PDLSPDLS©©::Children in Disaster: Public Children in Disaster: Public Health Considerations and Health Considerations and Disaster MitigationDisaster Mitigation

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Preparing for the Public Health Preparing for the Public Health consequences of disaster involving consequences of disaster involving children should occur at the Community, children should occur at the Community, State and Federal levels. State and Federal levels.

The benefits of this type of planning have The benefits of this type of planning have been proven many times overbeen proven many times over

• Identify personnel, equipment and infrastructure for pediatric disaster preparednessIdentify personnel, equipment and infrastructure for pediatric disaster preparedness

• Learn the principles of family disaster planningLearn the principles of family disaster planning

• Recognize which potential biological disasters may be mitigated by public health measuresRecognize which potential biological disasters may be mitigated by public health measures

• Consider public health implications of chemical and radiation attacksConsider public health implications of chemical and radiation attacks

• Understand the components of disaster mitigationUnderstand the components of disaster mitigation

ObjectivesObjectives

Community Resources Community Resources Pediatric emergency and trauma centersPediatric emergency and trauma centers

Pre-hospital care providers, including EMS, fire departments Pre-hospital care providers, including EMS, fire departments and policeand police

Social servicesSocial services

SchoolsSchools

Local health clinicsLocal health clinics

Departments of HealthDepartments of Health

Government Government

Local and national media Local and national media

Photo Courtesy of FEMA

Emergency Medical Services for Emergency Medical Services for Children (EMS-C) in a DisasterChildren (EMS-C) in a Disaster

AA program of Health Resources and program of Health Resources and Services Administration (HRSA)Services Administration (HRSA)

- Education and grant funding for Education and grant funding for development pre-hospital pediatric caredevelopment pre-hospital pediatric care

Provides designations for pediatric Provides designations for pediatric disaster centersdisaster centers

- Emergency Department Approved for Emergency Department Approved for Pediatrics (EDAP)Pediatrics (EDAP)

- Pediatric Critical Care Center (PCCC)Pediatric Critical Care Center (PCCC)

- Stand-by Emergency Department Stand-by Emergency Department Approved for Pediatrics (SEDP)Approved for Pediatrics (SEDP)

Plans for Surge Capacity FacilitiesPlans for Surge Capacity FacilitiesHospitals without formal pediatrics servicesHospitals without formal pediatrics services

Community health centersCommunity health centers

Rehabilitation hospitalsRehabilitation hospitals

Urgent care centers Urgent care centers

Physicians’ officesPhysicians’ offices

Nursing homesNursing homes

School-based health centersSchool-based health centers

Field hospitals in gymnasiums, warehouses, arenas and convention centersField hospitals in gymnasiums, warehouses, arenas and convention centers

Religious or faith-based facilitiesReligious or faith-based facilities

Healthcare Providers CourseworkHealthcare Providers CourseworkAvailable coursework for pediatricAvailable coursework for pediatricclinician disaster preparedness:clinician disaster preparedness:

Basic and Advanced Disaster Life Basic and Advanced Disaster Life Support (BDLS, ADLS) Support (BDLS, ADLS)

Disaster Preparedness for School Nurses Disaster Preparedness for School Nurses

Pediatric Advanced Life Support (PALS)Pediatric Advanced Life Support (PALS)

Advanced Pediatric Life Support (APLS)Advanced Pediatric Life Support (APLS)

Emergency Nursing Pediatric Course Emergency Nursing Pediatric Course (ENPC) (ENPC)

Pediatric Education for Pre-hospital Pediatric Education for Pre-hospital Professionals (PEPP) Professionals (PEPP)

Advanced Trauma Life Support (ATLS)Advanced Trauma Life Support (ATLS)

Equipment Necessary for Pediatric Equipment Necessary for Pediatric Disaster PreparednessDisaster Preparedness Airway equipmentAirway equipment

IV access devices ( intravenous lines, IV access devices ( intravenous lines, intraosseous needles)intraosseous needles)

