/ downloads/pdf/bhpp/bhpp-hospital-pediatric-guidelines.pdf. Chokshi N, Behar S, Nager A, Dorey F, & Upperman JS. Disaster Management Among Pediatric Surgeons: Preparedness, Training and Involve- ment. Am J Disaster Med, 3(1): 5-14, 2008. Office of the Assistant Secretary for Preparedness and Response Hospital Preparedness Program .National Guidance for Hospital Preparedness, 2012. Accessed July 2014 from http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf. King County Healthcare Coalition Pediatric Triage Task Force, Public Health – Seattle and King County. Hospital Guidelines for Management of Pediatric Patients in Disasters. March 17, 2010. Accessed December 30, 2013 from http://www.calhospitalprepare.org/post/hospital-guidelines-man- agement-pediatric-patients-disasters. Monteiro S, Shannon M, Sandora TJ, and Chung S. Pediatric Aspects of Hospital Preparedness. Clinical Pediatric Emergency Medicine 10(3); 2009. The Joint Commission. New and Revised Requirements Address Emergency Management Oversight. The Joint Commission Perspective 33(7); July 2013. Accessed July 8, 2014 from http://www.jointcommission.org/assets/1/18/JCP0713_Emergency_Mgmt_Oversight.pdf. University of Massachusetts Medical School, Interprofessional Center for Experiential Learning and Simulation. Pediatric Disaster Life Support from http://www.umassmed.edu/icels/certification-courses/. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Hospital All-Hazards Self-Assessment. Accessed March 2, 2014 from http://www.cdc.gov/phpr/healthcare/documents/HAH_508_Compliant_Final.pdf. References and Resources By Domain Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 17 Institute of Medicine. Preparedness, Response, and Recovery Considerations for Children and Families-Workshop Summary. December 17, 2013. Accessed July 2014 from http://www.iom.edu/Reports/2013/Preparedness-Response-and-Recovery-Considerations-for-Children-and-Families.aspx. Domain 2: Partnership-building for surge capacity Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene. Children in Disas- ters: Hospital Guidelines for Pediatric Preparedness, 3rd edition, August 2008. Accessed December 30, 2013 from http://home2.nyc.gov/html/doh/ downloads/pdf/bhpp/bhpp-hospital-pediatric-guidelines.pdf. Contra Costa Health Services, Emergency Medical Services. Pediatric/Neonatal Disaster and Medical Surge Plan and Preparedness Toolkit. Re- vised May 2011. Martinez, CA. Accessed Jan 8, 2014 from http://cchealth.org/ems/. EMSC National Resource Center. Pediatric Regionalization of Care Primer. Accessed May 27, 2014 from http://www.emscnrc.org/emsc-resources/pub- lications/regionalization/pediatric-regionalization-of-care-primer. Ferrer R, Balasuriya D, Iverson E, Upperman JS. Pediatric Disaster Preparedness of a Hospital Network in a Large Metropolitan Area. Am J Di- saster Med, 2009 (in press). Mills JW, Curtis A, Upperman JS. Using a Geographic Information System (GIS) to Assess Pediatric Surge Potential after an Earthquake. Disas- ter Medicine and Public Health Preparedness, 2009 (in press). New York City Department of Health and Mental Hygiene, Bureau of Health Care System Readiness. NYC Pediatric Disaster Coalition. Accessed April 29, 2014 from http://www.pediatricdisastercoalition.org/. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. Pediatric Hospital Surge Capacity in Public Health Emergencies. AHRQ Publication 09-0014. Rockville, MD. January 2009. Accessed December 30, 2013 from http://archive.ahrq.gov/prep/pedhospi- tal/pedhospital.pdf. U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response. Hospital Preparedness Program (HPP) Measure Manual: Implementation Guidance for the HPP Program Measures (v. 1.0), July 1, 2013 – June 30, 2014. Accessed Jan 2, 2014 from http://www.phe.gov/Preparedness/planning/evaluation/Documents/hpp-bp2-measuresguide-2013.pdf. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 18 U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response. Pediatric Preparedness for Healthcare Co- alitions [Webinar]. June 20, 2013. Accessed May 8, 2014 from http://www.phe.gov/Preparedness/planning/abc/Pages/webinar-resources-130620. aspx. U.S. Department of Health and Human Services, Health Resources and Services Administration, Emergency Medical Services for Children, Emer- gency Nurses Association, and Society of Trauma Nurses. Inter Facility Transfer Toolkit for the Pediatric Patient. 