Approach to Childrens Preparedness Eric Dziuban, MD, DTM, CPH, FAAP - - PowerPoint PPT Presentation

National Center on Birth Defects and Developmental Disabilities

Protecting a Child is the Public’s Health: An Integrated Approach to Children’s Preparedness

Eric Dziuban, MD, DTM, CPH, FAAP Team Lead, Children’s Preparedness Unit Chief Medical Officer, Office of the Director Division of Human Development and Disability, NCBDDD, CDC

AAP—Orange County Chapter May 14, 2016

Disclosure

• Neither I nor any member of my immediate family has a financial

relationship or interest (currently or within the past 12 months) with any proprietary entity producing health care goods or services consumed by, or used on, patients related to the content of this CME activity.

• I do not intend to discuss an unapproved/investigative use of a

commercial product/device.

Key Learning Objectives

• Identify the importance of

preparedness planning for children at every level

• Gain a better understanding
• f the work being done by

Children’s Preparedness Unit at CDC

• Improve capacity of Orange

County pediatric health care providers to engage in disaster response efforts

Introducing CDC’s Children’s Preparedness Unit

Children’s Preparedness Unit (CPU)

Division of Human Development & Disability (DHDD)

Primary programs:

• State Disability & Health Programs
• Public Health Practice & Resource Centers
• Disability & Health Data System
• Early Hearing Detection & Intervention
• National Spina Bifida Patient Registry
• Muscular Dystrophy Research Network
• Fragile X Syndrome
• Child Development Research & Interventions
• ADHD
• Tourette Syndrome
• Legacy for Children™
• Children’s Mental Health
• Children’s Preparedness

Mission and Pillars of CPU

To champion the needs of children in emergency preparedness and response by integrating children into public health planning at the federal, state, and local levels.

Build an evidence base of best practices, tools, and resources to guide planning Increase awareness

• f the importance
• f incorporating

children in preparedness planning Offer technical assistance and serve as SME to federal, state, and local public health Develop partnerships with leaders in preparedness planning

CPU and AAP: Championing Needs of Children in Emergencies

CDC and AAP: Partnering to integrate children in all aspects of emergency preparedness with a focus on the important role of pediatricians

Pediatrician and Public Health Exercise Children’s Hospital and Preparedness Calls Children and Youth with Special Health Care Needs Preparedness Influenza Preparedness

Pediatrics Public Health

Children’s Needs in Disaster Response

Unique Needs of Children in an Emergency

• Children are vulnerable in times
• f disaster

– Unique physiology, anatomy and developmental characteristics – Younger children partially or fully dependent on adults

• Both pediatric and non-pediatric

resources can become overwhelmed quickly with an influx or surge of children

How are Children Different than Adults?

Clinical Management Challenges

• Triage

– Normal range of vital signs different – Adult-based tools inaccurate in children

• Medications

– Weight-based dosing in children – Different medication formulations – Need to consider countermeasure stockpiles

• Equipment

– Need full range of sizes for pediatric care

• Oxygen masks, catheters, tubes

– Adult-based devices may not work

• Ventilators, monitors, infusion pumps

Medical Countermeasures (MCM) for Children

• Children require weight-based dosing, and may need:

– Different formulations in the Strategic National Stockpile – Different dispensing guidance for public health departments – Different guidance for the public

• Testing MCMs on children has serious ethical considerations
• Many MCMs are not FDA-approved for children

– These MCMs must be administered under alternative regulatory mechanisms

CPU Disaster Priorities

• Emerging infectious diseases (outbreaks and epidemics)
• Bioterrorism agents
• Radiation incidents
• Influenza (seasonal and pandemic)
• Chemical exposures (intentional and accidental)
• Infectious disease concerns secondary to natural disasters
• Natural disasters
• Hurricanes, winter storms, flooding, tornadoes, wildfires,

landslides, earthquakes, landslides, volcanoes

• Intentional mass casualty events (shootings, explosives)
• Unintentional mass casualty events
• Road incidents, building collapses, fires

