Protecting the Public’s Health from Disease, Disasters, and

Bioterrorism: Where are the Children?

Daniel B. Fagbuyi, MD, FAAPDaniel B. Fagbuyi, MD, FAAPMedical Director, Disaster Preparedness and Emergency ManagementMedical Director, Disaster Preparedness and Emergency Management

Children’s National Medical Center, Washington, DCChildren’s National Medical Center, Washington, DCAssistant Professor, Pediatrics and Emergency MedicineAssistant Professor, Pediatrics and Emergency Medicine

The George Washington University School of Medicine, Washington, DCThe George Washington University School of Medicine, Washington, DC

SITUATION:

•The US is The US is notnot adequately prepared for adequately prepared for public health emergencies and public health emergencies and disasters that involve childrendisasters that involve children

BACKGROUND:

•Children make up ~25% of the US populationChildren make up ~25% of the US population

•Most disaster plans fail to factor in children Most disaster plans fail to factor in children “benign neglect”“benign neglect”

BACKGROUND:

•Children have physiological, anatomical, Children have physiological, anatomical, dermatological, immunological and dermatological, immunological and developmental/psychosocial unique developmental/psychosocial unique characteristics characteristics

Predisposition to higher risk during a Predisposition to higher risk during a CBRNE (chem-bio-rad-nuc-explosive) CBRNE (chem-bio-rad-nuc-explosive) eventevent

DOES SIZE MATTER?

ASSESSMENT:

•Day to day pediatric emergency preparedness Day to day pediatric emergency preparedness is lacking nationwideis lacking nationwide

Pre-hospital to In-patient critical carePre-hospital to In-patient critical care

•Baseline deficiencies in pediatric surge Baseline deficiencies in pediatric surge capacity and healthcare system capability capacity and healthcare system capability aboundabound

Pre-hospital to In-patient critical carePre-hospital to In-patient critical care

ASSESSMENT:

•Over 2/3rd of pediatric medications currently Over 2/3rd of pediatric medications currently being used are administered “off-label”being used are administered “off-label”

•SNS is devoid of adequate pediatric MCMs SNS is devoid of adequate pediatric MCMs compared to that of the adultcompared to that of the adult

“BOOTS ON THE GROUND”, DATA & FACTS

•Emergency department (ED) overcrowding is a critical issue on the national agenda

Further exacerbated by H1N1 pandemic

•The science of ED surge remains relatively undeveloped

Nager AL, Khanna K. Emergency department surge: models and practical implications. J Trauma. 2009;67(2 Suppl):S96-99

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Daily Influenza-like illness (ILI) and Emergency Department (ED) volume Fall’09 H1N1. Solid line represents ED baseline volume.

H1N1 Impact on Children’s National Emergency Department Patient Volume

A Rapid Medical Screening Process Improved Emergency Department

Patient Flow during Surge Associated with Novel H1N1 Influenza Virus

Daniel B. FagbuyiKathleen Brown, David Mathison, Jennifer Kingsnorth, Sephora Morrison, Mohsen Saidinejad, Jeffrey Greenberg, Michael Knapp, James Chamberlain

Children’s National Medical CenterThe George Washington University School of Medicine

AAP in partnership with Children’s Health Fund conducted a public opinion poll on the use of resources related to disaster planning and response specific to children’s issues.

Findings• 76% of Americans agree that if resources are limited,

children should be given a higher priority for life-saving treatments

• 75% believe that if tough decisions must be made, life-saving treatments should be provided to children rather than adults with the same medical condition

• 92% agree that if there were a terrorist attack, our country should have the same medical treatments readily available for children as are now available for adults

Public Opinion on Children and Disasters

RECOMMENDATIONS:

•Reauthorization of PAHPAReauthorization of PAHPADistinguish children as a separate population

from the broader “at-risk” individuals’ category

Ensure federal public health preparedness programs, grants and planning include performance measures for children

RECOMMENDATIONS:

•Ensure stockpile MCMs, equipment, and Ensure stockpile MCMs, equipment, and supplies are appropriate for childrensupplies are appropriate for children

Achieve parity between medical Achieve parity between medical countermeasures developed and included in the countermeasures developed and included in the Strategic National Stockpile for children and Strategic National Stockpile for children and those for adultsthose for adults

Address Emergency Use Authorization barriers Address Emergency Use Authorization barriers and consider a pre-EUA processand consider a pre-EUA process

RECOMMENDATIONS:

•Involve pediatrics experts at Involve pediatrics experts at all levelsall levels of of planning and responseplanning and response

Expand pediatric subject matter expertise in Expand pediatric subject matter expertise in federal preparedness planning efforts e.g. federal preparedness planning efforts e.g. Federal Advisory Committees and BoardsFederal Advisory Committees and Boards

RECOMMENDATIONS:

•Ensure state and local planning includes the Ensure state and local planning includes the needs of children and familiesneeds of children and families

•Ensure EMS agencies and hospitals are Ensure EMS agencies and hospitals are prepared and can care for childrenprepared and can care for children

•Improve and ensure pediatric education and Improve and ensure pediatric education and training for all responderstraining for all responders

RECOMMENDATIONS:

•Augment and foster the linkage between all Augment and foster the linkage between all preparedness agencies and pediatric expertspreparedness agencies and pediatric experts

•Encourage and improve individual Encourage and improve individual preparedness, including families and children preparedness, including families and children with special healthcare needswith special healthcare needs

RECOMMENDATIONS:

•Ensure funding for preparedness and Ensure funding for preparedness and response are tied to addressing the pediatric response are tied to addressing the pediatric gaps identifiedgaps identified

•Improve strategic communications/messaging Improve strategic communications/messaging to parents/public, health professionals, to parents/public, health professionals, decision makers, and the mediadecision makers, and the media

RECOMMENDATIONS:

•Implement the recommendations from the Implement the recommendations from the work of the work of the National Commission on Children National Commission on Children and Disasters (October 2006)and Disasters (October 2006)

•Address the need for real-time data collection Address the need for real-time data collection during public health emergenciesduring public health emergencies

Take Home Points

•Children differ from adults in many aspects

•Failure to account for these differences will result in increase morbidity and mortality

•Cost-benefit analysis should consider life-years-saved vs. lives-saved

Take Home Points

•Remember the end-user and public accountability

With Questions, Please Contact:

American Academy of PediatricsWashington Office202/347-8600 Tamar Haro: tharo@aap.orgBetsy Dunford: bdunford@aap.org

Please visit: www.aap.org/disasters

Protecting the Public’s Health from Disease, Disasters, and

Bioterrorism: Where are the Children?

Daniel B. Fagbuyi, MD, FAAPDaniel B. Fagbuyi, MD, FAAPMedical Director, Disaster Preparedness and Emergency ManagementMedical Director, Disaster Preparedness and Emergency Management

Children’s National Medical Center, Washington, DCChildren’s National Medical Center, Washington, DCAssistant Professor, Pediatrics and Emergency MedicineAssistant Professor, Pediatrics and Emergency Medicine

The George Washington University School of Medicine, Washington, DCThe George Washington University School of Medicine, Washington, DC