Preparing for children’s needs in LA County Forging the way ahead Bridget Berg, MPH, FACHE Manager, Disaster Resource Center Children’s Hospital Los Angeles
Preparing for children’s needs in Los Angeles County – Forging the way ahead Bridget Berg, MPH, FACHE I have no relevant financial relationships with the manufacturer(s) or any commercial product(s) and/ or provider of commercial products or services discussed in this CME activity. I do not intend to discuss unapproved/ investigative use of commercial product(s)/ device(s) in my presentation. 2
Objectives By t he end of t his present at ion, at t endees should be able t o: – Describe common reactions of children following a disaster – Explain the main functions of a Family Information Center – Describe the purpose and concept of operations for the LA County Pediatric S urge Plan 3
How children are different? • Physical Differences • Developmental Differences – Pre-verbal – Reality vs fiction (~ 4 years of age) – Causality • Psychological Differences • Dosages of medications and volumes of fluid significantly difference than adults 4
MENTAL HEALTH - CHILDREN 5
Elements impacting child’s mental health response Effect of disaster depends on numerous factors: • Nature of event – amount of death, destruction and disruption • Degree of personal involvement • Duration of time before return to “ normalcy” • 1-time vs chronic event • Coping capability of caregiver • Preexisting mental health, developmental level, and baseline resiliency and coping skills • Nature of secondary stressors and losses following the event Source: Schonfeld D. et. al,.Providing Psychosocial Support to Children and Families in the Aftermath of Disasters and Crisis. Pediatrics Vol 136, Number 4. October 2015. DOI: 10.1542/peds.2015-2861 6
Children’s Mental Health and Development of Concept of Operations • Children have differential risk for disaster-engendered mental health consequences • Examples: – Hurricane Katrina, 4 years post event • 40% of Louisiana parents and 50% of Mississippi parents indicated children still had mental health disorders as a result of the hurricane • National Children’s Disaster Mental Health Concept of Operations – Efforts for each phase of disaster – Use of PsyS tart triage, “ Listen, Protect, and Connect” and services if needed Source: Schreiber, M. (2011). National Children’s Disaster Mental Health Concept of Operations. Oklahoma City, OK: Terrorism and Disaster Center at the University of Oklahoma Health Sciences Center. 7
Managing Pediatric Patients: Mental Health Psychological Impact • React ions may appear immediat ely or lat er • Reactions range – New disorders with complex comorbidities to short-term distress with improved resilience and possible growth • Impact may be great er for children who: – Have previously been abused – Have mental health problems – Lack family support 8
Managing Pediatric Patients: Mental Health Possible Reactions • Children 5 years and younger – Fear of being separated from parent – Crying, whimpering, screaming – Immobility or aimless motion – Frightened facial expressions – Excessive clinging – Regressive behaviors 9
Managing Pediatric Patients: Mental Health Possible Reactions • Children 6 to 11 years old – Extreme withdrawal – Disruptive behavior – Regressive behaviors – Inability to pay attention – Outbursts of anger – Bodily symptoms not medically based 10
Managing Pediatric Patients: Mental Health Possible Reactions • Adolescents 12 to 18 years – Flashbacks or Nightmares – Emotional numbing – Avoidance of reminders – Depression – Withdrawal – Isolation – S uicidal thoughts 11
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411,000 people evacuated 40 states 5,192 children separated 7 months later 13
Cortez Stewart Cortez Stuart , 4 years old Source: http://www.nbcnews.com/id/11909504/ns/us_news-katrina_the_long_road_back/t/final-hurricane-displaced- child-family-reunited/#.VR69AtLF-SU 14
FAMILY REUNIFICATION – FROM CONCEPT TO IMPLEMENTATION 15
Family Reunification – What is this? Caring for Unaccompanied Minor Family unaccompanied Registration minors Registration and (clinical and and Communication possible safe Identification area) • Physical description • Any info provided by minor • Description of clothing, jewelry • Distinguishing characteristics • Arrival date / time, location found, brought by • Triage tag number (if available) 16
