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Pediatric/Children
Topic Collection
November 11, 2024

Topic Collection: Pediatric/Children

Children under the age of 18 represent close to a quarter of the total U.S. population and are particularly vulnerable during a disaster. Their unique physical and behavioral needs and characteristics make it important to identify and incorporate special considerations for this population in preparedness, response, recovery, and mitigation. The resources in this Topic Collection can help healthcare facilities, healthcare coalitions, and other health and medical providers consider the specialized care and resources needed for children prior to, during, and after an incident.

NOTE: This Topic Collection contains resources relevant to general pediatric disaster planning. ASPR TRACIE has developed several additional Topic Collections with pediatric sub-categories; they are listed below (click on the link to be taken directly to the pediatric category of that Topic Collection, as relevant).

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

Must Reads

Abraham, H. (2014). Planning for Pediatrics in Disasters. Journal of Emergency Medical Services. 39(9).

The author encourages emergency medical planners to account for children's' unique physical, psychological, and communication needs when drafting pre-hospital emergency response plans. She also shares pediatric-specific care tips for decontamination, triage, airway procedures, drug dosage and delivery, and psychological care with an emphasis on emergency medical services.

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American Academy of Pediatrics, Altman, R.L., Santucci, K.A., Anderson, M.R., and McDonnell, W.M. (2019). Understanding Liability Risks and Protections for Pediatric Providers During Disasters.

This Policy Statement was created “to educate and raise awareness for providers and policy makers about the current state of liability risk and protection for health care providers who are caring for children during disasters.” Recommendations are included for pediatricians, the US Department of Health and Human Services, healthcare entities, and medical liability insurers. https://pediatrics.aappublications.org/content/early/2019/02/21/peds.2018-3892

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American Academy of Pediatrics, in collaboration with Massachusetts General Hospital, Center for Disaster Medicine. (2018). Family Reunification Following Disasters: A Planning Tool for Health Care Facilities.

This planning tool was created to assist hospitals with their plans to provide information, support services, and safe reunification assistance to family members of patients who have experienced disasters. It provides potential solutions to reunification-related challenges, including: planning for the secure reception, tracking, and care of large numbers of children who may present to a hospital following a mass-casualty event; identifying injured and unaccompanied children in a disaster; tracking unaccompanied children during their hospital stay; and what legal authority a hospital has to administer care to minors when the parent/guardian is unavailable to participate in the informed consent process.

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American Academy of Pediatrics, Needle, S. and Wright, J. (2015). Ensuring the Health of Children in Disasters. 136(5):e1407- e1417.

This policy statement addresses how pediatricians and others involved in the care and well-being of children can prepare for and mitigate the effects of disasters, encourage preparedness and resiliency among children and families and within communities, and ensure that children’s needs, including those of children and youth with special healthcare needs, are not neglected in planning, response, and recovery efforts. It also contains a list of family disaster resources and provider education resources.

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American Academy of Pediatrics, Remick, K., Gausche-Hill, M., Joseph, M.M., at al. (2018). Pediatric Readiness in the Emergency Department. Pediatrics. 142(5).

This comprehensive Policy Statement defines the recommended resources Emergency Departments need to be prepared to treat pediatric patients including policies, leadership, staff training, and equipment. Though aimed at daily emergency care it is a very valuable resource for overall pediatric emergency care planning.

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Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois Emergency Medical Services for Children. (2018). Pediatric Disaster Preparedness Guidelines for Hospitals (Third Edition).

These comprehensive guidelines (now in their 3rd edition) were developed as a resource to assist hospitals and healthcare entities address the needs of children in disaster planning. This document outlines the specific needs of children during and after a disaster event and lists strategies and logistical requirements for addressing those needs across a wide variety of topic areas.

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ASPR TRACIE. (2018). Pediatric Issues in Disasters: Webinar.

In this ASPR TRACIE webinar, pediatric professionals at the federal, state, regional, and local levels share tangible examples and best practices of how to integrate pediatric issues in healthcare preparedness plans, trainings, and exercises. The lessons learned and examples provided during this webinar can be applied by facilities and jurisdictions across the country.

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ASPR TRACIE. (2020). Developing a Healthcare Coalition Pediatric Surge Annex (Webinar).

This ASPR TRACIE webinar features speakers sharing guidance, resources, and lessons learned to help healthcare coalitions develop a pediatric surge annex.

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ASPR TRACIE. (2023). Lessons Learned from the Pediatric Tripledemic-Systems, Staff, Space, and Supplies (ASPR TRACIE Roundtable).

ASPR TRACIE and ASPR’s Pediatric Disaster Care Centers of Excellence hosted this roundtable where panelists shared lessons learned from the 2022-2023 pediatric surge due to influenza, COVID-19, and respiratory syncytial virus. Participants discussed successes and challenges in information sharing, the use of specialty resources in response (e.g., Medical Operations Coordination Centers), augmenting staff, and coordination with supply chain and coalition partners

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Barfield, W. and Krug, S. (2017). Disaster Preparedness in Neonatal Intensive Care Units. Pediatrics. 139(5):e20170507.

The authors discuss lessons learned from recent disasters that have affected neonatal intensive care units (NICU) and then share how mass critical care concepts (e.g., drills, training, and personnel) can be applied to the NICU. They also highlight characteristics of the NICU population, and cover ethical issues related to surge capacity, evacuation, triage, and transport.

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Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene (NYC DOHMH) Pediatric Disaster Advisory Group, and NYC DOHMH Healthcare Emergency Preparedness Program. (2008). Children in Disasters: Hospital Guidelines for Pediatric Preparedness.

This document highlights the efforts of the New York City Centers for Bioterrorism Preparedness Planning to assist the Department of Health and Mental Hygiene in preparing local hospitals to serve the needs of pediatric patients. The authors noted "hospitals of concern" (those which had limited pediatric services) and focused the report on 13 areas related to disaster preparedness (e.g., decontamination of children, family information and support, staffing, and security).

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Chung, S., and Shannon, M. (2005). Hospital Planning for Acts of Terrorism and Other Public Health Emergencies Involving Children. Archives of Disease in Childhood. 90(12):1300-7.

The authors discuss the four major forms of mass casualty terrorism (biological, chemical, nuclear, and thermomechanical) including clinical signs and symptoms for each, the impact on healthcare personnel, and special considerations for children. They also outline key principles of hospital preparation with regard to pediatrics.

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Chung, S., Foltin, G., Schonfeld, D.J., et al. (2019). Pediatric Disaster Preparedness and Response Topical Collection. American Academy of Pediatrics.

This collection is based on an all-hazards approach and is designed for use by pediatricians and other healthcare providers who would care for children in a disaster. First responders; shelter, school, and child care personnel; volunteers; emergency planners; and policy makers can use the information to better understand and meet the specific needs of children during disasters.

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Emergency Medical Services for Children National Resource Center. (2022). Checklist of Essential Pediatric Domains and Considerations for Every Hospital's Disaster Preparedness Policies.

This checklist, developed by subject matter experts and organized into eleven domains, can help hospital administrators and leadership incorporate essential pediatric considerations into existing hospital disaster policies.

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EMSC Innovation and Improvement Center. (2020). National Pediatric Readiness Project Toolkit.

This toolkit provides resources for pediatric emergency care providers to better understand and achieve the components of pediatric readiness in their emergency department. The toolkit also provides support and recommendations for other stakeholders involved in pediatric emergency care such as hospital directors, quality improvement leaders, family advisory network personnel, caregivers, and patients.

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Frost, P., Upperman, J., Lubin, B., et al. (2010). Pediatric Surge Planning: Solutions Within Reach. Contra Costa County Health Services.

This document contains presentations from a September 2010 workshop about pediatric surge planning. The importance of community hospitals in planning for and managing pediatric surge is emphasized, as are some limitations of the current system based on data from the State of California.

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Gubbins, N. and Kaziny, B. (2018). The Importance of Family Reunification in Pediatric Disaster Planning. Clinical Pediatric Emergency Medicine. 19 (3): 252-259.