Warming blanketsWarming blankets

Radiant warmersRadiant warmers

Normal salineNormal saline

Pediatric nutrition supplies Pediatric nutrition supplies

- Formula, Formula,

- G-tube feeds, G-tube feeds,

- Child-friendly non-perishable itemsChild-friendly non-perishable items

Laryngeal Mask Airway

Vectors of Transmission of Infectious Vectors of Transmission of Infectious Diseases Affected by DisasterDiseases Affected by Disaster

Airborne Airborne - Crowded habitationCrowded habitation

WaterborneWaterborne- Contaminated water supplyContaminated water supply- Children most susceptibleChildren most susceptible

FoodborneFoodborne- Problems with proper storageProblems with proper storage

Insect and Animal borneInsect and Animal borne- Decrease disease transmission controlDecrease disease transmission control

Consider the Needs of Children in Consider the Needs of Children in Family Preparedness PlanningFamily Preparedness Planning

Listing of key phone numbersListing of key phone numbers

Create an emergency kitCreate an emergency kit

- Prescription medicationsPrescription medications

- OTC medicationsOTC medications

- Formula/FoodFormula/Food

- DiapersDiapers

- ClothesClothes

Create a list of trusted adults and a Create a list of trusted adults and a safety “password”safety “password”

Comfort objects and foodsComfort objects and foods

Family Disaster Planning Family Disaster Planning (focus on the (focus on the safety of the children):safety of the children):

Safe sites within the home

Family communication – reassembly plan (children at school parents at work)

Stored disaster supplies (water, food, cooking equipment, heat sources)

Conduct drills for common disasters (tornado, earthquake)

In reality few families have done any planningIn reality few families have done any planning

Pets in Disaster PlanningPets in Disaster Planning Case study-Katrina Case study-Katrina

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Family Disaster Planning Family Disaster Planning Preparation: HomePreparation: Home

Create and discuss disaster plan for familyCreate and discuss disaster plan for family

Acquaint all family members with first aid Acquaint all family members with first aid equipment in homeequipment in home

Route of egress from homeRoute of egress from home

Meeting place outsideMeeting place outside

Conduct drillsConduct drills

Preparation: HomePreparation: Home

Keep disaster stores of food, meds, diapers, Keep disaster stores of food, meds, diapers, etc.etc.

Have “disaster containers” in home and carHave “disaster containers” in home and car

Special needs children Special needs children

- Early evacuation plans, etcEarly evacuation plans, etc

Pharmaceutical/Medical Supply Pharmaceutical/Medical Supply StockpilesStockpiles

The Centers for Disease Control and Prevention (CDC) provide a Strategic The Centers for Disease Control and Prevention (CDC) provide a Strategic National Stockpile (SNS) National Stockpile (SNS)

- Developed in 1999 for anthraxDeveloped in 1999 for anthrax

- Point of delivery (POD) system for local distribution, with supplementation by state Point of delivery (POD) system for local distribution, with supplementation by state and national sources within 48 hours and national sources within 48 hours

States should plan on being self-sufficient for 72 hours before SNS arrivesStates should plan on being self-sufficient for 72 hours before SNS arrives

Instructions for accessing PODSInstructions for accessing PODS

- Use of United States Postal Service for distributionUse of United States Postal Service for distribution

- Security considerationsSecurity considerations

- Available media used to disseminate distribution point locationsAvailable media used to disseminate distribution point locations

Pre-event Public Health Planning Pre-event Public Health Planning Issues:Issues: Evacuation of populations at risk.Evacuation of populations at risk. Provide temporary shelter and protection from Provide temporary shelter and protection from

the environment. the environment. Provide food, water and clothing.Provide food, water and clothing. Plan for adequate personnel hygiene (toilets, Plan for adequate personnel hygiene (toilets,

showers, etc.).showers, etc.). Backup plans for communications, Backup plans for communications,

transportation and activities for children. transportation and activities for children. Plan for management of children with special Plan for management of children with special

needs. needs.

