the program for pediatric preparedness national center for disaster preparedness model pediatric...

The Program for Pediatric Preparedness

National Center for Disaster Preparedness

Model Pediatric Component for State Disaster Plans

and Additional Resources

David Markenson, MDDavid Markenson, MDDirector, The Program for Pediatric Preparedness Director, The Program for Pediatric Preparedness

Deputy Director, National Center for Disaster PreparednessDeputy Director, National Center for Disaster PreparednessMailman School of Public Health, Columbia UniversityMailman School of Public Health, Columbia University



Model Pediatric Component for State Disaster Plans• Goal IGoal I – Build a coalition of experts from the fields of pediatrics, – Build a coalition of experts from the fields of pediatrics,

disaster planning, emergency medicine, emergency response, trauma, disaster planning, emergency medicine, emergency response, trauma, and mental health.and mental health.

• Goal IIGoal II – Utilizing the expertise of the coalition, build a consensus as – Utilizing the expertise of the coalition, build a consensus as to the appropriate methodology for the development of a model to the appropriate methodology for the development of a model assessment method of both state disaster plans and recent disaster assessment method of both state disaster plans and recent disaster incidents, inclusive of the specific needs of children in disaster incidents, inclusive of the specific needs of children in disaster planning, preparation and response. This should include specific planning, preparation and response. This should include specific attention to the needs of special populations, such as culturally diverse attention to the needs of special populations, such as culturally diverse groups, the homeless or transitional, children of substance abusers, groups, the homeless or transitional, children of substance abusers, and children with special health care needs.and children with special health care needs.

• Goal IIIGoal III – Use information gained via the assessment models, to – Use information gained via the assessment models, to develop a Model Pediatric Component (MPC) for use in state disaster develop a Model Pediatric Component (MPC) for use in state disaster planning. planning.



Model Pediatric Component

• Key PrinciplesKey Principles• Based on Federal Response PlanBased on Federal Response Plan• Structured using Structured using

• Emergency Support FunctionsEmergency Support Functions

• Existing and NewExisting and New

• AnnexesAnnexes



Model State Pediatric Disaster Plans

• ESF #1 - Transportation• ESF #2 -

Telecommunications and Information Technology

• ESF #3 - Public Works and Engineering

• ESF #4 - Firefighting• ESF #5 - Emergency

Management• ESF #6 - Mass Care,

Housing, and Human Services

• ESF #7 - Resource Support• ESF #8 - Public Health and

Medical Services

• ESF #9 - Urban Search and Rescue

• ESF #10 - Oil and Hazardous Materials2 Response

• ESF #11 - Agriculture and Natural Resources

• ESF #12 - Energy• ESF #13 - Public Safety and

Security• ESF #14 - Community

Recovery, Mitigation, and Economic Stabilization

• ESF #15 - Emergency Public Information and External Communications



Incident Annexes• Biological Incident Annex• Catastrophic Incident Annex• Cyber Incident Annex Food and

Agriculture Incident Annex• Nuclear/Radiological Incident Annex• Oil and Hazardous Materials Incident

Annex • Terrorism Law Enforcement and

Investigation Annex



Support Annexes• Financial Management• Insular Affairs• International Coordination• Logistics Management• Private Sector Coordination• Public Affairs• Science and Technology• Tribal Relations• Volunteer and Donations Management• Worker Safety and Health



Additional Pediatric Specific Plans

• EMSEMS• Mental Health Mental Health • SchoolsSchools

• Schools, Day Care, Summer Camps, etc…Schools, Day Care, Summer Camps, etc…• DMATDMAT

• NDMS, DMAT, MMRSNDMS, DMAT, MMRS• HospitalHospital



Model State Pediatric Disaster Plans• FormatFormat

• Two VersionsTwo Versions• Complete ESF or Annex with Pediatric Complete ESF or Annex with Pediatric

AdditionsAdditions• Pediatric Additions OnlyPediatric Additions Only

• Additional ResourcesAdditional Resources• Specific Guidelines and RecommendationsSpecific Guidelines and Recommendations• Template GuidesTemplate Guides• Detailed benchmarksDetailed benchmarks



Model State Pediatric Disaster Plans

• Based on revised federal response plan and Based on revised federal response plan and documentsdocuments• FRP Revised 6/30/04FRP Revised 6/30/04• New National Response PlanNew National Response Plan• New National Incident Management New National Incident Management

SystemSystem• Draft for review Winter/Spring 2005Draft for review Winter/Spring 2005• Final product available Summer 2005Final product available Summer 2005



Coordination with Federal Pediatric Efforts• National Advisory CommitteeNational Advisory Committee• Strategic National StockpileStrategic National Stockpile• Food & Drug AdministrationFood & Drug Administration• CDC/HRSA Cooperative AgreementsCDC/HRSA Cooperative Agreements

• Pediatric Advisory GroupPediatric Advisory Group



Objective A of the NACCT: The preparedness of the healthcare system to respond to terrorism as it relates to children.1.1. Federal Federal

ResponsibilitiesResponsibilities

2.2. Schools and Other Schools and Other Child Congregate Child Congregate Care SettingsCare Settings

3.3. Mental Health and Mental Health and Psychosocial SupportPsychosocial Support

4.4. Primary Care Primary Care Pediatric Providers Pediatric Providers

5.5. Pre-Hospital and Pre-Hospital and Hospital CareHospital Care

6.6. Community Community InvolvementInvolvement

7.7. TrainingTraining

8.8. Health Intelligence Health Intelligence

9.9. Risk Communication Risk Communication and Public Educationand Public Education



Objective B of the NACCT: Needed changes to the healthcare and emergency medical service systems and emergency medical services protocols to meet the special needs of children

