71 research outputs found
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Pediatric Preparedness for Disasters and Terrorism: A National Consensus Conference: Executive Summary
In a time of crisis, it is essential to ensure the needs of children are being met in planning and preparing for disasters and terrorist events. The current adult models and guidelines cannot be applied to the care of children. We convened experts from the multiple areas of expertise and disciplines involved in the planning for and care of children during times of disaster and terrorist events. The goals of this unprecedented meeting were to: 1) Build collaboration among individuals with expertise in pediatrics, pediatric emergency medicine, pediatric critical care, pediatric surgery, and emergency management, including disaster planning, management, and response; 2) Review and summarize the existing data on the needs of children in disasters, including planning, preparation, and response; 3) Develop consensus on the needs of children in disasters; 4) Create a research agenda to address knowledge gaps based on the limited data that exist on the needs of children in disasters
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Bioterrorism
Terrorism preparedness is a highly specific component of general emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, terrorism preparedness must consider several additional issues, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if not carefully monitored. It is well known that children may exhibit different effects of biologic agents.
Here are some examples:
• Smallpox: Lack of immunity in children, whereas some adults who were vaccinated as children may still possess some degree of immunity.
• Trichothecenes: The data show that children maybe more susceptible.
• Melioidosis : Children manifest unique parotitis.
• Anthrax: Recent and older data support the concept that children are less susceptible to the effects of anthrax
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Hospital Referral Patterns: How Emergency Medical Care is Accessed in a Disaster
BACKGROUND: A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning. METHODS: We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data. RESULTS: Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care. CONCLUSIONS:
Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major inciden
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Disaster and Terrorism Preparedness: What Pediatricians Need To Know
This chapter is designed to provide an overview of key issues for the pediatrician with respect to terrorism and disaster preparedness. It is not intended to be a complete compendium of didactic content, but it does represent an approach to understanding what needs to be learned by the pediatrician on this difficult topic and how pediatricians must lend their expertise and perspective to the urgent national need to enhance preparedness in every community
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Utilizing paramedics for in-patient critical care surge capacity
INTRODUCTION: While many hospitals have developed preliminary emergency department and in-patient surge plans, the ability to surge is often limited by critical resources. The resource which is often the most limited is usually the human resource and within this category the limiting factor is almost universally nursing. As a result, nursing shortages can result in an inability of a hospital or emergency department to create surge capacity to deal with large numbers of ill or injured patients. Utilizing paramedics in acute-care hospitals or at alternate care sites could serve as expansion staff to supplement existing nursing staff allowing fewer nurses to care for a larger numbers of patients during a disaster, act of terrorism, or public health emergency. While the procedures performed for nursing do vary from hospital to hospital, there are national certifications for both emergency nursing (CEN) and critical care nursing (CCRN) that can be used to establish a standard for comparison. METHODS: A detailed review and curriculum mapping of the specific educational objectives and competencies of the U.S. Department of Transportation National Standard Curriculum for the Emergency Medical Technician-Paramedic as well as the competencies and criteria for board certification as a Certified Emergency Nurse (CEN) and Critical Care Registered Nurse (CCRN) was performed. RESULTS: Approximately 90 percent of the CEN and CCRN knowledge skills and competencies are met or exceeded by the National Standard Paramedic Curriculum. CONCLUSIONS: With appropriate training and orientation, paramedics may be used in an in-patient setting to augment emergency and critical care nursing staff during a disaster, act of terrorism, or public health emergency
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Pediatric Terrorism Preparedness National Guidelines and Recommendations: Findings of an Evidenced-based Consensus Process
A cadre of experts and stakeholders from government agencies, professional organizations, emergency medicine and response, pediatrics, mental health, and disaster preparedness were gathered to review and summarize the existing data on the needs of children in the planning, preparation, and response to disasters or terrorism. This review was followed by development of evidence-based consensus guidelines and recommendations on the needs of children in disasters, including chemical, biological, and radiological terrorism. An evidence-based consensus process was used in conjunction with a modified Delphi approach for selection of topic areas and discussion points. These recommendations and guidelines represent the first national evidence-based standards for pediatric disaster and terrorism preparedness
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The Willingness of U.S. Emergency Medical Technicians to Respond to Terrorist Incidents
A nationally representative sample of basic and paramedic emergency medical service providers in the United States was surveyed to assess their willingness to respond to terrorist incidents. EMTs were appreciably (9-13%) less willing than able to respond to such potential terrorist-related incidents as smallpox outbreaks, chemical attacks, or radioactive dirty bombs (p < 0.0001). EMTs who had received terrorism-related continuing medical education within the previous 2 years were twice as likely (OR = 1.9, 95% CI 1.9, 2.0) to be willing to respond to a potential smallpox dissemination incident as those who indicated that they had not received such training. Timely and appropriate training, attention to interpersonal concerns, and instilling a sense of duty may increase first medical provider response rates
Public Health Department Training of Emergency Medical Technicians for Bioterrorism and Public Health Emergencies: Results of a National Assessment
Hypothesis: The public health system has a specialized body of knowledge and expertise in bioterrorism and public health emergency management that can assist in the development and delivery of continuing medical education programs to meet the needs of emergency medical service providers. Methods: A nationally representative sample of the basic and paramedic
emergency medical service providers in the United States was surveyed to assess whether they had received training in weapons of mass destruction, bioterrorism, chemical terrorism, radiological terrorism, and/or public health emergencies, and how the training was provided. Results: Local health
departments provided little in the way of training in biologic, chemical, or radiological terrorism to responders (7.4%- 14.9%). State health departments provided even less training (6.3%- 17.3%) on all topics to emergency medical services providers. Training that was provided by the health department
in bioterrorism and public health emergency response was associated with responder comfort in responding to a bioterrorism event (OR = 2.74, 95% CI = 2.68, 2.81). Conclusions: Local and state public health agencies should
work with the emergency medical services systems to develop and deliver training with an all-hazards approac
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Preparing for disasters: What should you know, and when should you know it?
Three waves of terrorism have ushered in a new era in public health, safety, and health care in the United States: The February 26, 1993 explosions at New York's World Trade Center, the April 19, 1995 bombing at the Murrah Federal Building in Oklahoma City, and the September 11, 2001 attacks, along with the anthrax cases that followed. Those events have awakened federal, state, and local governments to the urgency of improving their disaster-response capabilities. The health professions have also stepped forward to delineate the roles of their members in disasters, establish minimum competencies, and develop new training programs. Physician assistants have a strong tradition of responding to crisis. In all likelihood, PAs will be among the first responders to any disaster in the United States. It is incumbent on the profession and on individual PAs to understand what their roles would be in a disaster and to prepare accordingly
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