Post-event Public Health Response Post-event Public Health Response Issues:Issues:

Finding and extracting individuals who Finding and extracting individuals who refused to evacuaterefused to evacuate

Manage neglected chronic medical issues Manage neglected chronic medical issues (diabetes, heart disease, etc.)(diabetes, heart disease, etc.)

Provide for medical emergencies and Provide for medical emergencies and childbirthchildbirth

Keeping confined children healthy Keeping confined children healthy (medical & psychological). (medical & psychological).

Public Health Issues: Infectious Public Health Issues: Infectious Disease Outbreaks Disease Outbreaks

TypeType

• Airborne illnesses:Airborne illnesses:

• Vector borne Vector borne illnesses:illnesses:

• Water-borne Water-borne illnesses: illnesses: (oral-fecal (oral-fecal transmission)transmission)

• Food borne illnesses:Food borne illnesses:

ExamplesExamples

Influenza, tuberculosisInfluenza, tuberculosis

Avian flu, malaria, Avian flu, malaria, dengue, tick relateddengue, tick related

Cholera, salmonella, Cholera, salmonella, shigella, norovirus, shigella, norovirus, cryptosporidiosiscryptosporidiosis

Fungi, E-ColiFungi, E-Coli

InfluenzaInfluenza Influenza, a common viral Influenza, a common viral

respiratory virus with a long respiratory virus with a long history of periodic pandemicshistory of periodic pandemics

Mutations in strains of Mutations in strains of influenza including bird flu influenza including bird flu pose risk of widespread pose risk of widespread outbreakoutbreak

Risk of death increases with Risk of death increases with secondary bacterial infectionssecondary bacterial infections

Highly contagious, spread via Highly contagious, spread via droplet and contact routesdroplet and contact routes

Influenza: Treatment and Influenza: Treatment and PreventionPrevention

Amantadine is used for influenza A Amantadine is used for influenza A in children > 12 monthsin children > 12 months- Useful if given within 2 days of Useful if given within 2 days of

symptoms symptoms Oseltamivir (Tamiflu) is approved Oseltamivir (Tamiflu) is approved

for children > 12 monthsfor children > 12 months- Prevents release of viral particles Prevents release of viral particles

from infected cellsfrom infected cells- Efficacious for influenza A and BEfficacious for influenza A and B- Given orally bid for 5 daysGiven orally bid for 5 days

Both agents approved for Both agents approved for chemotherapy, theoretically useful chemotherapy, theoretically useful as prophylaxisas prophylaxis

Influenza: Treatment and Influenza: Treatment and PreventionPrevention

Indications for immunoprophylaxis Indications for immunoprophylaxis (protection from influenza A and B)(protection from influenza A and B)- Children less than 9 years receiving Children less than 9 years receiving

influenza immunization for the first influenza immunization for the first time require two doses one month time require two doses one month apartapart

The following children require The following children require immunization:immunization:- Persons aged 2-18 years with Persons aged 2-18 years with

comorbid conditions comorbid conditions - Children aged 6-59 months Children aged 6-59 months - Pregnant adolescents Pregnant adolescents - Household contacts and out-of-Household contacts and out-of-

home caregivers of children aged <6 home caregivers of children aged <6 monthsmonths

Viral Hemorrhagic Fevers Viral Hemorrhagic Fevers Viral hemorrhagic fevers, a group Viral hemorrhagic fevers, a group

of diseases carried by animals and of diseases carried by animals and characterized by bleeding characterized by bleeding

- More likely to be fatal in childrenMore likely to be fatal in children

Examples include Argentine Examples include Argentine Hemorrhagic Fever, Ebola, Lassa, Hemorrhagic Fever, Ebola, Lassa, Hanta and Nipah virusesHanta and Nipah viruses

Usually spread via contaminated Usually spread via contaminated body fluids, mosquitoes and ticksbody fluids, mosquitoes and ticks

Rarely airborne Rarely airborne

Few antiviral drugs/chemotherapy Few antiviral drugs/chemotherapy availableavailable