2013. Accessed May 1, 2014 from http://www.emscnrc.org/emsc-resources/publications/hospital-care/inter-facility-transfer-tool-kit. U.S. Department of Health and Human Services, Health Resources and Services Administration, Emergency Medical Services for Children. Pediat- ric Regionalization of Care Primer. 2014. Accessed May 1, 2014 from http://www.emscnrc.org/emsc-resources/publications/regionalization/pediatric- regionalization-of-care-primer. Wei, X, Blair A, Christian S, et al. Implementing Telemedicine in Medical Emergency Response: Concept of Operation for Regional Telemedicine Hub. Journal of Medical Systems 36(3); 1651 – 1660. 2010. doi: 10.1007/s10916-010-9626-5. Domain 3: Essential resources necessary for pediatric surge capacity American Academy of Pediatrics. Pediatric Preparedness Resource Kit. Elk Grove Village, IL; American Academy of Pediatrics; 2013. Accessed Jan 3, 2014 from http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Children-and-Disasters/Documents/PedPreparednessKit.pdf. American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Committee, and Emergency Nurses Association. Joint Policy Statement—Guidelines for Care of Children in the Emergency Department. Annals of Emergency Medicine, 54(4). October 2009. Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene. Children in Disas- ters: Hospital Guidelines for Pediatric Preparedness, 3rd edition, August 2008. Accessed December 30, 2013 from http://home2.nyc.gov/html/doh/ downloads/pdf/bhpp/bhpp-hospital-pediatric-guidelines.pdf. Minnesota Department of Health. Minnesota Pediatric Surge Primer and Template Plan. January 2013. URL accessed July 2014: http://www. health.state.mn.us/oep/healthcare/pedsprimer.docx. Monteiro S, Shannon M, Sandora TJ, and Chung S. Pediatric Aspects of Hospital Preparedness. Clinical Pediatric Emergency Medicine 10(3); 2009. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 19 Neches R, Ryutov T, Kichkaylo T, Burke RV, Claudius IA, Upperman JS. Design and Evaluation of a Disaster Preparedness Logistics Tool. Am J Disaster Med, 2009. National Commission on Children and Disasters: Appendix E: Standards and Indicators for Disaster Shelter Care for Children (Updated June 2010) in National Commission on Children and Disasters: 2010 Report. Accessed June 3, 2014 from http://cybercemetery.unt.edu/archive/ nccd/20110427005443/http://www.childrenanddisasters.acf.hhs.gov/reports_studies/resources/Standards%20and%20Indicators%20for%20Disas- ter%20Shelter%20Care%20for%20Children_NCCD%202010%20Report.pdf. New York City Department of Health and Mental Hygiene. Bed Surge Capacity Expansion Tool (BSCET) Template [Microsoft Excel template]. Win- ter 2013. Accessed April 29, 2014 from http://www.nyc.gov/html/doh/html/em/emergency-surge.shtml#spec. New York City Department of Health and Mental Hygiene. Patient Surge in Disasters: A Hospital Toolkit for Expanding Resources in Emergencies. (1st edition), Winter 2013. Accessed April 29, 2014 from http://www.nyc.gov/html/doh/downloads/pdf/bhpp/hepp-hosps-bscet-wip020909.pdf. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. Pediatric Hospital Surge Capacity in Public Health Emergencies. AHRQ Publication 09-0014. Rockville, MD. January 2009. Accessed December 30, 2013 from http://archive.ahrq.gov/prep/pedhospi- tal/pedhospital.pdf. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Strategic National Stockpile (SNS) [Webpage]. Ac- cessed July 9, 2014 from http://www.cdc.gov/phpr/stockpile/stockpile.htm. U.S. Department of Health and Human Services. Chemical Hazards Emergency Medical Management [website]. Accessed May 29, 2014 from http://chemm.nlm.nih.gov/index.html. Domain 4: Triage, infection control, and decontamination Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene. Children in Disas- ters: Hospital Guidelines for Pediatric Preparedness, 3rd edition, August 2008. Accessed December 30, 2013 from http://home2.nyc.gov/html/doh/ downloads/pdf/bhpp/bhpp-hospital-pediatric-guidelines.pdf. Cohen R, Murphy B, Ahern T, Hackel A. Regional Disaster Planning for Neonatology. Journal of Perinatology 30; 709-711: 2010. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 20 Contra Costa Health Services, Emergency Medical Services. Pediatric/Neonatal Disaster and Medical Surge Plan and Preparedness Toolkit. Re- vised May 2011. Martinez, CA. Accessed Jan 8, 2014 from http://cchealth.org/ems/. Kissoon N. Deliberations and Recommendations of the Pediatric Emergency Mass Critical Care Task Force: Executive Summary. Pediatric Critical Care Medicine, 12[Suppl]: S103-S108. 2011. Monteiro S, Shannon M, Sandora TJ, and Chung S. Pediatric Aspects of Hospital Preparedness. Clinical Pediatric Emergency Medicine 10(3); 2009. Domain 5: Family tracking, security, support, and reunification Blake N, Stevenson K. Reunification: keeping families together in crisis. J Trauma 2009; 67(2Suppl.): S147-S151. Brandenburg MA, Watkins SM, Brandenburg KL, Schieche C. Operation Child-ID: Reunifying Children with their Legal Guardians after Hurricane Katrina. Disasters 2007; 31(3): 277-287. Broughton DD, Allen EE, Hannemann RE, Petrikin JE. Reuniting Fractured Families After a Disaster: The Role of the National Center for Missing and Exploited Children. Pediatrics 177(5); S442 – S445. Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene. Children in Disas- ters: Hospital Guidelines for Pediatric Preparedness, 3rd edition, August 2008. Accessed December 30, 2013 from http://home2.nyc.gov/html/doh/ downloads/pdf/bhpp/bhpp-hospital-pediatric-guidelines.pdf. Chung S, Shannon M. Reuniting Children with their Families During Disasters: A Proposed Plan for Greater Success. Am J Disaster Med 2007; 2(3): 113-117. U.S. Department of Homeland Security, Federal Emergency Management Agency. Developing and Maintaining Emergency Operations Plans: Com- prehensive Preparedness Guide (CPG) 101 (V 2.0), November 2010. Accessed June 2, 2014 from http://www.fema.gov/pdf/about/divisions/npd/ CPG_101_V2.pdf. U.S. Department of Homeland Security, Federal Emergency Management Agency, American Red Cross, and National Center for missing and Exploited Children. Post-Disaster Reunification of Children: A Nationwide Approach. November 2013. Accessed June 2, 2014 from http://national- masscarestrategy.files.wordpress.com/2013/11/post-disaster-reunification-of-children-a-nationwide-approach.pdf. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 21 Domain 6: Legal/ethical issues Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene. Children in Disas- ters: Hospital Guidelines for Pediatric Preparedness, 3rd edition, August 2008. Accessed December 30, 2013 from http://home2.nyc.gov/html/doh/ downloads/pdf/bhpp/bhpp-hospital-pediatric-guidelines.pdf. Centers for Disease Control and Prevention. Coordinating Pediatric Medical Care During an Influenza Pandemic Hospital Workbook. January 2010. URL accessed July 2014: http://emergency.cdc.gov/healthcare/pdf/hospital_workbook.pdf. Hodge JG., Jr . Assessing the legal environment concerning mass casualty event planning and response. In: Phillips SJ, Knebel A, editors. Mass medical care with scarce resources: a community planning guide. Rockville (MD): Agency for Healthcare Research and Quality, Department of Health and Human Services (US); 2007. [cited 2008 Feb 18]. pp. 25–38. Also available from: URL: http://www.ahrq.gov/research/mce/mceguide.pdf. Courtney, B, Hodge, JG. Legal Considerations during Pediatric Mass Critical Care Events. Pediatric Critical Care Medicine 2011; 12(6): S152- S156. Hodge, JG. The Evolution of Law in Giopreparedness. Biosecurity and Bioterrorism 2012; 10(1):38-48. Hodge JG, Courtney B: Assessing the Legal Standard of Care in Public Health Emergencies. JAMA 2010; 303(4): 361–362. Hodge JG, Garcia AM, Anderson ED, Kaufman T: Emergency Legal Preparedness for Hospitals and Health Care Personnel. Disaster Med Public Health Prep 2009; 3(Suppl 2); S37–S44. Hoffman S: Responders’ Responsibility: Liability and Immunity in Public Health Emergencies. Georgetown Law Journal 2008; 96: 1913–1969 Courtney B: Waiving EMTALA Sanctions in Response to Public Health Emergencies. Biosecur Bioterror 2008; 6(3): 213–217. Institute of Medicine Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. (2012) Accessed July 2014 at: http:// www.iom.edu/Reports/2012/Crisis-Standards-of-Care-A-Systems-Framework-for-Catastrophic-Disaster-Response.aspx. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 22 Domain 7: Behavioral health Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene. Children in Disas- ters: Hospital Guidelines for Pediatric Preparedness, 3rd edition, August 2008. Accessed December 30, 2013 from http://home2.nyc.gov/html/doh/ downloads/pdf/bhpp/bhpp-hospital-pediatric-guidelines.pdf. Garrett A L, Redlener, I E. Pediatric Preparedness for Disasters, Terrorism, and Public Health Emergencies: A National Consensus Confer- ence: 2009 Update. New York, NY. National Center for Disaster Response. 2009. Accessed December 30, 2013 from http://hdl.handle.net/10022/ AC:P:8840. Gold J, Montano Z, Shields S, Mahrer N, Vibhakar V, Ybarra T, Yee N, Upperman JS, Blake N, Stevenson K, & Nager A. Pediatric Disaster Pre- paredness in the Medical Setting: Integrating Mental Health. Am J Disaster Med, 4(3): 137-146, 2009. National Child Traumatic Stress Network (NCTSN). Natural Disasters. http://www.nctsnet.org/trauma-types/natural-disasters. National Child Traumatic Stress Network (NCTSN). Terrorism: Healthcare Toolbox. Accessed April 26, 2014 from http://www.healthcaretoolbox.org/. National Child Traumatic Stress Network (NCTSN). Terrorism: Trauma-Informed Pediatric Care. Accessed April 26, 2014 from http://healthcaretool- box.org/index.php/tools-and-resources/training-tools. Pfefferbaum B, Flynn BW, Schonfeld D, et al. The Integration of Mental and Behavioral Health Into Disaster Preparedness, Response, and Recov- ery. Disaster Medicine and Public Health Preparedness 6(1): 60-66. 2012. Domain 8: Children with special health care needs American Academy of Pediatrics, Committee on Pediatric Emergency Medicine and Council on Clinical Information Technology, American College of Emergency Physicians, Pediatric Emergency Medicine Committee. Policy Statement—Emergency Information Forms and Emergency Prepared- ness for Children with Special Health Care Needs. Pediatrics 125(4), April 2010. pp 829-837. doi: 10.1542/peds.2010-0186. Accessed April 30, 2014 from http://pediatrics.aappublications.org/content/125/4/829.full. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 23 Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene. Children in Disas- ters: Hospital Guidelines for Pediatric Preparedness, 3rd edition, August 2008. Accessed December 30, 2013 from http://home2.nyc.gov/html/doh/ downloads/pdf/bhpp/bhpp-hospital-pediatric-guidelines.pdf. Murray JS. Disaster Preparedness for Children with Special Health Care Needs and Disabilities. Journal of Specialists in Pediatric Nursing 16(3): 226-232. 2011. Peacock G, Moore C, Uyeki T. Children with Special Health Care Needs and Preparedness: Experiences from Seasonal Influenza and the 2009 H1N1 Influenza Pandemic. Disaster Medicine and Public Health Preparedness 6(2): 91-93. 2012. Peek L, Stough LM. Children with Disabilities in the Context of Disaster: A Social Vulnerability Perspective. Child Development 81(4): 1260-1270. 2010. Institute of Medicine Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. (2012) Accessed July 2014 at: http:// www.iom.edu/Reports/2012/Crisis-Standards-of-Care-A-Systems-Framework-for-Catastrophic-Disaster-Response.aspx. Domain 9: Staffing, exercises, drills, and training Advocate Health Care; Advocate Good Shepherd Hospital. Pediatric Disaster Drills [Video]. Barrington, IL. January 8, 2013. Accessed April 26, 2014 from http://www.youtube.com/watch?v=kAOFWxK-RoE. Ballow S, Behar S, Claudius I, Stevenson K, Neches R, & Upperman, JS. Hospital-based disaster preparedness for pediatric patients: How to de- sign a realistic set of drill victims. Am J Disaster Med, 3(3): 171-180, 2008. http://www.ncbi.nlm.nih.gov/pubmed/18666514. Behar S, Upperman JS, Ramirez M, Dorey F, & Nager A. Training Medical Staff for Pediatric Disaster Victims: A Comparison of Different Teaching Methods. Am J Disaster Med, 3(4): 189-99, 2008. Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene. Children in Disas- ters: Hospital Guidelines for Pediatric Preparedness, 3rd edition, August 2008. Accessed December 30, 2013 from http://home2.nyc.gov/html/doh/ downloads/pdf/bhpp/bhpp-hospital-pediatric-guidelines.pdf. Chokshi N, Behar S, Nager A, Dorey F, & Upperman JS. Disaster Management Among Pediatric Surgeons: Preparedness, Training and Involve- ment. Am J Disaster Med, 3(1): 5-14, 2008. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 24 Claudius I, Behar S, Ballow S, Wood R, Stevenson K, Blake N, & Upperman JS. Disaster Drill Exercise Documentation and Management: Are We Drilling to Standard? Journal of Emergency Nursing, 34(6): 504-8, 2008. Ferrer R, Ramirez M, Sauser K, Iverson E, & Upperman JS. Emergency Drills and Exercises in Healthcare Organization: Assessment of Pediatric Population Involvement Using After Action Reports. Am J Disaster Med, 4(1): 23-32, 2009. Illinois Emergency Medical Services for Children. Disaster Preparedness Exercises Addressing the Pediatric Population. Loyola University Medical Center; Chicago, IL. 2006. Access April 25, 2014 from http://www.luhs.org/depts/emsc/pedsexercisesdec06.pdf. U.S. Department of Homeland Security. Homeland Security Exercise and Evaluation Program (HSEEP) 2013. https://www.llis.dhs.gov/HSEEP. Domain 10: Recovery and resiliency Burke RV, Golabek-Goldman M, Ryutov T, Berg BM, Neches R, & Upperman JS. The Pediatrician’s Role in Community Resilience Following a Di- saster. California Pediatrician, 2-3. Summer 2009. Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene. Children in Disas- ters: Hospital Guidelines for Pediatric Preparedness, 3rd edition, August 2008. Accessed December 30, 2013 from http://home2.nyc.gov/html/doh/ downloads/pdf/bhpp/bhpp-hospital-pediatric-guidelines.pdf. Garrett A L, Redlener, I E. Pediatric Preparedness for Disasters, Terrorism, and Public Health Emergencies: A National Consensus Confer- ence: 2009 Update. New York, NY. National Center for Disaster Response. 2009. Accessed December 30, 2013 from http://hdl.handle.net/10022/ AC:P:8840. Markenson D, Reynolds S, Committee on Pediatric Emergency Medicine and Task Force on Terrorism. The Pediatrician and Disaster Prepared- ness. Pediatrics 117(2); e340-e362. 2006. National Biodefense Science Board. Community Health Resilience Report. [Final Draft, v.04.16.14]. Accessed June 2, 2014 from http://www.phe. gov/Preparedness/legal/boards/nprsb/meetings/Documents/NBSB-CHRrecommendations.pdf. National Center for Disaster Preparedness, Earth Institute, Columbia University. Recovery and Resiliency [Webpage]. Accessed May 7, 2014 from http://ncdp.columbia.edu/research/recovery-resiliency/. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 25 National Commission on Children and Disasters. Resources on Children and Disasters [Webpage]. Accessed May 30, 2014 from http://cybercem- etery.unt.edu/archive/nccd/20110427002915/http://www.childrenanddisasters.acf.hhs.gov/resources.html. Additional Resources American College of Emergency Physicians. Hospital Disaster Self-Assessment Tool. April 18, 2013. Accessed on December 31, 2013 from http:// www.acep.org/clinical---practice-management/hospital-disaster-preparedness-self-assessment-tool. Children’s Health Fund. Reforming Disaster Case Management: National Lessons from Louisiana. Report and recommendations from Disaster case management in Louisiana: A Roundtable on Recovery from hurricanes Katrina, Rita, Gustav, and Ike. Louisiana State University; December 2009. Accessed May 30, 2014 from http://www.childrenshealthfund.org/sites/default/files/Disaster-Case-Management-Roundtable-Report-and- Recommendations-Dec-2009.pdf. Illinois Emergency Medical Services for Children and Pediatric Preparedness Workgroup, Illinois Terrorism Task Force. Hospital Pediatric Disaster Preparedness Checklist. Revised March 2012. Accessed December 30, 2013 from http://www.luhs.org/depts/emsc/HospPedPreparednessCheck- list.doc. Loma Linda University Children’s Hospital. Pediatric/Neonatal Disaster Reference Guide. 