This article briefly reviews the status of pediatric disaster planning; resources to support pediatric disaster planning; and essential components of a family reunification plan, with a focus on children’s needs.

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Illinois Department of Public Health. (2020). Pediatric and Neonatal Surge Annex.

This plan provides a detailed framework for various stakeholders involved in an emergency response within the State of Illinois and surrounding states in order to protect children and provide appropriate pediatric medical care during a disaster. The plan can be used to guide a state-level response and provides local medical services guidance on the care of children, including patient movement, system decompression, recommendations for care, and resource allocation during a surge of pediatric patients. It includes several tools such as transfer forms and algorithms.

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Loma Linda University Children's Hospital. (2013). Pediatric/Neonatal Disaster Reference Guide: Bridging the Gap Between EMS and Hospital Care.

This guide was created to help emergency managers, coordinators, and hospital staff in their efforts to develop their own specific departmental emergency operations plans that addresses the special needs of children and infants.

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Minnesota Department of Health. (n.d.). Pediatric Surge. (Accessed 9/25/2024.)

This webpage includes links to Minnesota's Pediatric Surge Plan, toolkit, assessment tools, educational tools (e.g., videos for healthcare workers), and exercise tools and templates.

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New York City Pediatric Disaster Coalition. (n.d.). Pediatric Disaster Coalition PICU Surge Template Plan. (Accessed 9/25/2024.)

This customizable plan template focuses on increasing surge capacity and capabilities for the PICU, the pediatric inpatient unit, other inpatient units, and the emergency department.

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Peacock, G., Anderson, M., Chernak, E., et al. (2015). Addressing Preparedness Challenges for Children in Public Health Emergencies. Centers for Disease Control and Prevention.

Presenters discuss strategies to address the unique vulnerabilities of children in every stage of emergency planning. They also discuss the need for enhanced collaboration between public health professionals and pediatric care providers to improve the outcomes for children during emergencies.

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Region V for Kids, the Western Regional Alliance for Pediatric Emergency Medicine, and Gulf-7-Pediatric Disaster Network. (2024). Joint PDCOE Pediatric Surge Report. Administration for Strategic Preparedness and Response.

This report illustrates how Pediatric Disaster Centers of Excellence (PDCOEs) have developed resources and capabilities to respond to medical surge events. It specifically highlights how PDCOEs functioned before and during the pediatric “tripledemic" experienced between October 2022 and January 2023.

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Wizemann, T., Reeve, M., and Altevogt, B. (2014). Preparedness, Response, and Recovery Considerations for Children and Families: Workshop Summary. Institute of Medicine of the National Academies Press.

In June 2013, the Institute of Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events convened a workshop to review tools and frameworks that can be modified to include children’s needs, and highlight best practices in resilience and recovery strategies for children. This report summarizes the presentations and discussions to include: leveraging healthcare coalitions; provider, hospital, insurer, and health system perspectives on funding; and mental and behavioral health recovery.

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WRAP-EM. (2021). Western Regional Alliance for Pediatric Emergency Management (WRAP-EM).

This regional alliance brings together organizations and pediatric disaster subject matter experts from Washington, Oregon, California, Nevada and Arizona, representing 13 million children from across the five states. WRAP-EM includes representatives from 17 medical centers, 10 universities, 2 NETEC biocontainment centers, poison control centers, state and local emergency management agencies and private health care delivery systems. Their work covers a multitude of response scenarios with a single mission: to impact the capacity and capabilities on the West Coast to respond to pediatric patients in a disaster.

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CBRNE and Terrorism

American Academy of Pediatrics. (2019). Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg. (Note that a paid subscription is required to access this resource.)

This Red Book® chapter is a summary of the epidemiology and clinical manifestations of Ebola and Marburg disease, and includes data from the 2014-2015 Ebola outbreak.

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American Academy of Pediatrics, Paulson, J.A. (2018). Pediatric Considerations Before, During, and After Radiological or Nuclear Emergencies. Pediatric Considerations Before, During, and After Radiological or Nuclear Emergencies. 142(6).

This Policy Statement provides updated recommendations for providers and governments to improve future responses to radiological or nuclear emergencies. It summarizes “newer scientific knowledge from studies of the Chernobyl and Fukushima Daiichi nuclear power plant events, use of improvised radiologic dispersal devices, exposures from inappropriate disposal of radiotherapy equipment, and potential health effects from residential proximity to nuclear plants.” Access the Technical Report here: https://pediatrics.aappublications.org/content/142/6/e20183001

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Bartenfeld, M., Peacock, G., and Griese. S. (2014). Public Health Emergency Planning for Children in Chemical, Biological, Radiological and Nuclear (CBRN) Disasters. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 12(4).

This article discusses the distinct physical, developmental, and social traits and characteristics of children in the context of the science behind exposure to, health effects from, and treatment for the threat agents potentially present in CBRN incidents.

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Chung, S., and Shannon, M. (2005). Hospital Planning for Acts of Terrorism and Other Public Health Emergencies Involving Children. Archives of Disease in Childhood. 90(12):1300-7.

The authors discuss the four major forms of mass casualty terrorism (biological, chemical, nuclear, and thermomechanical) including clinical signs and symptoms for each, the impact on healthcare personnel, and special considerations for children. They also outline key principles of hospital preparation with regard to pediatrics.

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* Chung, S., Baum, C.R., and Nyquist, A.C. (2020). Chemical-Biological Terrorism and Its Impact on Children. American Academy of Pediatrics. 145(1).

This policy statement addresses the steps that clinicians and policy makers can take to protect children and mitigate the effects of a chemical or biological attack. To access the technical report, copy and paste this link into a new browser: https://pediatrics.aappublications.org/content/early/2020/01/23/peds.2019-3750

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Chung, S., Foltin, G., Schonfeld, D.J., et al. (2019). Pediatric Disaster Preparedness and Response Topical Collection. American Academy of Pediatrics.

This collection is based on an all-hazards approach and is designed for use by pediatricians and other healthcare providers who would care for children in a disaster. First responders; shelter, school, and child care personnel; volunteers; emergency planners; and policy makers can use the information to better understand and meet the specific needs of children during disasters.

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Chung, S., Gardner, A.H., Schonfeld, D.J., et al. (2018). Addressing Children's Needs in Disasters: A Regional Pediatric Tabletop Exercise. Disaster Medicine and Public Health Preparedness. 12(5): 582-586.

This article discusses a tabletop exercise focused on a multi-state smallpox outbreak, and its impact on participants’ “understanding of and con?dence in their roles during pediatric public health emergencies.” Exercise participants identified over 100 communication and collaboration strategies to support pediatric preparedness, and their knowledge and confidence level for responding to a pediatric public health emergency increased as a result of their participation in the exercise.

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Gardner, A.H., Dziuban, E.J., Griese, S., et al. (2018). Medical Countermeasures for Children in Radiation and Nuclear Disasters: Current Capabilities and Key Gaps. (Abstract only.) Disaster Medicine and Public Health Preparedness.

The authors conducted a literature review and gap analysis related to pediatric medical countermeasures. They identified 15 gaps in information needed to support the safe and successful use of MCMs in children during radiation emergencies, and prioritized them based upon the potential to decrease morbidity and mortality, improve clinical management, strengthen caregiver education, and increase the relevant evidence base.

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Hamele, M., Poss, W.B., and Sweney, J. (2014). Disaster Preparedness, Pediatric Considerations in Primary Blast Injury, Chemical, and Biological Terrorism. World Journal of Critical Care Medicine. 3(1):15-23.

The authors review the presentation, pathophysiology, and treatment of pediatric victims of blast injury, chemical weapons, and biological weapons, with a focus on those injuries not commonly encountered in critical care practice.

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Henretig, F., Kirk, M., and McKay, C. (2019). Hazardous Chemical Emergencies and Poisonings. (Free registration required.) New England Journal of Medicine. 380: 1638-1655.