Mosquito and Tick

Photos Credit: CDC

Viral Hemorrhagic Fevers: Viral Hemorrhagic Fevers: Treatment and PreventionTreatment and Prevention

Most have no specific treatmentMost have no specific treatment

Supportive careSupportive care

Two ExceptionsTwo Exceptions

- Argentine hemorrhagic fever Argentine hemorrhagic fever convalescent serum convalescent serum

- Ribavirin is an antiviral drug Ribavirin is an antiviral drug useful for Lassa virususeful for Lassa virus

Ribavirin

SmallpoxSmallpox A delayed cutaneous A delayed cutaneous

infection spread via infection spread via respiratory routerespiratory route

Acute, contagious and Acute, contagious and sometimes fatal disease sometimes fatal disease caused by the variola virus caused by the variola virus (an orthopoxvirus)(an orthopoxvirus)

Historically important diseaseHistorically important disease

- Speculation about Speculation about availability as WMDavailability as WMD

Photos: CDC Photo Credit: CDC

SmallpoxSmallpox: : Treatment and Treatment and PreventionPrevention

Pre-exposure vaccination not currently Pre-exposure vaccination not currently recommended in childrenrecommended in children

Vaccine is effective in decreasing disease Vaccine is effective in decreasing disease severity within 4 days of exposureseverity within 4 days of exposure

Ring vaccination strategy recommended in Ring vaccination strategy recommended in event of an outbreakevent of an outbreak

Contraindications include eczema and Contraindications include eczema and immunodeficiencyimmunodeficiency

Vaccinia immune globulin (VIG) is Vaccinia immune globulin (VIG) is immunotherapy stockpiled by CDC for immunotherapy stockpiled by CDC for complications of vaccinecomplications of vaccine

Edward Jenner

TularemiaTularemia Tularemia, a disease of rabbits Tularemia, a disease of rabbits

and rodents, spread to people by and rodents, spread to people by contact with these animals or the contact with these animals or the ticks and mosquitoes that feed on ticks and mosquitoes that feed on themthem

Caused by Caused by Francisella tularensisFrancisella tularensis

- Can be aerosolized and used as Can be aerosolized and used as a weapona weapon

- No immunization is widely No immunization is widely availableavailable

Tularemia: Treatment and Tularemia: Treatment and PreventionPrevention AntibioticsAntibiotics

-First line agents include First line agents include gentamicin for 10 daysgentamicin for 10 days

- streptomycin and amikacin streptomycin and amikacin good alternativesgood alternatives

-Doxycycline and Doxycycline and fluoroquinolones are fluoroquinolones are second line agents, with second line agents, with risk of adverse effectsrisk of adverse effects

Doxycycline

Brucellosis Brucellosis A disease usually caused by A disease usually caused by

contact with infected animals contact with infected animals and animal products and animal products

Examples include cows and Examples include cows and milk milk

- Caused by Caused by Brucella Brucella bacteriabacteria

- Can be aerosolized and Can be aerosolized and used as a weaponused as a weapon

- No immunization is widely No immunization is widely availableavailable

Brucellosis: Brucellosis: Treatment and PreventionTreatment and Prevention

Indications for antibioticsIndications for antibiotics

-Recommendation for post-Recommendation for post-exposure prophylaxisexposure prophylaxis

-Rifampicin and trimethoprim-Rifampicin and trimethoprim-sulfamethoxazole (TMP-SMX) sulfamethoxazole (TMP-SMX) for 3-6 weeksfor 3-6 weeks

-May be given by mouth May be given by mouth

-May use quinolones, May use quinolones, doxycycline in children over 8doxycycline in children over 8

PlaguePlague Caused by Caused by Yersinia Yersinia

pestispestis, a bacterium , a bacterium found in rodents and found in rodents and their fleas in many areas their fleas in many areas around the world around the world

