Pediatrics and Disaster

Preparedness
CHESY NICHOLS, MD PGY-3
What is a Disaster?

 Definition: A serious disruption of the functioning of a community or society

involving widespread human, material, economic or environmental losses
and impacts, which exceeds the ability of the affected community or
society to cope with using its own resources.
 UN Office for Disaster Risk Reduction
 Natural disasters: earthquakes, wildfire, hurricanes, tornados, floods
 Pandemics: influenza
 Mass shootings
 Bioterrorism

Adapted from Pediatrics and Disaster Medicine: Are You Prepared? by Dr. Hilary Hewes
Utah

 33% of population are children

(vs US 25%)

 80% of Utah’s population (~1

million children) lives within 15
miles of the Wasatch fault line

 Majority of Utah is rural

http://spynenorthernutahgeo.blogspot.com/2014/10/the-wasatch-fault-
line.html

Adapted from Pediatrics and Disaster Medicine: Are You Prepared? by Dr. Hilary Hewes
Wasatch Front Earthquake
 Seismic history of Utah – earthquake every 1300-1500 years

 13% chance of a large earthquake somewhere along the

Wasatch Front in the next 50 years

Adapted from Disaster Essentials for Healthcare Providers by Dr. Mark Shah
Pandemic Flu in Utah

 Difficult to predict severity

 If as severe as 1918 pandemic, would cause:
1 million ill
 80,000 hospitalizations
 13,000 ICU hospitalizations
 6,400 needing ventilators
 16,000 deaths
Pediatric Hospital Capacity

 Primary Children’s Hospital

= 289 pediatric beds

 Shriner’s Hospital = 45 beds

 Total number of pediatric

surge beds = 400
Basic Disaster Principles

 Triage
 Medical Surge Strategies
 Prioritizing Care
 Crisis Standards of Care
 Provider Responsibility
 Legal Protections
Triage

“To do the best for the

most using the least”

https://www.sosproducts.com/product-p/45795.htm
https://i.pinimg.com/originals/20/af/0d/20af0d4a81
3b0ba80a5a0b0816d55240.jpg
Medical Surge Strategies

 Delay Care
 Increase wait times for non-urgent issues
 Clear waiting rooms, triage, delayed closure, delayed imaging,
delayed elective surgeries
 Degrade Care
 Early discharge
 Use alternate care sites
 Expand scope of providers
 Standing orders
 Use of volunteers

 Resource-sparing strategies
 Deny Care
 Refusal of aggressive care
 Withdrawal of care
https://toolkit.climate.gov/topics/human-health/building-health-care-sector-
resilience/element-4-essential-clinical-care-service

Adapted from Disaster Essentials for Healthcare Providers by Dr. Mark Shah

During a pandemic influenza
outbreak, you are asked to
decide which of the following
patients should receive the only
available ventilator in the
hospital. Which of these patients,
all in respiratory failure, should be
placed on the only ventilator?
15 YEAR OLD GIRL WITH MULTILOBAR
PNA, HISTORY OF T1DM
28 YEAR OLD MAN WITH INFLUENZA,
HISTORY OF T21 AND CHF
58 YEAR OLD, PREVIOUSLY HEALTHY
MAN WITH INFLUENZA
48 YEAR OLD WOMAN WITH
INFLUENZA AND STAGE 3 OVARIAN
CANCER
Adapted from Disaster Essentials for Healthcare Providers by Dr. Mark Shah
Prioritizing Care
 Sickest first
 Routinely used in the ED
 Leads to heavy resource utilization by some who won’t survive
 First-come, first served
 Routine used for ICU bed allocation
 Quickly uses up resources in a disaster
 Most likely to recover
 Used in severe shortage of life-saving medical resources
 Preserving the functioning of society
 Multiplier effect
 Vaccines vs. Ventilators
 Prioritizing Care

 Likelihood and duration of benefit

 Change in quality of life
 Urgency of need
 Amount of resources required
 Age and functional assessment
 Underlying health, prognosis

http://connection.cgc.edu/2015/05/disaster-day-gives-mass-casualty.html

Adapted from Disaster Essentials for Healthcare Providers by Dr. Mark Shah
Standard of Care