This contemporary review article on management of chemical casualties in a hospital environment includes adult and pediatric considerations. The authors provide an overview of decontamination, toxidromes, patient presentation, and current clinical management strategies for both patient populations.

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* Starke, E. and Cheung, E. (2023). How to Perform Patient Decontamination: A Picture Guide. Children's Hospital Los Angeles.

Health care providers and emergency responders can use this picture book (with information provided in five languages) to ease fear and explain each step of the pediatric decontamination process.

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U.S. Government Accountability Office. (2013). Efforts to Address the Medical Needs of Children in a Chemical, Biological, Radiological, or Nuclear Incident.

The U.S. Government Accountability Office was asked about efforts to address the needs of children in the event of a CBRN incident. This report examines: the percentage of CBRN medical countermeasures in the Strategic National Stockpile that are approved for pediatric use; how the U.S. Department of Health and Human Services (HHS) is addressing the challenges associated with developing and acquiring CBRN medical countermeasures for the pediatric population; and the ways HHS and state and local governments have addressed the dispensing of pediatric medical countermeasures in emergency response plans and guidance.

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Education and Training

American Academy of Pediatrics. (n.d.). Resilience Curriculum: Resilience in the Face of Grief and Loss. (Accessed 9/25/2024.)

This curriculum can help pediatric healthcare workers boost resilience. It highlights the perspectives of both children and their parents in emotionally challenging situations and teaches communication strategies that are both balanced and nurturing.

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ASPR TRACIE. (2018). Pediatric Issues in Disasters: Webinar.

In this ASPR TRACIE webinar, pediatric professionals at the federal, state, regional, and local levels share tangible examples and best practices of how to integrate pediatric issues in healthcare preparedness plans, trainings, and exercises. The lessons learned and examples provided during this webinar can be applied by facilities and jurisdictions across the country.

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ASPR TRACIE. (2020). Developing a Healthcare Coalition Pediatric Surge Annex (Webinar).

This ASPR TRACIE webinar features speakers sharing guidance, resources, and lessons learned to help healthcare coalitions develop a pediatric surge annex.

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Bank, I. and Khalil, E. (2016). Are Pediatric Emergency Physicians More Knowledgeable and Confident to Respond to a Pediatric Disaster After an Experiential Learning Experience? (Abstract only; free registration required to request full article.) Prehospital and Disaster Medicine. 31(5):551-556.

Pediatric emergency medicine physicians, and critical care and pediatric surgery residents, participated in a simulation-based workshop to increase their knowledge and confidence to respond to a disaster involving children. Program evaluations indicated an increase in physicians’ perceived preparedness for pediatric disaster response; this confidence persisted 6 months post-training.

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Coyote Crisis Collaborative. (2022). National Pediatric Disaster Conference Materials (2022).

This webpage includes links to presentations given at the 2022 National Pediatric Disaster Conference and a report that summarizes the conference. Topics include patient tracking, evacuation and transport, and pediatric disaster mental health.

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Fargason, C., Johnston, C., and Wingate, M.S. (2014). Needs of Our Children: Pediatric Care Before, During and After Disasters. (Requires free registration.) South Central Preparedness and Emergency Response Learning Center.

This training provides information related to children's needs during emergency or disaster events from both a clinical care and a public health planning perspective. A brief overview of the needs of the pediatric population and the delivery system that specifically serves children, and experiences from recent disasters where resources for children were limited are discussed.

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Federal Emergency Management Agency. (2015). IS-366: Planning for the Needs of Children in Disasters.

This 4-hour course provides guidance for emergency managers and implementers of children’s programs to meet the unique needs that arise among children as a result of a disaster or emergency. At the conclusion of this course, students will be able to create, update, or revise an emergency operations plan for their community or organization to effectively address the unique needs of children in disasters. Printable versions of each lesson are available.

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Flint, L. (2018). The Role of Pediatrics in Disaster Preparedness. New Jersey Chapter of the American Academy of Pediatrics.

This presentation discusses preparedness for pediatric providers in the office setting, as well as in the hospital setting. It includes considerations related to communications; vaccine security and viability; medical supplies and equipment; mental and behavioral health; evacuation; and personal preparedness for healthcare providers.

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Krug, S. (2012). Disaster Preparedness: Are We Ready for Kids? (Requires Real Player or Windows Media Player to view.) Alabama Department of Public Health.

The speakers in this 90-minute webinar discuss how improved readiness can be achieved through collaboration between public health, emergency management leadership, and key pediatric care experts and stakeholders in the private sector. The target audience includes pediatricians, nurses, social workers, emergency medical response providers, healthcare providers, and disaster management personnel.

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* Minnesota Department of Health. (n.d.). Pediatric Surge. (Accessed 9/25/2024.)

This webpage includes links to Minnesota's Pediatric Surge Plan, toolkit, assessment tools, educational tools (e.g., videos for healthcare workers), and exercise tools and templates.

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Peacock, G., Anderson, M., Chernak, E., et al. (2015). Addressing Preparedness Challenges for Children in Public Health Emergencies. Centers for Disease Control and Prevention.

Presenters discuss strategies to address the unique vulnerabilities of children in every stage of emergency planning. They also discuss the need for enhanced collaboration between public health professionals and pediatric care providers to improve the outcomes for children during emergencies.

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Peek, L. (2018). PrepTalks: Children and Disasters - Reducing Vulnerability and Building Capacity. Federal Emergency Management Agency.

In this 21-minute video, five specific ideas emergency managers may use to reduce the vulnerability of children to disasters are discussed.

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* Rucks, A., Baldwin, S., Beeman, K., et al. (2010). Multi-State, Multi-Organizational Solution to Limited Regional Pediatric Medical Surge Capacity in the Southeastern United States. Alabama Department of Public Health.

The speakers in this 90-minute webcast share strategies for addressing obstacles associated with pediatric surge.

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Schonfeld, D., Melzer-Lange, M., Hashikawa, A., et al. (2020). Participation of Children and Adolescents in Live Crisis Drills and Exercises. Pediatrics. 146(3), e2020015503.

This American Academy of Pediatrics policy statement clarifies that children and adolescents should only be include in exercises/drills when their involvement is not harmful to them and improves their readiness/confidence in real life events. The article advises against deception in drills and “high-intensity active shooter drills” (explained in the article). The policy also offers some considerations regarding the practice of active shooter drills in schools and child care programs, provides recommendations for adapting drills to accommodate children’s unique vulnerabilities.

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Texas A&M Engineering Extension Service. (n.d.). Pediatric Disaster Response and Emergency Preparedness. (Free in-person training given around the U.S.; classes in a particular location can be requested. Accessed 9/25/2024.)

This in-person training course prepares students to plan for and respond to a disaster involving children, and address the specific needs of pediatric patients. Pediatric-specific planning considerations include mass sheltering, triage, reunification planning, and decontamination. This is a management resource course geared towards pediatric physicians, emergency managers, emergency planners, and first responders.

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University of Colorado, School of Public Health, Center for Global Health. (2014). Pediatrics in Disasters Course. (Requires free registration.)

This 10-module online course provides the core principles for pediatric disaster planning and response. Modules include: pediatric trauma; management of prevalent infections in children following a disaster; diarrhea and dehydration; delivery and immediate neonatal care; nutrition and malnutrition; and the emotional impact of disasters in children and their families.

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* WRAP-EM. (2022). Radiation Surge Annex Pediatric Workshop Modules.

WRAP-EM hosted this workshop to provide pediatric-specific information for healthcare coalitions to include in their radiation surge annexes. Information is provided in three modules: Pediatric Considerations after a Dirty Bomb, Medical Countermeasures, and Additional Resources

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Guidelines and Protocols

Abraham, H. (2014). Planning for Pediatrics in Disasters. Journal of Emergency Medical Services. 39(9).

The author encourages emergency medical planners to account for children's' unique physical, psychological, and communication needs when drafting pre-hospital emergency response plans. She also shares pediatric-specific care tips for decontamination, triage, airway procedures, drug dosage and delivery, and psychological care with an emphasis on emergency medical services.

