Preparing for childrens needs in LA County Forging the way ahead - - PowerPoint PPT Presentation

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Preparing for childrens needs in LA County Forging the way ahead - - PowerPoint PPT Presentation

May 21, 2023 457 likes •945 views

Preparing for childrens needs in LA County Forging the way ahead Bridget Berg, MPH, FACHE Manager, Disaster Resource Center Childrens Hospital Los Angeles Preparing for childrens needs in Los Angeles County Forging the way ahead

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Bridget Berg, MPH, FACHE Manager, Disaster Resource Center Children’s Hospital Los Angeles

Preparing for children’s needs in LA County Forging the way ahead

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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.

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Preparing for children’s needs in Los Angeles County – Forging the way ahead

Bridget Berg, MPH, FACHE

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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

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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

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MENTAL HEALTH - CHILDREN

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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

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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
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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%
  • f Louisiana parents and 50%
  • f 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

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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.

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Psychological Impact

  • React ions may appear immediat ely
  • r 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

Managing Pediatric Patients: Mental Health

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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

Managing Pediatric Patients: Mental Health

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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

Managing Pediatric Patients: Mental Health

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Possible Reactions

  • Adolescents 12 to 18 years

– Flashbacks or Nightmares – Emotional numbing – Avoidance of reminders – Depression – Withdrawal – Isolation – S

uicidal thoughts

Managing Pediatric Patients: Mental Health

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5,192 children separated 411,000 people evacuated 40 states 7 months later

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Source: http://www.nbcnews.com/id/11909504/ns/us_news-katrina_the_long_road_back/t/final-hurricane-displaced- child-family-reunited/#.VR69AtLF-SU

Cortez Stuart , 4 years old

Cortez Stewart

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FAMILY REUNIFICATION – FROM CONCEPT TO IMPLEMENTATION

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Family Reunification – What is this?

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Family

Registration and Communication Unaccompanied Minor

Registration and Identification

Caring for

unaccompanied minors (clinical and possible safe 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)
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CHLA – Family Information Center Plan TTX High Level Results

Plan Development

  • Inclusive planning

– S

  • cial 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

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LA COUNTY CONTINUING TO LEAD THE WAY

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LOS ANGELES COUNTY PEDIATRIC SURGE PLAN

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Pediatric Surge Plan – Process and Approach

Phase 2 2012-2013 Phase 3 2013-2015 Phase 4 2015

Assessment and Plan Development Plan Implementation and Training Plan Exercise and Evaluation Plan Revision

Phase 1 2011 - 2012

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Existing Systems and Resources

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  • 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

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LAC Peds Surge Plan

Hospital Tier (# of hospitals) Tier Description Tier 1 (13)

Full Pediatric Services

Tier 2 (6)

Adult Trauma Centers

Tier 3 (11)

Peds Acute Beds

Tier 4 (18)

Emergency Department Approved for Pediatrics (EDAP)

Tier 5 (21)

No Pediatric Services

Tier 6 (8)

No Emergency Services / Specialty

Acuity Level Over 8 years of age

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Phase 3 – Plan Evaluation - Exercises April 20, 2015 and June 11, 2015

Children’s Hospital Los Angeles –Susan Goldman

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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.

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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

  • f LA County

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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

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LAC Peds Surge Plan – UPDATED 6/15

Hospital Tier (# of hospitals) Tier Description Tier 1 (13) Tier 2 (6)

Adult Trauma Centers

Tier 3 (11)

Peds Acute Beds

Tier 4 (18)

Emergency Department Approved for Pediatrics (EDAP)

Tier 5 (21)

No Pediatric Services

Tier 6 (8)

No Emergency Services / Specialty

Acuity Level Over 8 years of age Tier 1 Medical Tier 1 Trauma

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HOSPITAL TIER TIER DESCRIPTION Tier 1 Pediatric Centers (PTC/PMC) Tier 2* Pediatric Medical Centers (PMC) Tier 3 Adult Trauma Centers Tier 4 Pediatric Acute Beds Tier 5 Emergency Departments Approved for Pediatrics (EDAP) Tier 6 No Pediatric Services Tier 7 No Emergency Services / Specialty Centers

Acuity Level

Over 8 years

  • ld

Pediatric Surge Plan - 2016

* * Note: In a pediatric trauma surge event, patients would go to Tier 3 before Tier 2

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SUPPORTING HOSPITALS AND PROVIDERS - TOOLS

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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
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SURGE TRAIN

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ht t p:/ / S urgeWorld.lachildrenshospit al.net

Why register?

