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Pediatric Medical Surge Annex [Draft]

Pediatric Medical Surge Annex

The REDi Healthcare Coalition works to strengthen the emergency preparedness and response planning for all aspects of healthcare through community coordination and collaboration. Healthcare Coalition

participation is appropriate for all types of healthcare providers, mental health providers, EMS professionals, public health professionals, emergency managers and related services.

The Healthcare Coalition consists of members who both provide expertise and receive the benefit of other’s experience to achieve their agencies’ goals. Membership in the coalition is defined as any

healthcare entity that actively contribute to strategic planning, operational planning and response, information sharing, and resource coordination and management.

The Healthcare Coalition is grant funded under Health and Human Services Assistant Secretary of Preparedness and Response Healthcare Preparedness and Response grant; the benefits of Healthcare

Coalition membership are currently free for all partners. To receive more information on coalition activities, please contact us at [email protected].

Regional Emergency and Disaster Healthcare Coalition

OUR MISSION

To prepare for, respond to and recover from crisis using all available resources to provide patient care at the appropriate level in the most efficient manner for the best

patient outcomes.

mailto:[email protected]


Annex Maintenance and Review

This annex has been developed in collaboration with REDi HCC partners, stakeholders, subject matter experts, and staff. REDi Healthcare Coalition core members will approve and maintain the Pediatric Medical Surge Annex through a quorum vote of the REDi HCC Core Member Advisory Group and an annual response plan review.

REDi HCC will update the annex annually and following exercises, planned events and real-world incidents. The review will include identifying gaps in the preparedness plan and working with REDI HCC members and external partners to define strategies to address the gaps. All members have opportunity to review, provide input and receive a copy of revised response plan.

The following entities represented on the HCC Core Member Advisory Group will be listed here when finalized.

Healthcare

Emergency Medical Services

Emergency Management

Public Health



Contributing Partners

Confluence Central Washington HospitalConfluence HealthHanford Fire DepartmentHoly FamilyKootenai HealthNorth Central District Health DepartmentPanhandle Health DistrictProvidence Sacred Heart Medical Center & Children’s HospitalProvidence St. Mary Medical CenterPullman Regional HospitalSpokane Regional Health DistrictSt. Joseph Regional Medical CenterTrios HealthVirginia Mason Memorial Hospital


Victoria Warthen, 12/20/19,

Still adding to this list


Record of ChangesVersion Number

Description of Change Date Entered

Posted By

1.0 Framework developed 09/06/19 Stephanie Crawford

2.0 Draft 1: Content added to most sections

09/17/19 Victoria Warthen

3.0 Draft 2: Incorporated SME feedback 11/8/19 Victoria Warthen

4.0 Draft 3: Incorporated 11/14/19 planning meeting and other partner

feedback


5.0 Draft 4: Incorporated 12/3/19 planning meeting and other partner

feedback




Table of ContentsAnnex

Approval and Review iii

Contributing Partners ……………………………………………………………………………………………………………............iv

Record of Changes................................................................................................................................v

Table of Contents...............................................................................................................................vii

1. Introduction...................................................................................................................................1

1.1. Purpose.....................................................................................................................................1

1.2. Scope.........................................................................................................................................1

1.3. Overview/Background...............................................................................................................1

1.4. Access and Functional Needs....................................................................................................2

1.5. Planning Assumptions...............................................................................................................2

2. Concept of Operations...................................................................................................................4

2.1. Activation....................................................................................Error! Bookmark not defined.

2.2. Communications........................................................................................................................5

2.3. Roles and Responsibilities.........................................................................................................5

2.4. Logistics.....................................................................................................................................9

2.5. Oeprations...............................................................................................................................11

2.6. Patient Distribution/Placement (DMCC)......................................Error! Bookmark not defined.

2.7. Patient Tracking...........................................................................Error! Bookmark not defined.