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American Academy of Pediatrics. (2021). Newborn Screening in Emergencies.

This web page is targeted to office-based pediatricians and includes links to contingency planning resources and related protocols to ensure that newborn screening and reporting of results to families continues to be performed during emergencies or disasters.

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American Academy of Pediatrics, Ahdoot. S., and Pacheco, S.E. (2015). Global Climate Change and Children’s Health. Pediatrics. 136(5): e1407-e1417.

This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children’s health.

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American Academy of Pediatrics, Altman, R.L., Santucci, K.A., Anderson, M.R., and McDonnell, W.M. (2019). Understanding Liability Risks and Protections for Pediatric Providers During Disasters.

This Policy Statement was created “to educate and raise awareness for providers and policy makers about the current state of liability risk and protection for health care providers who are caring for children during disasters.” Recommendations are included for pediatricians, the US Department of Health and Human Services, healthcare entities, and medical liability insurers. https://pediatrics.aappublications.org/content/early/2019/02/21/peds.2018-3892

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American Academy of Pediatrics, Faherty, L.J., Rasmussen, S.A., and Lurie, N. (2016). Planning for Research on Children During Public Health Emergencies. Pediatrics. 137(2).

This resource “discusses the importance of including children in public health emergency research and proposes components of a robust infrastructure that need to be in place to facilitate this research.” Barriers to including children, the risks and benefits of doing so, and infrastructure needs to facilitate research are discussed.

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American Academy of Pediatrics, Frush, K. (2007). Preparation for Emergencies in the Offices of Pediatricians and Pediatric Primary Care Providers. Pediatrics. 120(1).

This resource addresses how pediatricians and pediatric primary care providers can prepare for emergencies when they become the entry point into the EMS system for a child.

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American Academy of Pediatrics, Needle, S. and Wright, J. (2015). Ensuring the Health of Children in Disasters. 136(5):e1407- e1417.

This policy statement addresses how pediatricians and others involved in the care and well-being of children can prepare for and mitigate the effects of disasters, encourage preparedness and resiliency among children and families and within communities, and ensure that children’s needs, including those of children and youth with special healthcare needs, are not neglected in planning, response, and recovery efforts. It also contains a list of family disaster resources and provider education resources.

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* American Academy of Pediatrics, Remick, K., Gausche-Hill, M., Joseph, M.M., at al. (2018). Pediatric Readiness in the Emergency Department. Pediatrics. 142(5).

This comprehensive Policy Statement defines the recommended resources Emergency Departments need to be prepared to treat pediatric patients including policies, leadership, staff training, and equipment. Though aimed at daily emergency care it is a very valuable resource for overall pediatric emergency care planning.

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* Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois Emergency Medical Services for Children. (2018). Pediatric Disaster Preparedness Guidelines for Hospitals (Third Edition).

These comprehensive guidelines (now in their 3rd edition) were developed as a resource to assist hospitals and healthcare entities address the needs of children in disaster planning. This document outlines the specific needs of children during and after a disaster event and lists strategies and logistical requirements for addressing those needs across a wide variety of topic areas.

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Bagwell, H.B., Liggin, R., and Thompson, T. (2016). Disaster Preparedness in Families With Children With Special Health Care Needs. (Abstract only.) Clinical Pediatrics.

The authors assessed the impact of a disaster supply starter kit intervention on preparedness for families of children with special healthcare needs. They found that families who received the kit improved their preparedness, as evidenced by a significant increase in the presence of an Emergency Information Form and disaster kit.

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Branson, R.D. (2011). Disaster Planning for Pediatrics. Respiratory Care. 56(9):1457-63.

The author discusses issues related to pediatric needs; the medical system's shortcomings in caring for children; and recommendations of the National Commission on Children and Disasters. He also reviews anatomic and physiologic characteristics that make children more susceptible to the consequences of disasters, and shares information on performance of Strategic National Stockpile ventilators in pediatric use.

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Burke, R.V., Kim, T.Y., Bachman, S.L., and Iverson, E.I. (2014). Using Mixed Methods to Assess Pediatric Disaster Preparedness in the Hospital Setting. (Abstract only.) Prehospital and Disaster Medicine. 29(6):576-9.

The authors used quantitative and qualitative data from participants and observers for a “full-functional” earthquake exercise conducted at 3 hospitals in Los Angeles, CA to assess the disaster response of three hospitals, focusing on pediatric disaster victims. They note that results suggest opportunities for improving preparedness, such as through increased training on pediatric disaster triage methods and the safety and security of children, as well as the regular assessment and evaluation of supplies, equipment, leadership assignments, and inter-hospital communication.

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Centers for Bioterrorism Preparedness Program Pediatric Task Force, New York City Department of Health and Mental Hygiene (NYC DOHMH) Pediatric Disaster Advisory Group, and NYC DOHMH Healthcare Emergency Preparedness Program. (2008). Children in Disasters: Hospital Guidelines for Pediatric Preparedness.

This document highlights the efforts of the New York City Centers for Bioterrorism Preparedness Planning to assist the Department of Health and Mental Hygiene in preparing local hospitals to serve the needs of pediatric patients. The authors noted "hospitals of concern" (those which had limited pediatric services) and focused the report on 13 areas related to disaster preparedness (e.g., decontamination of children, family information and support, staffing, and security).

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* Chung, S., Baum, C.R., and Nyquist, A.C. (2020). Chemical-Biological Terrorism and Its Impact on Children. American Academy of Pediatrics. 145(1).

This policy statement addresses the steps that clinicians and policy makers can take to protect children and mitigate the effects of a chemical or biological attack. To access the technical report, copy and paste this link into a new browser: https://pediatrics.aappublications.org/content/early/2020/01/23/peds.2019-3750

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Dziuban, E., Peacock, G., and Frogel, M. (2017). A Child’s Health Is the Public’s Health: Progress and Gaps in Addressing Pediatric Needs in Public Health Emergencies. American Journal of Public Health.

This article discusses progress and accomplishments in pediatric preparedness, primarily since the September 11, 2001 terrorist attacks, and notes remaining gaps to be addressed.

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Federal Emergency Management Agency, American Red Cross, and the Department of Education. (2015). National Strategy for Youth Preparedness Education: Empowering, Educating and Building Resilience. Federal Emergency Management Agency.

This document was developed to encourage community stakeholders to educate youth about actions that they and their families can take to protect their safety and well-being and that of their communities when disasters threaten or strike.

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Gubbins, N. and Kaziny, B. (2018). The Importance of Family Reunification in Pediatric Disaster Planning. Clinical Pediatric Emergency Medicine. 19 (3): 252-259.

This article briefly reviews the status of pediatric disaster planning; resources to support pediatric disaster planning; and essential components of a family reunification plan, with a focus on children’s needs.

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Hinton, C.F., Griese, S.E., Anderson, M.R., et al. (2015). CDC Grand Rounds: Addressing Preparedness Challenges for Children in Public Health Emergencies. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. 64(35);972-974.

The authors discuss the integration of coordinated contributions from community-based healthcare providers, regional healthcare coalitions, state and local health departments, and federal agency initiatives necessary for an effective pediatric response to public health emergencies.

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Ketterhagen, T., Dahl-Grove, D., and McKee, M. (2018). National Survey of Institutional Pediatric Disaster Preparedness. (Abstract only.) American Journal of Disaster Medicine. 13(3).

The authors surveyed hospitals that provide emergency care to pediatric patients throughout the United States to “describe how pediatric patients are included in institutional disaster preparedness plans.” Most hospitals account for pediatric patients in their disaster plans, and those with an individual designated for pediatric disaster planning were more likely to specifically address the care of pediatric patients.

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Loma Linda University Children's Hospital. (2013). Pediatric/Neonatal Disaster Reference Guide: Bridging the Gap Between EMS and Hospital Care.