Forms: Forms: Bubonic, Septicemic Bubonic, Septicemic and Pneumonicand Pneumonic

Can be aerosolized and Can be aerosolized and used as a weaponused as a weapon

Plague: Treatment and PreventionPlague: Treatment and Prevention

A plague vaccine is not A plague vaccine is not currently available for use in currently available for use in the United States the United States

Antibiotics must be given Antibiotics must be given within within 24 hours of first symptoms 24 hours of first symptoms

Streptomycin 30 mg/kg/day Streptomycin 30 mg/kg/day divided in two dosesdivided in two doses

Streptomycin

AnthraxAnthrax Anthrax, a disease of animal handlers and Anthrax, a disease of animal handlers and

those who encounter contaminated those who encounter contaminated animal productsanimal products

Inhalational most likely weaponInhalational most likely weapon

- Used in 2001 anthrax mail contaminationUsed in 2001 anthrax mail contamination

- Highly lethalHighly lethal

- Initial flu-like illness for 2-5 daysInitial flu-like illness for 2-5 days

- Followed by intra-thoracic bleeding, Followed by intra-thoracic bleeding, dyspnea, dyspnea, pleural effusions and widened mediastinumpleural effusions and widened mediastinum

AnthraxAnthrax

Delayed symptomsDelayed symptoms

- Oral-gastrointestinalOral-gastrointestinal

- CutaneousCutaneous

- Hemorrhagic meningitisHemorrhagic meningitis

Lesion of Cutaneous Anthrax Associated With Microangiopathic Hemolytic Anemia and Coagulopathy in a 7-Month-Old infant

CutaneousCutaneous AnthraxAnthrax

Pediatric case:Pediatric case:

-systemic illness seensystemic illness seentransient DICtransient DIC

renal dysfunctionrenal dysfunction

-unique susceptibility?unique susceptibility?

Anthrax Anthrax

DecontaminationDecontamination

-Undress, soap/shower. Use 0.5% Undress, soap/shower. Use 0.5%

diluted household bleach for gross or diluted household bleach for gross or

visible contaminationvisible contamination

-Environment: 0.5% bleachEnvironment: 0.5% bleach

Anthrax: Treatment and PreventionAnthrax: Treatment and Prevention BioThrax immunization for animal BioThrax immunization for animal

handlers and military handlers and military

Limited data support intramuscular Limited data support intramuscular doses at 0, 2 and 4 weeks after doses at 0, 2 and 4 weeks after exposureexposure

- No human studies showing efficacy No human studies showing efficacy in post-exposure prophylaxisin post-exposure prophylaxis

- Prevents cutaneous anthrax in Prevents cutaneous anthrax in humanshumans

- Animal studies show prevention of Animal studies show prevention of inhalation diseaseinhalation disease

Not licensed by FDA for Not licensed by FDA for post-exposure prophylaxispost-exposure prophylaxis

Anthrax: Treatment and PreventionAnthrax: Treatment and Prevention Initial prophylaxis with either fluoroquinolone or tetracyclineInitial prophylaxis with either fluoroquinolone or tetracycline

- Ciprofloxacin (10-15 mg/kg/dose po q 12 hrs) not to exceed Ciprofloxacin (10-15 mg/kg/dose po q 12 hrs) not to exceed 1 gram per day 1 gram per day oror

- Doxycycline - up to and including 8 years or over 8 years and less Doxycycline - up to and including 8 years or over 8 years and less than or equal to 45 kg (2.2 mg/kg/dose po BID)than or equal to 45 kg (2.2 mg/kg/dose po BID)

Benefit of protecting children outweighs risks of medication exposure

Once susceptibility of organism established, change to amoxicillin, clindamycin or vancomycin

Treat for 60 days to allow time for sporesto germinate and be killed

BotulismBotulism Botulism, a paralytic disease Botulism, a paralytic disease

caused by the toxin of caused by the toxin of Clostridium botulinumClostridium botulinum

-Can be aerosolized and Can be aerosolized and used as a weaponused as a weapon

-Non-terrorist cases caused Non-terrorist cases caused by contaminated foodby contaminated food