Normal – unlimited resources for the greatest good for

each individual patient

Disaster

Disaster – allocation of limited resources for the good of

the greatest number of patients

Adapted from Disaster Essentials for Healthcare Providers by Dr. Mark Shah
Crisis Standards of Care

 A substantial change in usual health care operations and the level of care it is
possible to deliver, which is made necessary by a pervasive (e.g. pandemic
influenza) or catastrophic (e.g. earthquake, hurricane) disaster
 Change in the level of care delivered is justified by specific circumstances and is
formally declared by a state government, in recognition that crisis operations will
be in effect for a sustained period
 Formal declaration that crisis standards of care are in operation enables specific
legal/regulatory powers and protections for healthcare providers in the
necessary tasks of allocating and using scarce medical resources and
implementing alternate care facility operations
 “BECAUSE OF THEIR COMMITMENT
TO CARE FOR THE SICK AND
INJURED, INDIVIDUAL PHYSICIANS
HAVE AN OBLIGATION TO
PROVIDE URGENT MEDICAL CARE
Provider DURING DISASTERS. THIS
OBLIGATION HOLDS EVEN IN THE
Responsibility FACE OF GREATER THAN USUAL
RISKS TO PHYSICIANS’ OWN
SAFETY, HEALTH, OR LIFE.”

- AMERICAN MEDICAL ASSOCIATION

Utah Legal Protections

 Good Samaritan Act

 Protects non-negligent care if NO “duty to treat”

 Utah Emergency Medical Services Act

 Protects expanded scope of practice if acting as a “Good Samaritan”

 Health Care Providers Immunity from Liability Act

 Protects non-negligent care during a declared disaster, even if there IS a
“duty to treat”

Utah Code Sections: 78B-4-501, 26-8a-308, 58-13-2.6

Are We Prepared?

 Hospital Supplies
 Water, sewage, gas, oxygen
 24-48 hours of IV fluids
 Power: Accudose, medication refrigerators, badge readers,
elevators
 Batteries/flashlights
 Food: for staff and patients/families

 Disaster Response Procedure Flipchart

Adapted from Pediatrics and Disaster Medicine: Are You Prepared? by Dr. Hilary Hewes
Are You
Prepared?
Portable “go-bag”
½ tank of gas in your car
Plan of where/how to contact
and reunite your family
Plan for your pets
 Disaster supply kit – supplies to allow
you and your family to survive for
72-96 hours
 Food and water
 Critical medications
 Blankets
 Flashlights and batteries
 Battery-operated radio
Resources

 FEMA preparedness: www.ready.gov

 Utah preparedness: bereadyutah.gov
 CERT: www.ready.gov/citizen-corps
 MRC: www.utahmrc.org
 Utah DMAT
 Disaster Supplies List for Families: www.healthychildren.org/English/safety-
prevention/at-home/Pages/Family-Disaster-Supplies-List.aspx
 Handbook for Earthquakes in Utah:
https://www.utah.gov/beready/documents/roots_earthquake_low.pdf
References

 Hewes, Hilary. “Pediatrics and Disaster Medicine: Are You Prepared?”. 17 September 2015
 “Risks and Disasters”. http://www.un-spider.org/risks-and-disasters
 Shah, Mark. “Disaster Essentials for Healthcare Providers” Course.
 Institute of Medicine. “Guidance for Establishing Crisis Standards of Care for Use in Disaster
Situations: A Letter Report”. September 2009
 CDC. “Ethical Considerations for Decision Making Regarding Allocation of Mechanical
Ventilators during a Severe Influenza Pandemic or Other Public Health Emergency”. 1 July
2011
 AMA. “Code of Medical Ethics: Physicians’ Responsibilities in Disaster Response and
Preparedness”.
 Hewes, Hilary et. al. “Chapter ON1: Disaster Preparedness and Response”. AAP Textbook
of Pediatric Care, 2nd Edition.