2012. Accessed Jan 3, 2013 from http://cchealth.org/ ems/pdf/Pediatric-Neonatal-Disaster-Reference-Guide.pdf. Response Systems Disaster Preparedness for Healthcare and Communities. Works nationwide with hospitals, public health and homeland security settings to prepare for disaster situations. Services include Pediatric Disaster Life Support training, disaster plan consulting, and medical surge equipment sales. http://www.disasterpreparation.net/index.html. State of California Health and Human Services Agency, Emergency Medical Services Authority. EMSC Pediatric Disaster Preparedness Guidelines: LEMSAs. Las Angeles, CA: March 24, 2010. Accessed April 25, 2014 from http://www.emsa.ca.gov/Media/Default/PDF/EMSA197.pdf. The Joint Commission. Hospital: Emergency Management. The Joint Commission E-dition. Effective Date January 2012. Accessed July 9, 2014 from http://www.uhnj.org/mdstfweb/The_Joint_Commission/Emergency%20Management.pdf. Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 26 Acknowledgements Sue Cadwell, RN, MSNDirector ED InitiativeHCANashville, TN Art Cooper, MD, MS, FACS, FAAP, FCCMProfessor, Clinical SurgeryColumbia University College of Physicians and SurgeonsNew York, NY Elizabeth Edgerton, MD, MPHDirector, Division of Child, Adolescent and Family HealthMaternal and Child Health Bureau/HRSA/HHSRockville, MD Diana Fendya, MSN(R), RNTrauma/Acute Care Specialist, EMSC National Resource CenterChildren’s National Health SystemWashington, DC George Foltin, MD, FAAP, FACEPAssociate Professor, Departments of Emergency Medicine and PediatricsNew York University Langone Medical CenterNew York, NY Michael Frogel, MD, FAAPAssociate Professor of Pediatrics Albert Einstein College of MedicinePrincipal Investigator Pediatric Disaster Coalition DOHMHNew York, NY Marianne Gausche-Hill, MD, FACEP, FAAPProfessor of Clinical Medicine, David Geffen School of Medicine at UCLA Vice Chair and Chief of the Division of Pediatric Emergency Medicine Director Pediatric Emergency Medicine and EMS Fellowships Harbor-UCLA Medical Center, Department of Emergency Medicine Anthony Gilchrest, MPA, EMT-PEMS Program Manager, EMSC National Resource CenterChildren’s National Health SystemWashington, DC Cynthia Hansen, PhDSenior Advisor, Division of National Healthcare Preparedness ProgramsHHS/ASPR/OEMWashington, DC James HodgeLincoln Professor of Health Law and EthicsSandra Day O’Conner College of LawArizona State UniversityTemple, AZ Jocelyn HulbertPublic Health Analyst/Project Officer, EMSC ProgramMaternal and Child Health Bureau/HRSA/HHSRockville, MD Steve Krug, MD, FAAPProfessor, Pediatric Emergency MedicineNorthwestern University Feinberg School of MedicineChicago, IL Sharon Mace, MD, FAAP, FACEPDirector of Pediatric Education, Department of Emergency MedicineCleveland ClinicCleveland, OH Charles Macias, MD, MPHChief Clinical Systems Integration OfficerTexas Children’s HospitalHouston, TX Sametria McCammon, MSPHResearch Program Coordinator, EMSC National Resource CenterChildren’s National Health System Washington, DC Angela Mickalide, PhD, MCHESPrincipal Investigator, EMSC National Resource CenterChildren’s National Health System Washington, DC Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies 27 Theresa Morrison-QuinataDirector, EMSC ProgramMaternal and Child Health Bureau/HRSA/HHSRockville, MD Patricia Pettis, MS, APRN, PNP-BCCaptain, US Public Health Service, Field Project OfficerDHHS, ASPR – Region 1Boston, MA Diane Pilkey, RN, MPHNursing Consultant, EMSC ProgramMaternal and Child Health Bureau/HRSA/HHSRockville, MD Peki Prince, PhD(c), CCEMT-P, MIFirE, CFOEMS Emergency Preparedness Coordinator Georgia Department of Public HealthAtlanta, GA Jean Randolph, RN, MPANurse Consultant-Healthcare Preparedness ActivityCenters for Disease Control and PreventionAtlanta, GA Katherine Remick, MD, FAAP Medical Director-Austin/Travis County EMS SystemPediatric Emergency Medicine-Dell Children’s Medical CenterAustin, TX Ellen Schenk, MPHFellow, EMSC ProgramMaternal and Child Health Bureau/HRSA/HHSRockville, MD David Schonfeld, MD FAAPPediatrician-in-ChiefSt. Christopher’s Hospital for ChildrenPhiladelphia, PA