  • Allows collection of feedback
  • Ability to see play by hospital
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IMPROVING PREPAREDNESS FOR CHILDREN WITH ACCESS AND FUNCTIONAL NEEDS

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Defining At-Risk Individuals

  • Before, during, and after an incident, members of at -risk

populations may have additional needs in one or more of the following functional areas:

– maintaining independence – communication – transportation – supervision – medical care

  • Examples: children, senior citizens, pregnant women,…

individuals who have disabilities; live in institutionalized settings; are from diverse cultures; have limited English proficiency or are non- English speaking; are transportation disadvantaged; have chronic medical disorders; and have pharmacological dependency.

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Source: Pandemic and All-Hazards Preparedness Act (PAHPA), Progress report Aug 2008

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Project Definition

Type of Special Healthcare Need

  • Chronic Medical

Conditions Special Education Eligibility or Accommodations

  • Other Health

Impairments, Orthopedic Impairments Risks during Disaster/Emergency

  • Medications, medical

procedures for survival (oxygen, g-tube feedings, ventilators, ostomies); mobility

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Project Deliverables

  • 1. Los Angeles County Hospital S

ystem Plan for CS HCN

– Annex to the Pediatric S

urge Plan

– S

pecific focus on CS HCN and utilizes existing hospital resources within the county

  • 2. Develop web-based platform

– Provide families with special healthcare needs via

two functions: (1) A resource sharing site (2) Opportunity to complete an online emergency information form

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HEALTHCARE PREPAREDNESS FOR CHILDREN

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Elements of Pediatric Preparedness for healthcare facilities

  • Awareness and acknowledgement
  • Leadership

– Identify a pediatric champion (MD

and non-MD)

  • Plan

– Understand your risks – Family Reunification

  • Decontamination Nuances

– Keep parents / babies together,

baby baths, Warmers,

  • Pharmaceuticals

– A method for dosing

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  • S

afety & S ecurity

  • S

taff

–

Pre-identified

  • S

upplies

– Basic supplies (diapers,

nutrition, activities & distraction)

– Medical supplies (e.g.,

smaller items – ETT , Ivs)

  • Transportation
  • Triage

–

JumpS TART reference tools

  • Training

– Advanced training – Just-in-time training

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CHILDREN IN DISASTERS WORKING GROUP

Co-Chairs Rita Burke, PhD, MPH

USC and Children’s Hospital Los Angeles

Bob Spears

Former LAUSD Emergency Manager

LAC OEM – Access and Functional Needs Meets Monthly

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www.CHLA.org/DisasterCenter

Jeffrey S. Upperman, MD FACS FAAP Director, Trauma and PDRTC Nancy Blake, PhD, RN, CCRN,

NEA-BC, FAAN

VP, Critical Care Services Bridget M. Berg, MPH, FACHE Manager Rita V. Burke, PhD, MPH Assistant Professor of Research Katie Meyer, RN, BSN House Supervisor Brenna Carlson, MPH Emergency Management and Trauma Surge Coordinator

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QUESTIONS?

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Resources – Hospitals and Healthcare

  • American Academy of Pediatrics –

Children & Disasters

  • Children’s Hospital Los Angeles Pediatric Disaster Resource and

Training Center

– www.CHLA.org/ DisasterCenter

  • DHHS

– Technical Resources, Assistance Center, and Information Exchange

– https:/ / asprtracie.hhs.gov/

  • Mental Health

– Resource link for Listen Protect Connect and PF

A

  • http:/ / www.cdms.uci.edu/ disaster_mental_health.asp

– S

chonfeld Article

  • http:/ / pediatrics.aappublications.org/ content/ 136/ 4/ e1120

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Resources – Child Preparedness (Schools and Families)

  • LA County Children in Disasters Working Group

–

http:/ / www.childrenindisaster.com/

  • S

ave the Children – Get Ready Get S afe

–

http:/ / www.savethechildren.org/ site/ c.8rKLIXMGIpI4E/ b.8777055/ k.18AB/ Get _Ready_Get_S afe_Plan_Ahead.htm

–

Training (must register)

  • http:/ / www.savethechildren.org/ site/ c.8rKLIXMGIpI4E/ b.9111279/ k.8B62/

Get_Ready_Get_S afe_Training.htm

  • American Red Cross

–

Pillowcase proj ect for schools

–

http:/ / www.redcross.org/ get-help/ prepare-for-emergencies/ resources-for- schools

  • RAND

–

school-based group intervention for elementary students exposed to stressful and traumatic events.

–

http:/ / bouncebackprogram.org/

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