Emsc pediatric disaster preparedness guidelines: hospitals




НазваниеEmsc pediatric disaster preparedness guidelines: hospitals
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STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY

ARNOLD SCHWARZENEGGER, Governor







EMERGENCY MEDICAL SERVICES AUTHORITY

1930 9th STREET

SACRAMENTO, CA 95811-7043

(916) 322-4336 FAX (916) 324-2875









EMSC PEDIATRIC

DISASTER PREPAREDNESS GUIDELINES: HOSPITALS





EMSA #198

March 24, 2010











EMSC PEDIATRIC DISASTER PREPAREDNESS GUIDELINES: HOSPITALS


Prepared by:


The Pediatric Disaster Preparedness Subcommittee


Bonnie Sinz, RN

EMS Systems Division Chief

California EMS Authority


~

Donna Westlake

EMS for Children Coordinator

California EMS Authority


~


R. Steven Tharratt, MD, MPVM

Director

California EMS Authority


Kim Belshé

Secretary

California Health and Human Services Agency


Arnold Schwarzenegger

Governor


Acknowledgements


EMS for Children Technical Advisory Committee


Art Andres EMT-P

Paramedic

Ontario Fire Department





Judith Brill MD

Director PICU Mattel Childrens Hospital

UCLA Medical Center





Patrice Christensen PHN

Injury Prevention Program Coordinator

San Mateo County EMS Agency


Bernard Dannenberg MD

Director, Pediatric Emergency Medicine

Lucile Packard Children's Hospital





Ron Dieckmann MD

Director, Pediatric Emergency Medicine

San Francisco General Hospital





Robert Dimand MD

Chief of Pediatrics

Children's Hospital Central California


Erin Dorsey BSN, PHN

School Nurse

Long Beach USD





Jan Fredrickson MSN

CPNP

California State Emergency Nurses Assoc.





Les Gardina RN

EMSC/Trauma System Coordinator

San Diego County EMS Agency


Marianne Gausche-Hill MD

Director, EMS & Pediatric Emergency Medicine

Harbor UCLA Medical Center





Jim Harley MD

Emergency Medicine

Children's Specialists of San Diego





Donna Black

EMSC Representative

State of CA Office of Traffic Safety


Ramon Johnson MD

Director, Pediatric Emergency Medicine

Emergency Medicine Associates





Nancy McGrath PNP

Pediatric Liaison Nurse

Harbor UCLA Medical Center





Maureen McNeil

EMSC Technical Advisor



Allen Morini DO

EMDAC Representative






Michael Osur

Deputy Director, Public Health

Riverside County EMS Agency





Barbara Pletz

EMS Administrator

San Mateo County EMS


Debby Rogers MSN

Vice President, QI & EMS

California Hospital Association





Nicholas Saenz MD

Pediatric Surgeon

Rady Children's Hospital (Trauma Center)