2.8. Patient Movement.......................................................................Error! Bookmark not defined.

2.9. Deactivation and Recovery..........................................................Error! Bookmark not defined.

2.10 Special Considerations.............................................................................................................13

3. Appendices..................................................................................................................................13

3.1. Pediatric Transfer Agreements ...............................................................................................13

3.2. Additional Resources/References............................................................................................13



1.Introduction1.1. Purpose

This Annex applies to a mass casualty incident or evacuation with a large number of pediatric patients. For the purposes of this Annex, pediatric patients are defined as individuals ages 21 and under per national standards. This Annex supports the REDi Healthcare Coalition (HCC) Response Plan by addressing the specific needs of children and supporting appropriate pediatric medical care during a disaster. This Annex is intended to support, not replace, any existing facility or agency policy or plan by providing uniform response actions in the case of an emergency that involves (or could involve) significant numbers of children.

1.2. ScopeThe Pediatric Medical Surge Annex to the Response Plan addresses issues of availability of space, personnel, medications, supplies and equipment specific to the pediatric patient population. It outlines the framework of critical response partners (hospitals, local health jurisdictions, emergency medical services, jurisdictional emergency managers, etc.) in the REDi HCC region to respond to a large influx, or impending large influx, of pediatric patients.

This annex is founded on a tiered system based on surge capacity and capability. Surge capacity is defined as the ability to expand care capabilities to meet sudden and/or more prolonged demand for patient triage and treatment. Therefore, patient age and acuity need to be considered when determining where children will be treated. Given the variability in pediatric care, all hospitals are requested to plan for an event resulting in a surge of pediatric patients. Although hospital capabilities and capacity vary, all hospitals could be asked to support the medical surge needs of a pediatric medical surge. This annex is based on caring for more critically ill children in facilities that are accustomed to caring for children and allowing them to decompress less critically ill children and adults to other facilities.

1.3. Overview/BackgroundIn the National Hospital Ambulatory Medical Care Survey, it was reported that in 2014 there were approximately 5,000 Emergency Departments (ED) in the United States. Of the more than 141 million ED visits in the United States in 2014, approximately 20% were for children younger than 15 years old. Children have unique anatomic, physiologic, developmental and medical needs that differ from those of adults. Furthermore, pediatric patients require size-specific equipment and caregivers trained to use that equipment. These characteristics also present the caregiver with significant challenges (Table 1).

Table 1: Unique Consequences in Children During Disasters1

Characteristic Cause ConsequencesLarger head for a given body weight

High center of gravity More likely to suffer head injuries and falls

Greater skin surface for body Evaporative heat and water losses

Hypothermia and dehydration

1 Branson, R. (2011). Disaster planning for pediatrics. Respiratory Care, 56(9), 1457-1465. DOI: 10.4187



Can some subject matter experts and pediatric specialists review this section?


National standards according to pediatric specialists


Do we need to specify?


Closer proximity of solid organs with less bony protection

Relative size with younger age Greater chance of multi-organ injuries

Wide range of normal vital signs Large differences in size, weight, and normal values

Difficult to determine normal values for a given individual, particularly for clinicians more accustomed to caring for adult patients

Rapid heart and respiratory rate Normal physiologic variables based on age and weight

Faster intake of airborne agents and dissemination to tissues

Wide range of weight across pediatric age range

Normal physiologic variables based on age and weight

Greater likelihood of medication errors

Shorter height Closer to the ground Greater exposure to chemical and biologic toxins that settle near the ground due to higher density

Often found in groups Daycare and school More likely to see multiple casualties

Immature cognitive and coping skills

Age and experience, psychological development

Less likely to flee from danger, inability to cope, inability to care for themselves, find sustenance, and avoid danger

Small blood vessels Relative size with younger age Difficult venous access, more difficult fluid and medication delivery

1.4.Access and Functional NeedsCaring for pediatric patients includes several unique needs such as:

Family/Guardians follow pediatric patients

Pediatric patients cannot be left alone

Consent must be granted before pediatric patients can be treated

There are special considerations for children with pre-existing conditions and learning disabilities

1.5. Planning AssumptionsThis annex has been designed with the following assumptions in mind and includes, but are not limited to the following:

• This annex will be activated in response to an event that has a disproportionate number of pediatric patients.