-No antibiotic/chemotherapy No antibiotic/chemotherapy treatment existstreatment exists

Clostridium Botulinum

Photo Credit: CDC

Botulism:Botulism:Treatment and PreventionTreatment and Prevention

Suspected cases require supportive Suspected cases require supportive carecare

- Respiratory supportRespiratory support

- Intravenous nutritionIntravenous nutrition

Botulinum antitoxin is available Botulinum antitoxin is available

- Should be used in symptomatic Should be used in symptomatic cases before laboratory confirmationcases before laboratory confirmation

- Approved for use in children by FDAApproved for use in children by FDA

- Manufactured by California Manufactured by California Department of Health ServicesDepartment of Health Services

Case Study – Rapid DisplacementCase Study – Rapid Displacement

Rwandan Civil War – 1994Rwandan Civil War – 1994

Disaster Type: Disaster Type: Rapid displacement of a large Rapid displacement of a large

improvished populationimprovished population

(aka – complex humanitarian disaster)(aka – complex humanitarian disaster)

Medical Issues:Medical Issues: Epidemics of infectious Epidemics of infectious disease such as: cholera, disease such as: cholera,

hepatitis, hepatitis, exposure, nutritional exposure, nutritional needs of needs of children children

Public Health Issues – Airborne ToxinsPublic Health Issues – Airborne Toxins

Smothering construction materials, fuels, Smothering construction materials, fuels, freonfreon

Examples: Silica, asbestos, h2g, CO, Examples: Silica, asbestos, h2g, CO, Lead, etc. Lead, etc.

Public Health Issues – Airborne Public Health Issues – Airborne RadiationRadiation

“In some respects, major radiation exposure due to a terrorist attack should be easier to manage than chemical or biological attacks. An important resource is the tens of thousands of persons who deal with radiation daily at hospitals, universities, military units, national laboratories, and government agencies”.

NEJM 2002

Radiation ExposureRadiation ExposureRadiation ExposureRadiation Exposure

Radiation CharacteristicsRadiation Characteristics

TypeType PenetratePenetrate CommentsComments

AlphaAlpha NoNo Inhale, ingest, Inhale, ingest, open woundopen wound

BetaBeta SuperficialSuperficial Electrons, a few Electrons, a few centimeterscentimeters

GammaGamma DeepDeep Easy penetrationEasy penetration

X-RayX-Ray DeepDeep Easy penetrationEasy penetration

SeveritySeverity

None Death

Nausea

Vomitin

g

Diarrh

ea

Hypot

ensio

nCon

fusio

n

Seiz

ures

Com

a

ED MD ResponseED MD Response Seal ED with police-securitySeal ED with police-security

Get Radiation Safety to ED STATGet Radiation Safety to ED STAT

Create decontamination area Create decontamination area OutsideOutside

Don’t Contaminate EDDon’t Contaminate ED

Wear gowns, gloves, radiation detectorsWear gowns, gloves, radiation detectors

Public Health Issues – Personal & Public Health Issues – Personal & Intrapersonal Violence and AbuseIntrapersonal Violence and Abuse

Child abuse, PTSD, partner abuse, suicide, Child abuse, PTSD, partner abuse, suicide, substance abusesubstance abuse

What is Disaster Mitigation?What is Disaster Mitigation?

Steps taken prior to and after a disaster to Steps taken prior to and after a disaster to minimize morbidity and mortalityminimize morbidity and mortality

Examples include:Examples include:

- disaster plans: community, school, and homedisaster plans: community, school, and home

- pre-designated shelterspre-designated shelters

- clean water stores, food storesclean water stores, food stores

- post disaster emotional supportpost disaster emotional support

Examples of Disaster Mitigation Examples of Disaster Mitigation Activities: Activities:

Community wide influenza vaccination Community wide influenza vaccination programsprograms

Enforcement of engineering codes for Enforcement of engineering codes for construction projectsconstruction projects

Avoidance of construction in disaster Avoidance of construction in disaster prone areasprone areas

