PDLS 2.0 Outline

Draft April 21, 2023

Course Introduction

• Pediatric Disaster Life Support is designed to give emergency personnel a foundation of knowledge and skills to allow them to more effectively respond to a disaster involving children

• The structure and timeline of the course can fit in as little as 1 day or be expanded to 2 days for those requesting additional practice

Prerequisite Training

• This course builds on the fundamental pediatric assessment and resuscitation skills that are the backbone of courses such as:– Pediatric Advanced Life Support (PALS)– Advanced Pediatric Life Support (APLS)– Pediatric Emergency for the Prehospital Provider

(PEPP)

• One of these courses is prerequisite– Or equivalent professional experience

Concurrent PALS Training

• It is the goal that the PDLS training course described here will be paired with an opportunity to obtain PALS certification as well

• The day prior to PDLS training would be the “skills and examination day” for PALS– Attendees wishing to obtain PALS certification will

have completed the new on-line PALS course to prepare for the “skills and examination day”

Day 1:Pediatric Skills(PALS Testing)

Day 2:Pediatric Disaster

Life Support course

Day 3:Optional AdditionalModules for PDLS

On-line PALS

PDLS Syllabus

• Registration• Introduction• Fundamental Concepts in Pediatric Disaster

Medicine (didactic)• Case Study Exercise• Practical Issues in Pediatric Disaster

Medicine (didactic)• Field Training Practical Exercise• Debriefing and Test

PDLS Syllabus

• Optional Additional Modules:– Practical Disaster Scenarios– Expanded WMD/biohazard didactic training

Introduction

• Beginning Lecture– “Children as victims of disasters and terrorism”

• Introduce statistics• Examples of disasters affecting children• Establish that children have unique needs• Concept of children “not fitting the mold” for standard

preparedness dogma• Caring for children more difficult for providers• Introduce new paradigm

– Children as intentional victims of terrorism

• Purpose of PDLS– Teach basic concepts to allow for children to have to same

chance as adults to to survive disaster

Fundamental Concepts

• Purpose– Establish a framework of pediatric-specific

knowledge pertinent to disaster medicine– Build on general concepts in pediatric

assessment and resuscitation such as those taught in Pediatric Advanced Life Support (PALS)

Fundamental Concepts

• “Children don’t fit the mold”– Most disaster medicine concepts have

grown from adult and military model– Specific needs demand specific planning– Focus on vulnerabilities of children to tailor

disaster response options already in place

Fundamental Concepts

• A “Bio-Psycho-Social” approach• Recognizes that effective preparedness and

response requires integration of three realms

Biological

SocialPsychological

Fundamental Concepts

Biological

• BIOLOGICAL– Anatomy and Physiology unique to children– Focus on vulnerabilities of children, not on

resuscitation– Discuss relationship to:

• Environmental exposure (heat, cold, entrapment)• Decontamination• Susceptibility to Chemicals, Toxins• Behaviors that increase risk• Immature immune systems• Lack of verbal skills• Lack of self-preservation skills

Fundamental Concepts

Psychological

• PSYCHOLOGICAL– Emotional Response to Disaster– Focus on general concepts, not by age group– What to expect & scope of problem

• Behavior changes, aggression, regression• Post traumatic stress and anxiety

– Latest research from disaster setting

– How to anticipate and recognize problems– How to help– How long do these disorders last?– Where is help available?– Integrating these concepts into disaster prepared- ness and response plans

Fundamental Concepts

Social

• SOCIAL– Kids are irreversibly integrated into our society

• If children are not accounted for, parents will not comply with officials

– Adapting to the concept that children may be intentional targets of terrorism

– Role of parents in disaster– Role of media in disaster, a double edged sword– Role of schools, where children spend the bulk of their time

away from home– Children routinely cause increased stress in emergency

providers

Case Study

• Hypothetical Hurricane Fiona (2010)• Same track as Hurricane Katrina 2005• Role play from 3 perspectives/phases:

– Planning– Response– Recovery

• Students will assume leadership roles and open forum discussion will occur– Goal is to apply material from Fundamental Concepts

session and discuss how children will be accounted for in all three phases of a major event

Practical Issues

• Goal of this section:– To apply the vulnerability concepts learned

in the Fundamental Concepts session– Teach specific information which will

enhance the application of this information in pediatric disaster planning, response, and recovery

– Further develop the Bio-Psycho-Social model’s applicability to disaster medicine

Practical Issues

• Pediatric Triage: JumpSTART tool– What exactly is triage, how and where is it

used?• Why develop triage tools in the first place?• Mass casualty incident • Mass casualty receiving• Re-evaluation

– Review adult START triage– Why modify adult triage?

• Review anatomy/phys

– Handout protocol

Practical Issues

• Focus on integration, rather than separation, of pediatric triage concepts

• Mini simulated drill with poll-the-audience response – Show video/slides of 10 adults and children

requiring triage at both MCI scene and a casualty receiving point

Practical Issues

• Children with Special Health Care Needs:– Introduce scope of issue with statistics– Examples from Indonesia and Katrina

• What may be affected?– Mobility– Communication (Visual/Verbal/Hearing)– May be technology-dependent (examples)– Resources required– Emphasize the integration, rather than separation of CSHCN– How will this affect the following two topics

• Sheltering• Decontamination

Practical Issues

• Sheltering– What aspects of shelter management may not work well for

children as they exist now?– Identify and plan for specific needs in advance:

• Security• Safety (childproofing, etc.)• Hygiene• Nutrition• Health Screening• Sleep schedule• CSHCN• Recreation

– Should CSHCN be sheltered separately or integrated?

Practical Issues

• Decontamination– What aspects of on scene and hospital decon need to be

addressed for children?• Patient flow (need to keep with parents) and timing• Prevention of heat and cold injuries• Chemical decontamination dangerous to kids (e.g. bleach)• Clothing for children after decon• CSHCN durable medical equipment/hardware• Responding to surge capacity• Ensuring responder safety• Tracking non-verbal naked children

– What do you do with exposed children before decon occurs?

– Utilize concepts from BCH Pediatric Decon DVD

Practical Issues

• Chem/Bio/Rad– Issues facing children during these incidents– Review why children may be at higher risk during an

exposure based on behavior and biology– Utilize Cieslak/Henretig material

• Specific topics:– Personal Protection– Diagnosing exposures in children– Role of Primary Care– Immunization– Prophylaxis challenges– Treatment challenges

Field Exercise

• Purpose– Give students a focused, practical experience to apply the

skills learned in PDLS– Review key concepts:

• JumpSTART Triage• Resource Allocation• Need for proper decontamination• Recognizing suspicious pattern of illnesses

– Same scenario approached from two angles• “secure” mass casualty incident requiring triage• Mass casualty receiving and decon at the closest emergency

department• Course director will choose scenario based on audience

Field Exercise 1

Hospital

Chemical Tanker

Schoolbus

Decon

Triage on scene

Triage at hospital

1 driver

1 escort

14 children

1 child in wheelchair

1 deaf child

Field Exercise 2

Hospital

School Shooting

Triage on sceneTriage at

hospital

1 teacher

1 principal

20 children

1 child in wheelchair

1 visually impaired child

Field Exercise 3

Hospital

Triage on scene

Triage at hospital

2 pilots

20 children

1 child in wheelchair

1 visually impaired child

Debriefing and Test

• Discussion of scenarios

• Short examination

• Evaluation

• Train the trainer comments