• If a hospital’s emergency operations plan (EOP) has been activated, it is assumed that the Hospital Incident Command System (HICS) will be used throughout the duration of the hospital’s emergency response.



Do we need to include all of these assumptions? Are any missing or can we leave out any?


Can some subject matter experts and pediatric specialists review this section?


• All hospitals providing emergency services are equipped to initially treat and stabilize pediatric patients in accordance with their available resources. All hospitals have differing capacities and capabilities of treating and stabilizing pediatric patients; however, all hospitals can at minimum provide initial triage and resuscitation for pediatric patients.

• Each pediatric trauma center has an updated medical surge plan to fully maximize and leverage their organizational resources prior to activating the REDi HCC Pediatric Medical Surge Annex.

• The pediatric surge response will use existing NIMS/HICS response frameworks. • Most critical access hospitals will not be able to treat critically injured pediatric patients’ long term

and will need to transport them to a higher trauma level hospital. • Planning and response under the Pediatric Medical Surge Annex will be coordinated with other

response plans because most disasters involving pediatric patients also include other patients. • Determination of whether a child meets pediatric age should follow both organizational definitions

and assessment of physical maturity and anatomical characteristics of victim.• After an incident, many loved ones will immediately call or self-report to the hospital where they

believe their children may have been taken. • Hospitals will plan for family reunification in collaboration with others. Hospital efforts and protocols

will be integrated with other critical partner organizations’ plans and systems within the community.• A specific Pediatric-Safe Area (PSA) will be established for the hospitals accepting these pediatric

patients for unaccompanied minors to ensure appropriate safety precautions before release to an appropriate custodial adult.

• Children’s behaviors may change after a disaster. Caregivers who care for children in the PSA can reduce long-term mental health impacts by understanding developmentally appropriate behaviors and identifying behaviors that need immediate interventions.

• Families will expect hospitals to provide identification of all patients affected by disaster, access to accurate and timely information and real-time updates, and assistance to reunify with their loved ones

• A Hospital Family Reunification Center is necessary to provide a safe place for families to convene until a regional Family Assistance Center or shelter is activated.

• Call centers or other means of handling the high volume of information may be necessary for effective coordination of information.

• Non-pediatric facilities can receive children from mass casualty events• In large incidents, or when access to the facility is an issue, hospitals may have to provide ongoing

care pending arrival of sufficient transportation or treatment resources• If the event involves more than one facility, regional coordination will be required with the health

care coalition (HCC)• Priority is to transfer the most critical and then youngest patients (<8 years old) as early as possible

to an appropriate referral center

2.Concept of Operations2.1. Activation

Indications/Triggers

When an incident occurs resulting in a surge of pediatric patients, the initial response should follow local emergency operations and medical surge plans. Local hospitals and EMS agencies should assess:



Can we provide more details regarding indicators/triggers here or is this sufficient?

Victoria Warthen, 10/17/19, RESOLVED

Minnesota DOH Pediatric Surge Plan Template: https://www.health.state.mn.us/communities/ep/surge/pediatric/pediatrictemplate.docx


MN DOH Pediatric Surge Plan: https://www.health.state.mn.us/communities/ep/surge/pediatric/pedsurgeplan.pdf


Scope and magnitude of the incident; Estimated influx of pediatric patients with a potential impact on the healthcare system; Specific response needs (e.g., infectious disease, hazardous materials, etc); and Internal response plan activation(s)

Activation

The REDi Pediatric Medical Surge Annex should be activated in response to any emergency that has a disproportionate number of pediatric patients relative to the capacity of the area hospitals’ space, staffing, and resources to care for those patients. Each hospital will determine which surge strategies to implement to meet the surge of pediatric patients based on their facility’s bed capacity and capabilities. The decision to activate may be made by the hospital’s Incident Commander, EMS Agency on scene, or DMCC activating patient placement protocols. Hospitals should activate HICS whenever they activate the surge annex. Facilities should designate one 24/7 person and a backup to activate the HICS and the pediatric disaster annex (e.g., administrator on duty, director of nursing, ED director, pediatric department chair, etc.).