10. Emergency Medical Service 10. Emergency Medical Service Systems and ProtocolsSystems and Protocols



Objective C of the NACCT: Changes, if necessary, to the National Strategic Stockpile under Section 121 of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 to meet the emergency health security of children

11. Strategic National Stockpile11. Strategic National Stockpile



Strategic National Stockpile

• Pediatric representationPediatric representation• Ciprofloxacin suspensionCiprofloxacin suspension• Doxycycline suspensionDoxycycline suspension• Pediatric airways, NG tubes, oxygen masksPediatric airways, NG tubes, oxygen masks• Pediatric Atropine auto-injectorsPediatric Atropine auto-injectors• Ventilators with Pediatric CapabilityVentilators with Pediatric Capability



HRSA Guidance

• Clear Focus on PediatricsClear Focus on Pediatrics• Majority of critical benchmarks specify Majority of critical benchmarks specify

inclusion of childreninclusion of children• Most quantifiable benchmarks include childrenMost quantifiable benchmarks include children



HRSA Guidance

• Critical Benchmark #2-2: Surge Capacity: Critical Benchmark #2-2: Surge Capacity: Isolation CapacityIsolation Capacity

In addition, the awardee must identify at least In addition, the awardee must identify at least one regional healthcare facility in each awardee one regional healthcare facility in each awardee hospital preparedness region as defined by the hospital preparedness region as defined by the awardee’s FY 2003 work plan that is able to awardee’s FY 2003 work plan that is able to support the initial evaluation and treatment of at support the initial evaluation and treatment of at least least 10 adult and pediatric patients10 adult and pediatric patients at a time in at a time in negative pressure isolation. negative pressure isolation.



FDA

• Expedited review and licensingExpedited review and licensing• Pediatric testing not requiredPediatric testing not required• If not tested for pediatric considered off If not tested for pediatric considered off

label usagelabel usage



Additional Resources to be Included



Pediatric Disaster and Terrorism PreparednessA National Consensus Conference

andThe Pediatric Expert Advisory Panel



Recommendations• PriorityPriority• Preparedness and Preparedness and

TreatmentsTreatments• BiologicBiologic• ChemicalChemical• RadiologicRadiologic• NPSNPS• DecontaminationDecontamination

• Natural DisastersNatural Disasters• Hospital PreparednessHospital Preparedness

• Mental Health SchoolsMental Health Schools• Primary Care ProvidersPrimary Care Providers• Displaced ChildrenDisplaced Children• National Disaster National Disaster

Medical SystemMedical System• TrainingTraining• Drills and SimulationsDrills and Simulations



Second Consensus Conference• PediatricsPediatrics

• Update of previous guidelinesUpdate of previous guidelines• Expanded focusExpanded focus

• Schools and congregate facilitiesSchools and congregate facilities• Community Healthcare AssetsCommunity Healthcare Assets• DecontaminationDecontamination

• NewNew• SurgeSurge• EvacuationEvacuation



Second Consensus Conference

• Persons with DisabilitiesPersons with Disabilities• Disability PerspectiveDisability Perspective• Emergency Preparedness Function Emergency Preparedness Function

PerspectivePerspective



Pediatric Expert Advisory Panel• The purpose of the The purpose of the Pediatric Expert Advisory Pediatric Expert Advisory

Panel (PEAP) Panel (PEAP) is to:is to: • Discuss and analyze current issuesDiscuss and analyze current issues

• Multi-disciplinaryMulti-disciplinary• Governmental and non-governmental bridgeGovernmental and non-governmental bridge• On-going program On-going program • Ability for rapid analysisAbility for rapid analysis• Dissemination of findingsDissemination of findings

• WebWeb• InfoBriefInfoBrief• Conference or SymposiaConference or Symposia



AtroPen InfobriefKey Points• AtroPen® is AtroPen® is onlyonly ½ of a Mark-I Kit ½ of a Mark-I Kit

• Does not include pralidoxime. Does not include pralidoxime. • Pralidoxime should be added for Pralidoxime should be added for

appropriate treatment of nerve agent appropriate treatment of nerve agent exposure.exposure.

• Complete treatment will require the Complete treatment will require the usage of anticonvulsantsusage of anticonvulsants



AtroPen InfobriefRecommendation

The Mark 1 Kit should remain as the The Mark 1 Kit should remain as the preferred emergency treatment for children of preferred emergency treatment for children of any age. any age. This recommendation includes using This recommendation includes using the Mark 1 Kit in children younger than 3 the Mark 1 Kit in children younger than 3 years old after bona fide nerve agent years old after bona fide nerve agent exposure.exposure.



Future InfoBriefs

• Pediatric DecontaminationPediatric Decontamination• Pediatric Surge CapacityPediatric Surge Capacity



NYC BOE 9/11 Report

• Evaluation of NYC BOE response to 9/11Evaluation of NYC BOE response to 9/11• Critical assessmentsCritical assessments• Lessons learnedLessons learned



Questions



David Markenson, MD

National Center for Disaster PreparednessNational Center for Disaster Preparedness

www.ncdp.columbia.eduwww.ncdp.columbia.edu

212-342-0408212-342-0408

[email protected]@columbia.edu

the program for pediatric preparedness national center for disaster preparedness model pediatric...

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model pediatric component

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