This guide was created to help emergency managers, coordinators, and hospital staff in their efforts to develop their own specific departmental emergency operations plans that addresses the special needs of children and infants.

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Loyola University Medical Center, Illinois Emergency Medical Services for Children. (2018). Pediatric Disaster Preparedness Guidelines.

This document was prepared by a multidisciplinary work group to help address the needs of children in any care setting, from acute care hospitals to community agencies serving children. This resource addresses the following: pediatric supplies, medication guidance, training resources, specific concerns for children with special health care needs in both community and institutional settings, staffing levels for pediatric patients, mental health needs, legal concerns, and security issues.

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Monteiro, S., Shannon, M., Sandora, T., and Chung, S. (2009). Pediatric Aspects of Hospital Preparedness. Clinical Pediatric Emergency Medicine. 10(3): 216-228.

The authors describe the key pediatric considerations for inclusion into hospital-based emergency preparedness programs, particularly: hospital incident command system, surge capacity, decontamination, infection control, sheltering in place, and evacuation.

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Mortelmans L.J.M, Maebe S, Dieltiens G, and Anseeuw, K. (2016). Are Tertiary Care Paediatricians Prepared for Disaster Situations? (Abstract only.) Prehospital and Disaster Medicine. 31(2):126-131.

The authors presented a survey to emergency pediatricians and pediatric emergency physicians in specialized tertiary centers to capture demographics; hospital disaster planning; estimated risk and capability for disasters; training; and willingness to work; as well as a set of six content assessment questions to evaluate knowledge. They found that respondents felt most prepared to respond to trauma, and least prepared to respond to nuclear incidents, and that willingness to work correlated significantly with age, self-estimated capability, and risk estimation.

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National Advisory Committee on Children and Disasters. (2015). Healthcare Preparedness for Children in Disasters: A Report of the NACCD Healthcare Preparedness Working Group.

This report was developed in response to a tasking by the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) to assess the readiness to care for children affected by disasters. It focuses on three key areas: coalition building, workforce development, and medical countermeasure readiness.

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National Advisory Committee on Children and Disasters. (2018). Joint NACCD and NBSB Future Strategies for Children Report.

This report includes “a prioritized set of future strategy recommendations and initial implementation steps” specific to children’s needs in disasters, for the Office of the Assistant Secretary for Preparedness and Response (ASPR) to take. Ten recommendations are noted, including those related to strengthening medical countermeasures development; use of data and research to inform each phase of the disaster cycle; integration of preparedness policy and incentives into other initiatives; expanded involvement in coalitions; continued prioritization of all-hazards strategies; and increased public visibility of ASPR’s work.

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National Pediatric Disaster Coalition. (2015). Improving Pediatric Disaster Preparedness: After Action Report.

This After Action Report is from the first National Pediatric Disaster Coalition Meeting held in 2015 that used a workshop exercise format. The report discusses successes in pediatric disaster planning, remaining gaps, and opportunities for improvement as of November 2015.

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New York City Department of Health and Mental Hygiene. (2020). Disaster Preparedness for Children with Disabilities: Durable Medical Equipment.

This document (available in a variety of languages) was created to help people caring for a child with a disability make better informed decisions about the child’s health and safety, and support the implementation of public-private collaborations in communities during a disaster.

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Stough, L.M., Ducy, E.M., and Kang, D. (2017). Addressing the Needs of Children With Disabilities Experiencing Disaster or Terrorism. Current Psychiatry Reports.

The authors conducted a literature review to identify psychosocial factors relating to children with disabilities in the context of disaster or terrorism. They found that there are very few studies on the psychological effects of disaster/terrorism on children with pre-existing disabilities and “empirical evidence of the effectiveness of trauma-focused therapies for this population is limited.” They note that social stigma and health concerns, compromise the recovery of these children, who are disproportionately affected by disasters, terrorism, and war.

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U.S. Department of Health and Human Services, Administration for Children and Families, Office of Human Services Emergency Preparedness and Response. (2010). National Commission on Children and Disasters: 2010 Report to the President and Congress.

This report includes the findings and recommendations from the Commission’s examination and assessment of the preparedness, response, and recovery needs of children from all hazards. It includes 32 recommendations in areas such as disaster management, mental health, emergency medical services and pediatric transport, sheltering, and evacuation. Appendix B of the report includes an index organized by the agency, group, or individual charged with implementing the recommendations.

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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). Hurricane Response – Resources for Children with Special Health Care Needs.

The resources on this ASPR webpage can help families, organizations, and clinicians who provide care to children with special healthcare needs in hurricane-affected areas. Links are provided under these categories: General Resources; CSHCN Specific Resources; Trauma-Informed Care and Mental Health Support; Family Support & Health Financing; and Resources for Clinical Providers.

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* Watkins, K., Ghasemzadeh, R., and Fatch, S. (2021). Just In Time Handbook: A Quick Pediatric Reference Guide for Adult Healthcare Providers. Western Regional Alliance for Pediatric Emergency Management (WRAP-EM).

This handbook can help adult healthcare providers care for pediatric patients in a disaster or public health emergency. Links to related resources are included throughout.

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Wizemann, T., Reeve, M., and Altevogt, B. (2014). Preparedness, Response, and Recovery Considerations for Children and Families: Workshop Summary. Institute of Medicine of the National Academies Press.

In June 2013, the Institute of Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events convened a workshop to review tools and frameworks that can be modified to include children’s needs, and highlight best practices in resilience and recovery strategies for children. This report summarizes the presentations and discussions to include: leveraging healthcare coalitions; provider, hospital, insurer, and health system perspectives on funding; and mental and behavioral health recovery.

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Zagory, J., Jensen, A., Burke, R., and Upperman, J. (2016). Planning for the Pediatric Patient During a Disaster. Current Trauma Reports. 2(4): 216–221.

The authors discuss preparedness, response, and recovery for pediatric casualties from a disaster. They advocate for a “community-participatory approach integrating families, physicians, hospital, and community organizations.”

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Lessons Learned

* American Academy of Pediatrics. (2013). Preparedness Checklist for Pediatric Practices.

This document offers checklists and steps that office-based pediatricians or their practice staff can take to improve office preparedness. It allows for advanced preparedness planning that can mitigate risk, ensure financial stability, strengthen the medical home, and help promote the health of children in the community.

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American Academy of Pediatrics. (2022). Guidance on Providing Pediatric Well-Care During COVID-19.

This document provides guidance on the health care that should continue to be provided to children during the COVID-19 pandemic.

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Ames, S.G., Davis, B.S., Marin, J., et al. (2019). Emergency Department Pediatric Readiness and Mortality in Critically Ill Children. (Abstract only.) American Academy of Pediatrics. 144(3).

The authors conducted a retrospective study on 20,483 critically ill children presenting to 426 hospitals in five states. Patients ranged from 0 to 18 years old and either required intensive care admission or experienced death during the visit. Statistical analysis revealed decreased mortality rates associated with increased pediatric readiness scores. Access the related commentary here: https://pediatrics.aappublications.org/content/144/3/e20191636.

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* ASPR TRACIE. (2023). Lessons Learned from the Pediatric Tripledemic-Systems, Staff, Space, and Supplies (ASPR TRACIE Roundtable).

ASPR TRACIE and ASPR’s Pediatric Disaster Care Centers of Excellence hosted this roundtable where panelists shared lessons learned from the 2022-2023 pediatric surge due to influenza, COVID-19, and respiratory syncytial virus. Participants discussed successes and challenges in information sharing, the use of specialty resources in response (e.g., Medical Operations Coordination Centers), augmenting staff, and coordination with supply chain and coalition partners

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ASPR TRACIE. (2023). Managing a Pediatric Tripledemic: Lessons Learned from 2022.

During the winter months in 2022-2023, hospitals in the state of Washington were overwhelmed by pediatric patients suffering from influenza, COVID-19, and respiratory syncytial virus (RSV). In this article, subject matter experts provide an overview of the health care coalition, the state’s pediatric capabilities, and how they used their Medical Operations Coordination Center (MOCC) and health care coalitions to balance patient loads throughout the state during this “tripledemic.”