Incidents that could prompt the activation of the Pediatric Medical Surge Annex include, but are not limited to:

1. Disaster expands and local resources are exhausted2. Overwhelming influx or surge of pediatric and neonatal patients 3. Inadequate pediatric health care facility resources (e.g., inpatient monitored beds, ventilators,

isolation beds) 4. Damage or threats to health care facility(ies) 5. Staffing limitations (e.g., qualified and trained staff to care for pediatric or neonatal patients)6. Activation of health care facility(ies) disaster plan when surge capacity for pediatric patients has

been exceeded 7. Requests from border states to assist with a surge of pediatric patients

Each hospital should use existing facility response plans to care for children during a surge. Hospitals that routinely care for children may be requested to increase their capacity to provide intensive care to less stable pediatric patients. This may require hospitals to surge capacity, provide secondary transfers or decompress to make room for incoming pediatric patients. More stable pediatric patients and adult patients may be sent, diverted or transferred to other facilities for care. Hospitals can request the help of the DMCC and Healthcare Coalition to support coordinated distribution of patients throughout the region. Please refer to the REDi HCC Patient Placement Annex for more information.

2.2. CommunicationsAlert/Notification

Activation of this Annex should include information sharing and coordination across the healthcare system.

As appropriate, the organization activating the PMSA or the DMCC should send out regional alerts via WATrac to all users in the pediatric surge role providing:



link


Is this detailed enough or do we need to be more specific?


This is included in the assumptions above. Do we need to state this here too?


Who else could activate this annex?


Situational awareness (e.g., incident details, estimation on number of patients, number of transported and/or admitted patients, number of possible patients at the scene, potential impact to the healthcare system);

Bed availability request to be completed in a specified time frame; and Action items (e.g., conference call, frequent bed availability updates, etc)

Please note, HCC staff can also send WATrac alerts or provide WATrac support. For ongoing communications during a disaster, the Healthcare Coalition will provide situational awareness with HCC partners as requested according to the REDi HCC Response Plan.

Messaging

Public information and messaging should be coordinated among all involved partners according to facility-specific plans. Designated Public Information Officers (PIOs) can work with hospital communications staff to draft and coordinate public messaging and information as needed to inform and educate the public about the incident and response efforts. Public information materials may include, but are not limited to news releases, talking points, public website updates, and social media posts. Information can be shared with response partners in a variety of methods, including a virtual Joint Information Center (JIC).

2.3. Roles and ResponsibilitiesThis annex calls for all hospitals with the capability and experience in caring for acute pediatric patients to expand capacity to accommodate a surge of pediatric patients. This may require shifting non-critical patients from these facilities so that the most critically ill children are cared for by hospitals most accustomed to caring for and treating critically ill children. The remainder of hospitals will be called upon to meet the remaining need. As the emergency unfolds, there may be a need for secondary transfers of patients to move more stable patients to alternate locations.

This section provides general guidance to support the distribution of pediatric patients throughout the region during a pediatric medical surge. These guidelines are intended to supplement, not replace, existing plans and processes. This should be used in conjunction with facility-specific plans and the REDi Patient Placement Annex to the Response Plan. Pediatric medical subject matter experts should also be consulted in the triage and distribution of pediatric patients. The Washington State Department of Health Pediatric Consultation and Transfer Guidelines document contains additional information regarding hospital pediatric trauma designation, contact information, and guidelines regarding pediatric transfer.