Examples of CPU Activities

Pillar 1

Build an evidence base

• f best practices, tools,

and resources to guide planning

• Integrate children into

clinical guidelines, such as “Clinical Guidance for Smallpox Vaccine Use” and “Clinical Guideline Support for Treatment of Botulism”

• Perform analyses on flu
• utcomes for children

with special healthcare needs

Pillar 2

Increase awareness of the importance of incorporating children in preparedness planning

• Create and maintain a “Caring for

Children in Disasters” web page

• Produce a supplementary

instructional video on pill crushing (Anthrax MCM ) that was tested with focus groups

• Develop content for Ready Wrigley

children’s activity books

Pillar 3

Offer technical assistance and serve as SME to federal, state, and local public health

• Served as Children’s Health Team

during Flint, MI Water Contamination response

• Consult with regional and

national disaster coalitions

• Hosted Public Health and

Pediatrics Tabletop Exercise

Pillar 4

Develop partnerships with leaders in preparedness planning

• Participate in Children’s Health and

Human Services (HHS) Interagency Leadership on Disasters (CHILD) Working Group

• Facilitate meetings with SNS

leadership and AAP’s Disaster Preparedness Advisory Council (DPAC) semi-annually

Mission and Pillars of CPU: What about Responses?

To champion the needs of children in emergency preparedness and response by integrating children into public health planning at the federal, state, and local levels.

Build an evidence base of best practices, tools, and resources to guide planning Increase awareness

• f the importance
• f incorporating

children in preparedness planning Offer technical assistance and serve as SME to federal, state, and local public health Develop partnerships with leaders in preparedness planning

Emergency Operations Center (EOC): Activations

• Responses with CPU

Involvement:

• H1N1 (2009-2010)
• H3N2v (2012)
• Unaccompanied Minors

(2014)

• Ebola (2014-2015)
• Zika (2016)
• Flint, MI Water

Contamination (2016)

• Content Examples:
• Pediatric medical

countermeasures

• Liaising with AAP and children’s

hospitals

• Children’s mental health
• Parental presence
• Breastfeeding & transmission
• Pediatric case investigations
• Infant diagnostic guidelines
• Pediatric FAQs

Summary of CPU Work

• CDC is committed to including children in

preparedness and response planning

• The Children’s Preparedness Team does

this work by consulting and collaborating with groups across CDC and with federal, local and state governments and partners

• rganizations
• Our goal: ensure that children are

thoughtfully included in all public health preparedness and response activities

Efforts in 2016 and Lessons Learned (so far …)

Pediatric and Public Health Tabletop Exercise

• CONCEPT

– Increase connectedness between public health preparedness professionals and pediatricians at the state and local levels. – Improve pediatricians’ knowledge about public health emergency preparedness and response. – Improve public health professionals’ understanding of the needs

• f children in disasters and how pediatricians can help.

Pediatric and Public Health Tabletop Exercise

• OBJECTIVES

– Determine collaborative strategies that AAP chapters, pediatric clinicians, and public health leaders could implement to advance pediatric preparedness at the state and local level. – Develop communication between public health/pediatrician leaders during a response to a public health emergency to sufficiently address pediatric needs. – Evaluate ways to optimize plans for distribution and dispensing of medical countermeasures suitable for pediatric care, relevant to the infectious disease threat/situation raised in the exercise scenario.

Meanwhile on January 26th …

AAP Input:

• National

Leadership

• Disaster

Preparedness

• Infectious Disease
• Neonatology and

Fetal Medicine

• Neurology
• Children with

Disabilities

CDC Efforts in Flint, MI

Example Objective: Develop and implement targeted public health messaging for lead exposure in collaboration with the Genesee County Health Department, the Michigan Department of Health and Human Services, and the US Environmental Protection Agency.

Conclusions

Pediatric Practices in Orange County: Are You Ready?

Communication Coordination with emergency management Sheltering in place Plans and protocols Drills

Questions?

For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the

• fficial position of the Centers for Disease Control and Prevention.