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ASPR TRACIE. (2024). Pediatric Issues: Informing Current and Future Disaster Planning (Webinar).

Speakers from Pediatric Disaster Centers of Excellence share how their centers are shaping pediatric disaster care planning.

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Baker, A., Lee, L., Sard, B., and Chung, S.. (2024). The 4 S's of Disaster Management Framework: A Case Study of the 2022 Pediatric Tripledemic Response in a Community Hospital. Annals of Emergency Medicine.

The 2022 pediatric respiratory virus surge ("tripledemic") challenged community emergency departments (ED) across the U.S., where young patients are traditionally stabilized and transferred to pediatric hospitals with intensive care capabilities. The authors describe the effects of pediatric patient surge on a Massachusetts community ED and how leadership leadership used a disaster management framework based on the 4 S’s (space, staff, stuff, and structure) to manage it.

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Barfield, W. and Krug, S. (2017). Disaster Preparedness in Neonatal Intensive Care Units. Pediatrics. 139(5):e20170507.

The authors discuss lessons learned from recent disasters that have affected neonatal intensive care units (NICU) and then share how mass critical care concepts (e.g., drills, training, and personnel) can be applied to the NICU. They also highlight characteristics of the NICU population, and cover ethical issues related to surge capacity, evacuation, triage, and transport.

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Dixon, C., Kwok, R., Ludwig, L., et al. (2024). Pediatric Disaster Science: Understanding Needs, Highlighting Imperatives, and Leveraging Opportunities. National Academy of Medicine .

This discussion paper summarizes presentations from a 2022 symposium on children and disasters. It provides a historical overview of pediatric disaster science and strategies for prioritizing science throughout the cycle (from planning to reunification and recovery); highlights considerations for robust scientific research methods; and emphasizes the importance of an educated and well-trained workforce of pediatric disaster scientists.

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EMS for Children Innovation and Improvement Center. (2021). Summary of Activities: Year 2.

This document summarizes the activities of the Eastern Great Lakes Pediatric Consortium for Disaster Response during 2020 and 2021. Topics covered include white papers on behavioral health, surveys of children’s hospitals, education, EMS, and other topics regarding preparedness for children’s healthcare.

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Femino, M., Young, S., and Smith, V. (2013). Hospital-Based Emergency Preparedness: Evacuation of the Neonatal Intensive Care Unit-The Smallest and Most Vulnerable Population. (Abstract only.) Pediatric Emergency Care. 29(1):107-13.

The authors describe a full-scale neonatal intensive care unit evacuation exercise and emphasize the importance of constant, clear communication.

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National Association of County and City Health Officials. (2016). Summit Podcast Series: Lessons Learned from the Attempted Times Square Bombing.

In this podcast, Dr. Michael Frogel, Co-Principal Investigator for the New York City Pediatric Disaster Coalition shares his experience planning for a pediatric mass casualty event after the failed bombing attempt on Times Square in 2010.

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* Orlando, S., Bernard, M.L., and Mathews, P. (2008). Neonatal Nursing Care Issues Following a Natural Disaster: Lessons Learned from the Katrina Experience. (Abstract only.) The Journal of Perinatal and Neonatal Nursing. 22(2): 147-53.

The authors of this article address nursing care issues and lessons learned from the events that unfolded in New Orleans area neonatal units during and after Hurricane Katrina. They also provide guidance in support of disaster education for neonatal nurses.

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Pediatric Pandemic Network. (2023). Pediatric Respiratory Virus Surge Response, Fall/Winter 2022-23 (After-Action Report/ Improvement Plan).

This review covers the actions taken by the Pediatric Pandemic Network to support healthcare response to the pediatric respiratory medical surge Incident in fall/winter 2022-23.

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So, M., Dziuban, E.J., Franks, J.L., et al. (2019). Extending the Reach of Pediatric Emergency Preparedness: A Virtual Tabletop Exercise Targeting Children’s Needs. (Abstract only.) Public Health Reports.

The authors held and evaluated a virtual tabletop exercise with 26 pediatricians and public health practitioners from 4 states. They examined participants’ knowledge and confidence to fulfill targeted federal preparedness capabilities immediately before and after the exercise, then examined progress on actions 1 and 6 months post-exercise. Results were positive and the authors emphasize the need to address barriers to improve long-term pediatric preparedness efforts.

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* Watts, J. (2018). Pediatric Injuries Treated at a Level 1 Trauma Center After an F5 Tornado. (Abstract only.) Pediatric Emergency Care. 34(11):783-786.

The authors retrospectively reviewed records on 10 pediatric patients in the trauma registry following the 2011 F5 tornado in Joplin, MO to characterize their injuries. They found that traumatic brain injury was the most common diagnosis followed by orthopedic and maxillofacial injuries. Seven patients required surgical procedures in the operating room, and 8 patients were intubated and in the pediatric intensive care unit.

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Mental and Behavioral Health

American Academy of Pediatrics. (2023). Helping Children Cope and Adjust After a Disaster.

This webpage includes categories and links to related resources (e.g., video clips, fact sheets, and courses) that can help pediatric providers and others understand the impact of disasters on children.

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American Psychiatric Association. (2020). Child & Adolescent Telepsychiatry. (Accessed 9/25/2024.)

This webpage provide links to information and trainings for providing telepsychiatry services for children and adolescents.

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Bright Futures. (2020). Promoting Mental Health. American Academy of Pediatrics.

This tip sheet can help pediatric healthcare workers identify risk factors in young patients in culturally responsive ways and "connect families to needed resources and mitigate more significant mental health concerns later in life." It includes links to related tools and resource kits.

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Centers for Disease Control and Prevention. (2020). Helping Children Cope with Emergencies.

This webpage includes tips for helping children cope before, during, and after a disaster. It lists common reactions by age group and concludes with links to helpful resources.

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Cheung, A., Zuckerbrot, R., Jensen, P., et al. (2018). Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management. Pediatrics. 141 (3) .

An expert steering committee developed these clinical practice guidelines for youth aged 10 to 21 years to help pediatric healthcare providers treat and manage adolescent depression.

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* Federal Emergency Management Agency. (2017). Keeping Children Safe after Hurricane Harvey.

This fact sheet (available in a variety of languages) can help parents and caregivers keep children safe and feeling calm after a disaster. While specific to 2017's Hurricane Harvey, the fact sheet can be used for any type of major disaster.

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Federal Emergency Management Agency and The American Red Cross. (2004). Helping Children Cope with Disaster.

This document includes tips for parents, caregivers, and other adults regarding helping children cope with the effects of disaster. It also includes information on preparedness.

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Grolnick, W., Schonfeld, D., Schreiber, M., et al. (2018). Improving Adjustment and Resilience in Children Following a Disaster: Addressing Research Challenges. (Abstract only.) American Psychologist. 73(3):215-229.

The authors note that more research is needed on interventions that can help children experiencing negative behavioral health effects post-disaster. The article highlights knowledge gaps and key challenges in conducting research (e.g., obtaining consent, designing rigorous studies, and obtaining funding quickly enough to conduct the study). The authors list promising strategies (e.g., alternative study designs, working with schools and communities) that could overcome these challenges.

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* Li, J. (n.d.). Comprehensive Care Bundle. (Accessed 9/25/2024.) Emergency Medical Services for Children Innovation and Improvement Center.

This toolkit contains documents which may be of use to healthcare professionals providing care to children experiencing behavioral health symptoms. It includes an emergency department (ED) intake form, a tracking and behavioral health handoff form for continuity of care between shifts, documents for ensuring patient safety, and talking points for discussing what to expect in the ED with patients.

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* National Child Traumatic Stress Network. (2014). Pediatric Medical Traumatic Stress Toolkit for Health Care Providers.

This resource consists of a compendium of tools to help providers address the emotional, as well as the physical side of trauma. Included are guidebooks on implementing trauma-informed care, with case studies and examples, as well as complementary patient handouts for children and parents with evidence-based tips and activities.