The tiered model below outlines the capabilities of partners who may be involved in a response to a pediatric medical surge. The tiered structure is based upon pediatric trauma designations and other capabilities of the listed facilities. Patients should be distributed to an appropriate level of care given the specific circumstances of the emergency. This tiered model can be used in addition to facility-specific plans, the Patient Placement Annex, and other transfer guidelines to determine which facilities to request care for pediatric patients of specific ages and triage levels (red, yellow, or green).

For the purposes of this Annex:



Word choice?


Trauma specialists specifically?


Can we delete this section or should we keep it?


Link to the Response Plan


MN DOH Pediatric Surge Plan

https://www.doh.wa.gov/portals/1/Documents/Pubs/530092.pdf



Red-triaged patients: critical/unstable; immediate life threat; presents clinically with altered mental status/respiratory distress/signs of shock/truncal penetrating injury

Yellow-triaged patients: moderately injured or ill/potentially unstable; potential life threat (within hours); presents as generally non-ambulatory with injury that may become life-threatening if left untreated

Green-triaged patients: minor or non-injured/stable; no immediate life threat; generally ambulatory with isolated injuries that should not be life or limb-threatening

All REDi hospital partners should

Follow normal organizational referral protocols and transport criteria with respect to pediatric patients;

Monitor for and acknowledge all alerts, notifications, and communications during an incident; Provide information as requested to local, regional, and state partners; Maintain appropriate users in WATrac to receive and monitor notifications; and Maintain frequent communications with HCC, other pediatric trauma centers, EMS, and others

as deemed appropriate.

Additional roles and responsibilities during a pediatric medical surge are displayed in the table below by tier. Facilities within the first tier have the greatest potential to care for a larger number of, younger aged, or more critically injured pediatric patients. Facilities that may not typically care for acute pediatric patients may be asked to care for older (over age eight), more stable patients.

Tier Partner Role/Responsibility During Pediatric Medical Surge

1 Designated Level 1 Pediatric Trauma Hospital: Providence Sacred Heart Medical Center &

Children’s Hospital (509-474-5690 [Peds ED])

Designated Level 2 Pediatric Trauma Hospitals: Mary Bridge Children’s Hospital ((253) 403-

1418 [Emergency Dept]) Harborview Medical Center (1-888-744-

4791 [transfer center])

Hospitals that currently care for pediatric intensive, acute, neonatal, and trauma patients

These facilities may be requested to treat the most critically injured children throughout the region

Provide treatment and care per trauma level designation for: any Neonate or Pediatric patient up to scope of license; priority age 0-8; patients triaged as Red (most acute injuries); burn patients, as appropriate

2 Designated Level 3 Pediatric Trauma Hospitals: St. Joseph Regional Medical Center in

Lewiston, ID ((208) 743-2511) Confluence Central Washington Hospital

((509) 662-1511) Trios Health Providence St. Mary Medical Center ((509)

525-3320)

Hospitals that have a Pediatric Outpatient Unit

These facilities may be requested to treat anyone aged 9 or older triaged as red and less acute Pediatric patients (yellows) any age

Provide initial treatment and stabilization of any patient transferred



Word choice?


Is this an accurate definition of the red, yellow, green triage levels as is used in the REDi region?


Yakima Valley Memorial Hospital ((509) 575-8000)

Additional hospitals with similar capabilities: Kadlec Regional Medical Center Deaconess Hospital Kootenai Health

to their facility

3 Pediatric Critical Care Unit (non-trauma) Seattle Children’s Hospital Seattle, WA

(206) 987-8899 [Com-Center] Swedish Medical Center Seattle, WA (206)

405-7500 (Pediatric Hospitalist on-call pgr) (866) 470-4233 (transfer center) (206) 386-6000 (Hospital operator)

Additional hospitals with similar capabilities:: Providence Holy Family Hospital MultiCare Valley Hospital Shriners VA Astria Regional Medical Center Samaritan Healthcare Confluence Health /Wenatchee Valley