Stockpiling of supplies in safe placesStockpiling of supplies in safe places

Disaster Mitigation: Planning for Mass Disaster Mitigation: Planning for Mass GatheringGathering (particularly those involving children): (particularly those involving children):

Concerns: fire, riot-stampede, major Concerns: fire, riot-stampede, major accidents (stage collapse), inclement accidents (stage collapse), inclement weatherweather

Specifics: onsite EMS deployment; triage Specifics: onsite EMS deployment; triage plan from site to available medical plan from site to available medical facilities facilities

Preparation: SchoolPreparation: School

Makes disaster plan known to allMakes disaster plan known to all

Routes of egress from schoolRoutes of egress from school

Meeting placeMeeting place

DrillsDrills

Hospital InterfaceHospital Interface

Work with local and state officials to create Work with local and state officials to create disaster management plandisaster management plan

Local EMS plans for all schools & daycaresLocal EMS plans for all schools & daycares

Practice interface between school, EMS, and Practice interface between school, EMS, and hospital with drills at least once a yearhospital with drills at least once a year

Recovery Phase: InitialRecovery Phase: Initial

Shelters should be “kid friendly”Shelters should be “kid friendly”

Keep families togetherKeep families together

Personnel to organize area for orphaned and Personnel to organize area for orphaned and separated children until families reunitedseparated children until families reunited

Create children's groups in shelter, plenty of Create children's groups in shelter, plenty of toys, books, etc..toys, books, etc..

Recovery Phase: Long-termRecovery Phase: Long-term

Psychological services earlyPsychological services early

Be attentive to children's needs, consider Be attentive to children's needs, consider educational resources for long-term educational resources for long-term sheltering.sheltering.

Aberrant behavior may be manifestation of Aberrant behavior may be manifestation of emotional traumaemotional trauma

Recovery Phase: Long-termRecovery Phase: Long-term

Children must feel safe in home, community Children must feel safe in home, community and school; encourage thisand school; encourage this

Learn from mistakes Learn from mistakes

Disaster Mitigation: What you can doDisaster Mitigation: What you can do

Emergency physicians, Pediatric EM Emergency physicians, Pediatric EM physicians, Pediatricians, Nurses, other physicians, Pediatricians, Nurses, other health care professionals:health care professionals:

- Preparation before disasterPreparation before disaster

- Action during disasterAction during disaster

- Recovery phaseRecovery phase

Before Disaster StrikesBefore Disaster Strikes

Involve yourself in the local EMS and area Involve yourself in the local EMS and area disaster plan: help to develop systems that disaster plan: help to develop systems that keep children's’ needs in mindkeep children's’ needs in mind

Work with schools, daycares and local Work with schools, daycares and local hospitals to develop integrated disaster planshospitals to develop integrated disaster plans

Act as an advisor to your patients for home Act as an advisor to your patients for home disaster planningdisaster planning

Before Disaster StrikesBefore Disaster Strikes

Arrange disaster response drillsArrange disaster response drills

Promote community awareness addressing Promote community awareness addressing pediatric needspediatric needs

During A DisasterDuring A Disaster

Be active!! Be active!!

Institute disaster plans in your facilityInstitute disaster plans in your facility

Participate in the community response to Participate in the community response to disasterdisaster

Disaster RecoveryDisaster Recovery

Provide medical care to sheltersProvide medical care to shelters

Assume basic community services will be Assume basic community services will be disrupted for some timedisrupted for some time

Attend to emotional needs of the pediatric Attend to emotional needs of the pediatric population effectedpopulation effected

SummarySummary Pediatric disaster public health Pediatric disaster public health

issues require the right people, issues require the right people, places, tools and plansplaces, tools and plans

Disaster preparedness Disaster preparedness includes planning, training, and includes planning, training, and acquisition of appropriate acquisition of appropriate medications and equipmentmedications and equipment

Disaster mitigation begins Disaster mitigation begins before the eventbefore the event

Photo Credit: FEMA