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National Child Traumatic Stress Network. (2020). Age-Related Reactions to a Traumatic Event.

This tip sheet lists potential reactions to trauma by age and provides related suggestions for parents and caregivers. Note: Resource has been translated into Ukrainian, Russian, German, Spanish, Dari, and Pashto.

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National Institute of Mental Health. (n.d.). Helping Children and Adolescents Cope with Disasters and Other Traumatic Events: What Parents, Rescue Workers, and the Community Can Do. (Accessed 9/25/2024.)

Common responses to trauma by age group, strategies for helping children cope with trauma, and links to helpful resources are provided on this National Institute of Mental Health webpage.

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Russell, J.D., Neill, E.L., Carrion, V.G., and Weems, C.F. (2017). The Network Structure of Posttraumatic Stress Symptoms in Children and Adolescents Exposed to Disasters. Journal of the American Academy of Child and Adolescent Psychiatry. 56(8): 669-677.

The authors assessed 786 youth 8 to 13 years old (children) and 14 to 18 years old (adolescents) exposed to Hurricanes Katrina and Gustav for PTSD symptoms. They found that “the symptom network demonstrated meaningful variability across age, particularly in the strength of associations, and the relative importance of individual symptoms to the network as a whole.”

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Schonfeld, D., Demaria, T., and Committee on Psychosocial Aspects of Child and Family Health, Disaster Preparedness Advisory Council. (2015). Providing Psychosocial Support to Children and Families in the Aftermath of Disasters and Crises. Pediatrics. 136 (4).

This clinical report highlights risk factors and common adjustment difficulties in children in the aftermath of a disaster. Pediatric healthcare providers can help promote effective coping strategies in their patients, caregivers, and in consultation with schools, child care centers, and related sites.

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Schonfeld, D., Demaria, T., and Committee on Psychosocial Aspects of Child and Family Health, Disaster Preparedness Advisory Council. (2016). Supporting the Grieving Child and Family. Pediatrics. 138(3).

Pediatric healthcare providers are in a unique position to provide guidance and support to caregivers and children grieving the loss of a loved one. This article highlights factors related to mourning (e.g., triggers, negative mental health effects) and provides strategies for healthcare workers to use to help patients and caregivers work their way through grief.

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Schreiber, M. (2011). National Children’s Disaster Mental Health Concept of Operations. Terrorism and Disaster Center at the University of Oklahoma Health Sciences Center.

This document outlines an evidence-based, triage-enhanced children’s disaster mental health incident response strategy designed to be used in any community. The author matched the continuum of risk to a corresponding continuum of care and emphasizes the importance of an integrated response.

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The National Child Traumatic Stress Network. (2019). Childhood Traumatic Grief: Information for Pediatric Providers.

This guide can help pediatric providers discuss grief with children. It explains childhood traumatic grief and how it effects physical and mental health.

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2018). Behavioral Health Conditions in Children and Youth Exposed to Natural Disasters.

This resource discusses mental health and substance use (behavioral health) conditions in children and adolescents following exposure to natural disasters such as hurricanes, tornadoes, and earthquakes. It discusses the challenges faced by children and adolescents following natural disasters; sheds light on behavioral health consequences (such as PTSD, depression, and acute stress disorder) of being exposed to traumatic events; and presents various ways to reduce lasting impacts of such events.

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Wender, E. and The Committee on Psychosocial Aspects of Child and Family Health. (2012). Supporting the Family after the Death of a Child. Pediatrics. 130(6): 1164-1169.

This document can help pediatric healthcare providers provide support to families that have lost a child. It highlights the reactions that can be expected, suggests supportive strategies, and includes links to related resources.

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WRAP-EM. (2021). Western Regional Alliance for Pediatric Emergency Management (WRAP-EM).

This regional alliance brings together organizations and pediatric disaster subject matter experts from Washington, Oregon, California, Nevada and Arizona, representing 13 million children from across the five states. WRAP-EM includes representatives from 17 medical centers, 10 universities, 2 NETEC biocontainment centers, poison control centers, state and local emergency management agencies and private health care delivery systems. Their work covers a multitude of response scenarios with a single mission: to impact the capacity and capabilities on the West Coast to respond to pediatric patients in a disaster.

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Zuckerbrot, K. Cheung, A., Jensen, P., et al. (2018). Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics. 141 (3).

An expert steering committee developed these clinical practice guidelines for youth aged 10 to 21 years to help pediatric healthcare providers identify and manage adolescent depression.

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Natural Disasters

Capita Social, Inc. and the Aspen Institute. (2023). Flourishing Children, Healthy Communities and a Stronger Nation: The U.S. Early Years Climate Action Plan.

This plan, developed by a taskforce of twenty parents and climate and health leaders, highlights how climate change affects children under age 8, with a focus on children and families, child- and family-facing programs, and communities. Recommendations for federal, state, and local government and community groups include strategies such as monitoring air quality where children play, designing outdoor spaces with kids in mind, and efforts to make a healthier planet for children are accompanied by examples.

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* Federal Emergency Management Agency. (2017). Keeping Children Safe after Hurricane Harvey.

This fact sheet (available in a variety of languages) can help parents and caregivers keep children safe and feeling calm after a disaster. While specific to 2017's Hurricane Harvey, the fact sheet can be used for any type of major disaster.

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MotherToBaby. (2024). Breastfeeding Following a Natural Disaster.

Routine vaccinations prior to a disaster can prevent serious illness in breastfeeding people should one occur. This website covers infections that can follow a disaster and how they might affect babies who are being breastfed. Other considerations (e.g., accounting for limited access to refrigeration for breast milk, maintaining routine medication use in consultation with a healthcare provider, and the use of insect repellant to prevent mosquito- and tick-borne diseases) are provided. The website also highlights the potential impacts of cleaning agents and pollutants on breastfeeding parents and children.

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MotherToBaby. (2024). Pregnancy and Natural Disasters.

This website includes links to Centers for Disease Control and Prevention information relevant to pregnant people on topics such as exposure to infections, mosquito-borne illness, exposure to lead, lack of clean water, stress, and mold. The authors recommend continuing to breastfeed during a disaster, because breast milk can help prevent infections in babies.

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* Orlando, S., Bernard, M.L., and Mathews, P. (2008). Neonatal Nursing Care Issues Following a Natural Disaster: Lessons Learned from the Katrina Experience. (Abstract only.) The Journal of Perinatal and Neonatal Nursing. 22(2): 147-53.

The authors of this article address nursing care issues and lessons learned from the events that unfolded in New Orleans area neonatal units during and after Hurricane Katrina. They also provide guidance in support of disaster education for neonatal nurses.

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Stough, L. and McAdams Ducy, E. (2019). Evacuating Under Fire: Children with Special Healthcare Needs in Disaster. Natural Hazards Center, University of Colorado.

This article highlights challenges faced by children with special health care needs in the event of evacuations or shelter in place orders. The authors briefly cover lessons learned and promising practices and provide links to tools for caregivers and planners at the end.

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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). Hurricane Response – Resources for Children with Special Health Care Needs.

The resources on this ASPR webpage can help families, organizations, and clinicians who provide care to children with special healthcare needs in hurricane-affected areas. Links are provided under these categories: General Resources; CSHCN Specific Resources; Trauma-Informed Care and Mental Health Support; Family Support & Health Financing; and Resources for Clinical Providers.

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U.S. Environmental Protection Agency. (2022). Children's Health and Wildfire Smoke Exposure Workshop Recommendations.

Public health officials can use the recommendations provided in this document to help in decision-making as it relates to children’s health and the impacts of wildfire smoke. Workshop recommendations focused on four areas: respirator use by children; indoor air quality in schools; sensor use; and school activity guidelines.

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* Watts, J. (2018). Pediatric Injuries Treated at a Level 1 Trauma Center After an F5 Tornado. (Abstract only.) Pediatric Emergency Care. 34(11):783-786.