Hospital

Hospitals that can provide inpatient acute care

These facilities may be requested to stabilize and provide care for any patient regardless of acuity based on incident needs (especially any Pediatric patients triaged as yellow ages 9 or older and greens any age)

Provide initial triage and stabilization of any patient transferred to their facility

4 All other hospitals and critical access hospitals: Newport Hospital & Health Services Providence Mount Carmel Hospital Providence St. Joseph’s Hospital (Chewelah) Pullman Regional Hospital Tri-State Memorial Hospital East Adams Rural Healthcare Ferry County Memorial Hospital Garfield County Memorial Hospital Lincoln Hospital Odessa Memorial Healthcare Center Othello Community Hospital Whitman Hospital & Medical Center St. Luke’s Rehabilitation Institute Lake Chelan Community Hospital Mid-Valley Hospital North Valley Hospital Three Rivers Hospital Coulee Medical Center Cascade Medical Center Columbia Basin Hospital Quincy Valley Medical Center Kittitas Valley Healthcare

Hospitals that do not provide inpatient pediatric services

These facilities may be requested to stabilize and provide care for any patient regardless of acuity based on incident needs (especially any Pediatric patients triaged as yellow or green ages 9 or older)

May be used for transfer once a patient is stable based on their capabilities



Hospital partners: Are these roles and responsibilities accurate? Are the partners listed for each tier accurate? Should we further separate these tiers? Make it 7 tiers?


Lourdes Medical Center Prosser Memorial Hospital Astria Sunnyside Hospital Astria Toppenish Hospital Dayton General Hospital

Additional Stakeholders

Non-hospital partners can support a response to a pediatric medical surge by maintaining appropriate users in WATrac to receive and monitor notifications and maintaining frequent communications with HCC, other pediatric trauma centers, EMS, and others as deemed appropriate. The following chart demonstrates some of the roles and responsibilities of these key stakeholders during a response.

Partner Role/Responsibility During Pediatric Medical Surge

Emergency Medical Services (EMS) Provide triage and basic medical support (as appropriate) for everyone on scene involved in the accident

Transport patients to area hospitals, distributing patients appropriately to minimize the risk of overwhelming individual medical facilities (patient placement and movement)

Aid in the collection of identification information (patient tracking)

Communicate with local hospitals and regional healthcare coalitions to share information/status

Regional Healthcare Coalition Activate the Redi HCC Pediatric Medical Surge Annex if requested

Provide situational awareness and support information sharing between Coalition partners

Coordinate resource requests between Coalition partners

Public Health Assist with family reunification, sheltering, feeding, health, and mental health support services

Coordinate with appropriate agencies and organizations for the temporary care and shelter of unaccompanied children

Coordinate with hospitals to develop centralized list of injured and missing individuals



Can we add Emergency Management or other partners?


2.4. LogisticsIn a disaster, the number of patients presenting for care may cause a “surge”. Surge is determined by the number of patients that a hospital can receive while maintaining usual standards of care. For each of the critical system components needed to respond to a medical surge incident, space, staff, and supplies, there are three measurements that provide guidance to overall surge capacity at each of the tiered levels. An incident does not have to overwhelm assets in all of the categories to have an impact on healthcare.

Conventional capacity is the ability for hospitals to manage a surge, while operating daily practices with little or no impact to the patients or facility. The spaces, staff and supplies (resources) used are consistent with daily practices within the institution.

Contingency capacity affects the ability for hospital daily practices to be consistent but has minimal impact to usual patient care. At this point, the demand for resources has not exceeded community resources. The spaces, staff and supplies (resources) used are not consistent with daily practices, but provide care that is functionally equivalent to usual patient care.

Crisis capacity may require adjustments in care not consistent with daily practices, but the standard of care is coherent within the setting of an emergency. The best possible care is provided to patients under these circumstances. Adaptive spaces, staff and supplies (resources) used are not consistent with usual standards of care, but provide sufficiency of care in the context of a catastrophic disaster (ie. Provide the best possible care to patients given the circumstances and resources available).