CHLA – Family Information Center Plan TTX High Level Results Plan Development • Inclusive planning – S ocial Work, Child Life, Emergency Department Plan Tabletop Exercise • Tabletop – 4 groups • Activation, Operations, Demobilization High Level Findings • S eparate registration and family call in line • Identify / develop day care documentation for children in safe area awaiting reunification 17
LA COUNTY CONTINUING TO LEAD THE WAY 18
LOS ANGELES COUNTY PEDIATRIC SURGE PLAN
Pediatric Surge Plan – Process and Approach Phase 1 Phase 2 Phase 3 Phase 4 2011 - 2012 2012-2013 2013-2015 2015 Plan Assessment Plan Plan Implementation and Plan Revision Exercise and Development and Training Evaluation
Existing Systems and Resources • 100 Acute Care Hospitals • 82 HPP Partners • 14 Trauma Centers • 13 Disaster Resource Centers (DRC’s) • LAC EMS Agency - Medical Alert Center (MAC) LAC EMS Agency – Medical Alert Center and Hub and spoke concept 21
LAC Peds Surge Plan Hospital Tier Description Tier (# of hospitals) Full Pediatric Services Tier 1 (13) Acuity Level Tier 2 (6) Adult Trauma Centers Peds Acute Beds Tier 3 (11) Over 8 years of Emergency Department Approved Tier 4 (18) age for Pediatrics (EDAP) No Pediatric Services Tier 5 (21) No Emergency Services / Specialty Tier 6 (8)
Phase 3 – Plan Evaluation - Exercises April 20, 2015 and June 11, 2015 Children’s Hospital Los Angeles –Susan Goldman
Exercise Highlights – Major Strengths • Pediatric S urge Plan and Targets – The hospitals were able to meet the surge expectations for their tier, as described in the LAC Pediatric S urge Plan. • Pediatric specific concerns – Participating hospitals were able to work through and resolve pediatric specific concerns. • Transfers – The Medical Alert Center was able to find destinations for all patients, from the field and accommodated secondary transfers.
Exercise Highlights Primary Areas for Improvement • Pediatric S urge Plan Modification – S eparate Tier 1 hospitals into medical and trauma • Important for pre-hospital providers • Provides support for hospitals re: what patients are likely to treated • ReddiNet – Concerns re: time process of entering patients – New staff • Training – Need for advanced and j ust-in-time training resources regarding pediatric specific concerns, particularly for lower tiered hospitals • Plan coordination – Consideration for geographic locations and regional planning outside of LA County 25
Additional Learnings • Family reunification – Continued development, guidance and exercise needed • Multi-site MCIs – Highlighted need to work through issues related to simultaneous MCIs at multiple locations – Knowledge and use of the Fire Operational Area Coordinator (FOAC) and Medical and Health Operational Area Coordinator (MHOAC) for additional resources 26
LAC Peds Surge Plan – UPDATED 6/15 Hospital Tier Description Tier (# of hospitals) Tier 1 (13) Tier 1 Trauma Tier 1 Medical Acuity Level Tier 2 (6) Adult Trauma Centers Peds Acute Beds Tier 3 (11) Over 8 years of Emergency Department Approved Tier 4 (18) age for Pediatrics (EDAP) No Pediatric Services Tier 5 (21) No Emergency Services / Specialty Tier 6 (8)
Pediatric Surge Plan - 2016 HOSPITAL TIER DESCRIPTION TIER Tier 1 Pediatric Centers (PTC/PMC) Tier 2* Pediatric Medical Centers (PMC) Acuity Level Tier 3 Adult Trauma Centers Tier 4 Pediatric Acute Beds Emergency Departments Approved Over 8 years Tier 5 for Pediatrics (EDAP) old Tier 6 No Pediatric Services No Emergency Services / Specialty Tier 7 Centers * * Note: In a pediatric trauma surge event, patients would go to Tier 3 before Tier 2
SUPPORTING HOSPITALS AND PROVIDERS - TOOLS
Pediatric Surge Quad Fold Includes: • Pediatric risks during disasters • Pediatric Assessment Triangle • Pediatric signs of respiratory distress and respiratory failure • JumpSTART triage • Daily maintenance fluid and electrolyte requirements • Nutrition • Dehydration • Normal development • Equipment sizes • Shock • Fluid Resuscitation • Burn Treatment – fluid resuscitation 30
SURGE TRAIN
ht t p:/ / S urgeWorld.lachildrenshospit al.net Why register? • Allows collection of feedback • Ability to see play by hospital
IMPROVING PREPAREDNESS FOR CHILDREN WITH ACCESS AND FUNCTIONAL NEEDS 37
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