Sandy Salaber

EMS Systems Program Analyst

California EMS Authority


Bonnie Sinz RN

Chief, EMS Systems Division

California EMS Authority





Debra Smades-Henes

EMSC Family Representative






R. Steven Tharratt, MD, MPVM

Director

California EMS Authority


Richard Watson

EMSC Technical Advisor

EMS for Children Program






Donna Westlake

EMSC Program Coordinator

California EMS Authority









Solomon Behar MD

Department of Emergency Medicine

Children's Hospital of Los Angeles





Ron Dieckmann MD

Director, Pediatric Emergency Medicine

San Francisco General Hospital






Erin Dorsey BSN, PHN

School Nurse

Long Beach USD



Calvin Freeman

Vice President

Global Vision Consortium




Deborah Henderson

EMSC Coordinator

Harbor UCLA Medical Center






Ramon Johnson MD

Director, Pediatric Emergency Medicine

Emergency Medicine Associates

Amy Kaji MD

Medical Director, Disaster Resource Center

Harbor UCLA Medical Center





John Michelini

Division Chief, Special Operations

Coummes Fire Department





Alan Nager MD

Director, Emergency & Transport Medicine

Children's Hospital, Los Angeles


Michael Osur

Deputy Director, Public Health

Riverside County EMS Agency






Mary Jo Quintero CCRN

Prehospital Liaison Nurse

ED, Children's Hospital Central California





Richard Watson

EMSC Technical Advisor

EMS for Children Program

Donna Westlake

EMSC Program Coordinator

California EMS Authority




Millicent Wilson MD

Disaster Training Specialist

Los Angeles Co. EMS Agency





Bonnie Sinz RN

Chief, EMS Systems Division

California EMS Authority








R. Steven Tharratt, MD, MPVM

Director

California EMS Authority






















Pediatric Disaster Subcommittee






FOREWORD


As in day-to-day medical emergencies, children face unique vulnerabilities during disasters. The events of Hurricane Katrina and the Southern California wildfires reinforced the need to provide pediatric-specific guidance to medical personnel responding to disasters in both the hospital and pre-hospital setting. Child-centric approaches are required for triage, treatment, and decontamination to achieve optimal outcomes for pediatric patients. Accordingly, the California EMS for Children Technical Advisory Committee appointed a Disaster Subcommittee to develop pediatric disaster medical guidelines for California’s Local EMS Agencies and hospitals (published as separate documents). These guidelines supplement the Emergency Department Guidelines for the Care of Pediatric Patients adopted by the Emergency Medical Services Commission on March 26, 2008, which describe the minimum standards for the care of children in day-to-day emergencies.


The Disaster Subcommittee considers these guidelines to be minimum standards for large and small hospitals and Local EMS Agencies serving both urban and rural California communities. The guidelines include references that provide supporting evidence for the recommendations and tools for implementation. Additional information is available at the website of the EMS Authority (www.emsa,ca.gov).


Finally, the EMS Authority views these guidelines as living documents to be expanded and modified as resources and new information become available.


The EMSC Pediatric Disaster Preparedness Guidelines:  Hospitals are partially supported by a grant from the HRSA/MCHB and through the Preventive Health and Health Services Block Grant from the Centers for Disease Control and Prevention.  Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.



EMSC PEDIATRIC DISASTER PREPAREDNESS GUIDELINES: HOSPITALS


TABLE OF CONTENTS


HOSPITAL CARE OF CHILDREN IN DISASTERS – OVERVIEW

Introduction 1

General Disaster Preparedness Checklist 5

HOSPITAL SURGE CAPACITY

Introduction 7

Hospital Surge Capacity Checklist 8

SAFETY AND SECURITY

Introduction 9

Safety and Security Checklist 10

DECONTAMINATION

Introduction 12

Decontamination Planning Checklist 13

PATIENT MANAGEMENT AND TREATMENT

TRIAGE

Introduction 19

Multi-Casualty Triage Checklist 26

MEDICATIONS

Introduction 29

Medications Checklist 31

EQUIPMENT

Introduction 32

Equipment Checklist 32

FLUID MANAGEMENT

Introduction 33

MENTAL HEALTH ISSUES

Introduction 35

Mental Health Checklist 37

SPECIAL NEEDS POPULATION

Introduction 38

Special Needs Population Checklist 39

DRILLS AND EXERCISES

Introduction 43

Drills and Exercises Checklist 46

FAMILY INFORMATION CENTER

Introduction 48

Family Information Center Checklist 48

ACRONYMS 52



HOSPITAL CARE OF CHILDREN IN DISASTERS - OVERVIEW


Introduction

The Joint Commission (JC) requires all hospitals to have a disaster plan in place; however, the formulation of hospital guidelines specific to pediatrics is often omitted. The following overview outlines the necessary components of hospital preparedness for disasters involving children.

Hospital Personnel Roles in Disasters

Within a hospital, disaster team personnel include clinicians and non-clinicians, both of whom must acquire the appropriate knowledge and skill and be willing responders during disaster conditions.

  • Primary clinicians include Emergency Department physicians and nurses, Critical Care physicians and nurses, surgeons and surgical nurses, and respiratory therapists.

  • Primary non-clinicians include administrative/executive leaders or managers, safety and security personnel, psychologists/social workers, emergency planners, and facilities personnel. This group of individuals aid in the clinical operations and safety and security of the building and surrounding areas.

  • Secondary clinicians include general pediatricians, pediatric subspecialists, family practitioners, and general surgeons. This group of clinicians can be called in for additional pediatric support, and relied upon for their knowledge about pediatric illness or injury management and their resuscitation skills.

  • Secondary non-clinicians include laboratory personnel, pharmacy staff, engineering, secretarial support, runners/transporters, and child life personnel. These individuals or departments provide services that are vital to the hospital environment and to the management and treatment of pediatric victims.

Alert, Notification, and Mobilization

Hospitals should establish a disaster tree (call schedule) to alert, notify, and mobilize their disaster teams. The disaster tree should include a variety of contact methods, such as cell phone, pager, and home phone.

Mobilization policies and procedures must take into account contingencies such as disaster related communications and transportation barriers, and the need for hospital staff to have available childcare or elder care. Transportation arrangements to and from the hospital must be planned in advance of a disaster to include: use of personal vehicles, car pool arrangements, meeting stations, and alternative parking sites.
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