Table 1 below demonstrates how each stage of surge capacity could potentially be managed as the number of pediatric patients increase.

Table 1 Potential Medical Surge Response Strategies

Conventional Capacity Contingency Capacity Crisis CapacitySupplies Stockpiled

supplies used Medical Supply

Chain able to resupply on request

Hospital MOUs Regional

Equipment SupplyPharmaceutical caches

Region Caches (ACF trailers in Tri-Cities and supplies at Providence Sacred Heart)

Space Cancel elective procedures

Use in-place elective procedures

Begin surge discharge

Clear patients from pre-induction and procedure areas

Fill all available beds

Bed availability reporting (WATrac)

Decompress hospitals

Place patients in hallways or lobby areas as needed

Staffing Use all staff trained to care

Request pediatric trained staff from

National Disaster Medical System



Sacred Heart and BFHD: How much detail should we provide here? Contact information?

Ruby, Darrell G, 11/05/19, RESOLVED

Talk to the lady that came to last week’s meeting from central WA who sat between Casey and Hannah. She referenced that she had just written a paper on EMTALA standards and crisis standards of care. I suspect she will have some good input here.


for pediatrics to provide care

regional hospitals Medical Reserve

Corps

(NDMS) Utilize staff not

trained for pediatric care

SuppliesMost emergency departments have some pediatric supplies, but they are limited in supply and may have issues sustaining pediatric patients if they are unable to acquire more supplies or transfer the patients. Children 14 years of age and older (or of certain size) may be able to use adult medical supplies. This should be consulted with pediatric specialists as appropriate.

Follow internal processes first when requesting additional supplies. If local resources are exhausted, please refer to county then regional response plans.

SpaceSpaces conducive to pediatric care are identified and further categorized here:

Conventional spaces, are areas where care is normally provided Contingency spaces, are areas where care could be provided at a level functionally equivalent to

usual care Crisis spaces, are areas where sufficient care could be provided when usual resources are

overwhelmed

StaffSources of staff with potential pediatric subject matter expertise may include providers (physicians, nurses, physician assistants, nurse practitioners, and others) working in emergency medicine, pediatrics, family medicine, anesthesia, ENT, pediatric surgery, trauma surgery, general surgery, orthopedics, urology, neurosurgery, thoracic surgery, the OR, PACU, ICUs, inpatient units and outpatient clinics, pharmacy, or respiratory therapy.

Additionally, staff in other categories/areas may have experience with pediatric care that provides them with a level of comfort and expertise allowing them to assist in care during a disaster. They should be encouraged to keep current with pediatric topics and enroll in available courses and offered trainings to maintain their skills and confidence.

Just-in time training may need to be provided to train additional staff to care for pediatric patients. As needed, receiving hospitals should video call providers at hospitals that traditionally provide specialized care for pediatric patients.

2.5.[2.4.] Operations TriageIn the event of a pediatric surge incident, EMS will triage patients in the field according to their standard of care. In the field, triage decisions will be left up to EMS at the time of the incident. JumpSTART is the most widely accepted process identified for triage of pediatric patients. It is the responsibility of all



Subject matter experts: what should this look like?


Do we need to create a process for staff sharing or just in time training or can we simply reference the REDi HCC duty officer number to request help?Should we include contact information in this Annex for just in time training.


Link to the REDi HCC Response Plan


Do we need to describe the REDi process for resource sharing here? For example, how can a partner request regional resources? The region has resources at Sacred Heart and ACF trailers at BFHD.


hospitals to perform secondary triage to determine the best setting for a patient to receive definitive care.

TreatmentAt this time, partners should refer to facility specific plans and protocols for guidelines regarding pediatric patient treatment.

2.6.[2.5.] Patient Distribution / Placement (DMCC)In the event of an emergency that produces a volume of pediatric patients that is beyond the scope of a single receiving hospital, a regional Disaster Medical Coordination Center (DMCC) will be used to efficiently coordinate the distribution of all affected patients to appropriate points of care. The role of the DMCC will be to identify the appropriate clinical match for the patient to receive the most appropriate care that will ensure the safety and health of the patient. Please refer to the REDi HCC Patient Placement Annex for more details regarding the process of patient placement, standard operating guidelines, categories of care placement algorithm, DMCC contact information, and the patient placement matrix.

2.7.[2.6.] Patient Tracking Assure pediatric patients are tracked according to the REDi HCC Patient Tracking Annex to facilitate timely situational awareness and determine and document patient identity, location, and involvement in the incident. Attempt to keep families together when possible and provide transfer information to Family Assistance Center as soon as possible for the purposes of family reunification. Please refer to facility-specific plans regarding special pediatric tracking and information disclosure considerations.

2.8.[2.7.] Patient MovementHealthcare will work with EMS to coordinate appropriate transportation. Facilities will follow their own Emergency Operations Plans for coordination of other transportation and staging, other needs and issues. Please refer to the REDi HCC Patient Movement Annex for more details.

2.9. Deactivation and RecoveryDeactivation of regional patient tracking will be dependent on community needs. To deactivate,

Deactivate the centralized database for patient tracking

Notify partners that the pediatric medical surge response has been completed.

Refer to public health and emergency management for more information regarding recovery such as family reunification, mental and behavioral health following trauma follow-up

2.10. Special ConsiderationsBehavioral HealthIn addition to caring for children’s physical needs during a disaster, it is essential to provide age appropriate emotional support to foster psychological resilience post disaster. Disasters can result in long lasting psychological effects such as post-traumatic stress disorder in addition to the acute



How is this annex deactivated?


We do not currently have a Patient Movement Annex and may not have one before next year


Link to Patient Movement Annex


Link to the Patient Tracking Annex


Link to the Patient Placement Annex


psychological issues such as fear, anxiety, grief, anger and confusion. Early psychological support for children affected by disaster can facilitate their initial and subsequent care and potentially reduce longer-term mental health complications. Every effort should be made to keep families together, and when this is not possible, to re-unite them as quickly as possible.

DecontaminationChildren may be more susceptible to injury from hazardous materials due to:

Failure to recognize a hazardous material or situation Failure to recognize signs of exposure or formulate an escape plan High surface area relative to mass (allows more skin contact) Higher minute ventilation (allows more inhalation exposure) Lower height may result in more concentrated exposure to gases with higher vapor densities

Decontamination for children requires planning and training that should be incorporated into the facility decontamination plan, i.e. identifying extra staff required to escort or accompany pediatric patients during decontamination operations.

• Children should be kept with parents whenever possible. • Additional personnel may be needed to escort and assist children during decontamination

EvacuationThere may be challenges and limitations evacuating some populations of pediatric patients (i.e. NICU patients). For most intents and purposes, a pediatric evacuation will be treated similarly to a mass casualty incident.

Infectious DiseaseFacility-specific infectious disease plans should account for pediatric-specific issues. It is beyond the scope of this document to go into detail about infection control and epidemic management.

Pediatric Safe AreaPlease refer to facility-specific emergency operations plans regarding the set-up and use of pediatric safe areas for the purposes of patient safety and security.

3.Appendices3.1. Pediatric Transfer Agreements Hospitals that are designated trauma centers must have transfer guidelines in place as part of the designation process.

3.2. Additional Resources/ReferencesWashington DOH Pediatric Consultation and Transfer Guidelines

Pediatric Care Medical Technical Specialist JD



What other resources should be referenced here?


This section will include a list of hospitals that do have these agreements in place and with whom they have these agreements.


Hospital partners: should we include any more information in this section in this annex?

http://hicscenter.org/Shared%20Documents/JASs/MTS/Pediatric%20Care.pdf