The authors retrospectively reviewed records on 10 pediatric patients in the trauma registry following the 2011 F5 tornado in Joplin, MO to characterize their injuries. They found that traumatic brain injury was the most common diagnosis followed by orthopedic and maxillofacial injuries. Seven patients required surgical procedures in the operating room, and 8 patients were intubated and in the pediatric intensive care unit.

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Pediatric Surge Capacity

* Alameda County Public Health Department. (2017). Alameda County Operational Area Pediatric Medical Surge Plan and Resources.

This concise plan describes a tiered approach to meeting surge capacity needs during incidents with a disproportionately high number of pediatric patients. Jurisdictions may consider this approach when conducting their related planning activities.

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American Journal of Disaster Medicine. 12(4):203-226 (2017). Factors Associated with Preparedness of the US Healthcare System to Respond to a Pediatric Surge during an Infectious Disease Pandemic. Is our Nation Prepared? Anthony, C., Thomas, T.J, Berg, B.M., et al

The authors of this article conducted a literature review to assess efforts in the U.S. healthcare system and their level of preparedness for infectious pandemics resulting in a pediatric surge. Results indicated that the U.S. healthcare system is not adequately prepared and response plans should be updated to meet national guidelines.

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* ASPR TRACIE. (2023). Lessons Learned from the Pediatric Tripledemic-Systems, Staff, Space, and Supplies (ASPR TRACIE Roundtable).

ASPR TRACIE and ASPR’s Pediatric Disaster Care Centers of Excellence hosted this roundtable where panelists shared lessons learned from the 2022-2023 pediatric surge due to influenza, COVID-19, and respiratory syncytial virus. Participants discussed successes and challenges in information sharing, the use of specialty resources in response (e.g., Medical Operations Coordination Centers), augmenting staff, and coordination with supply chain and coalition partners

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Bongiorno, D., Ravicz, M., Nadeau, N., et al. (2024). Pediatric Capacity Crisis: A Framework and Strategies to Prepare for a Pediatric Surge. Clinical Concepts.

The authors provide an overview of lessons learned from the fall and winter of 2022 surge in pediatric patients across the U.S.. This is followed by a discussion of the "Four S" model (space, staffing, supplies, and system) and related strategies by level of intervention (governmental/policy, hospital/health care system, and individual clinicians) for responding to pediatric surge.

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Boyer, E.W., Fitch, J., and Shannon, M. (2009). Pediatric Hospital Surge Capacity in Public Health Emergencies. (Archived.) Agency for Healthcare Research and Quality.

The special medical needs of children make it essential that healthcare facilities be prepared for both pediatric and adult victims of bioterrorism attacks and other public health emergencies. Clinicians and hospital administrators may use the report’s recommendations to develop unique responses to mass casualty events involving pediatric patients.

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Campbell, C. (2010). The Benefits of Designing a Stratification System for New York City Pediatric Intensive Care Units for Use in Regional Surge Capacity Planning and Management. Journal of Community Health. 35(4):337-347.

The author describes her work designing a New York City pediatric intensive care unit (PICU) surge stratification system that can help physicians, hospitals, and city agencies with regional surge capacity planning for critical pediatric patients. This included identification of factors to be considered when developing a stratification system, and creation of a preliminary system of PICU stratification based on clinical criteria and resources.

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Centers for Disease Control and Prevention. (2010). Coordinating Pediatric Medical Care During an Influenza Pandemic: Hospital Workbook. U.S. Department of Health and Human Services.

This workbook was designed to assist hospitals in coordinating the care of pediatric patients during an influenza pandemic. The workbook guides hospitals in thinking about needed actions to inform their preparedness planning. NOTE: This resource is outdated, however it provides useful information that may still be relevant.

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* Central Valley, CA. (2012). Regional Pediatric Disaster Surge Framework. California Hospital Association.

This document provides a framework for community collaboration to develop regional, comprehensive, integrated pediatric preparedness response plans.

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Foster, C.E., Marquez, L., Davis, A.L., et al. (2020). A Surge in Pediatric Coronavirus Disease 2019 Cases: The Experience of Texas Children’s Hospital From March to June 2020. Journal of the Pediatric Infectious Diseases Society.

This article addresses pediatric patients from ethnically diverse communities presenting with COVID-19 symptoms. Results indicated that a high percentage of Hispanic children tested positive for COVID-19 and required hospitalization. However, most of the children in the study did not have complicated illnesses. Findings from this study could be applied to planning resources that support pediatric triage during infectious disease surge.

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Frost, P., Upperman, J., Lubin, B., et al. (2010). Pediatric Surge Planning: Solutions Within Reach. Contra Costa County Health Services.

This document contains presentations from a September 2010 workshop about pediatric surge planning. The importance of community hospitals in planning for and managing pediatric surge is emphasized, as are some limitations of the current system based on data from the State of California.

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Ginter, P.M., Rucks, A.C., Duncan, W.J,. et al. (2010). Southeastern Regional Pediatric Disaster Surge Network: A Public Health Partnership. Public Health Reports. 125(Suppl 5): 117-125.

This article describes the development of the Southeastern Regional Pediatric Disaster Surge Network, comprised of over 40 agencies and institutions working together since 2005 to establish a regional pediatric disaster preparedness network across five states: Alabama, Florida, Louisiana, Mississippi, and Tennessee.

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* Illinois Department of Public Health. (2020). Pediatric and Neonatal Surge Annex.

This plan provides a detailed framework for various stakeholders involved in an emergency response within the State of Illinois and surrounding states in order to protect children and provide appropriate pediatric medical care during a disaster. The plan can be used to guide a state-level response and provides local medical services guidance on the care of children, including patient movement, system decompression, recommendations for care, and resource allocation during a surge of pediatric patients. It includes several tools such as transfer forms and algorithms.

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Kanter, R.K. (2007). Strategies to Improve Pediatric Disaster Surge Response: Potential Mortality Reduction and Tradeoffs. Critical Care Medicine. 35(12):2837-42.

The author modeled the potential for disaster mortality reduction with two surge response strategies: 1) control distribution of pediatric disaster victims to avoid hospital overcrowding near the scene, and 2) expand capacity by altering standards of care to only “essential” interventions. Modeling results suggest that the application of these two strategies in combination could decrease pediatric mortality rates in large disasters.

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Kelen, G.D., Troncoso, R., and Trebach, J. (2017). Effect of Reverse Triage on Creation of Surge Capacity in a Pediatric Hospital. JAMA Pediatrics. 171(4):e164829.

The authors conducted a year-long retrospective study to assess the effect of reverse triage of patients from pediatric hospitals on surge capacity. They concluded that “reverse triage adds a meaningful but modest contribution and may depend on psychiatric space.”

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* Los Angeles County Emergency Medical Services Agency. (2012). Pediatric Surge Quick Reference Guide. California Hospital Association.

This document contains summaries of critical information for managing the care of children during emergencies or disasters, including vital signs; risks during disasters; signs of respiratory distress; equipment sizes; and fluid resuscitation.

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* Los Angeles County Emergency Medical Services Agency. (2016). Los Angeles County Pediatric Surge Plan. California Hospital Association.

This plan provides details on how each hospital within Los Angeles County would support a pediatric surge of patients, including surge targets, supplies, and patient types. This plan also includes parameters for transporting children from prehospital field operations to healthcare facilities and transferring patients among hospitals.

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McCulley, K., Lozon, M., Hodge, J., and DeBruin, D. (2024). Pediatric Crisis Standards of Care. Pediatric Pandemic Network.

Speakers emphasized the need to include pediatric patients in crisis standards of care planning and highlighted strategies for addressing related legal and ethical considerations. Access the slides here: https://files.constantcontact.com/332bf3d1601/99af8e0d-cc58-42ca-85f3-ceb416f3abd7.pdf

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* Minnesota Department of Health. (2019). Minnesota Pediatric Surge Primer.

This primer is geared for small community hospitals that do not usually provide pediatric trauma or inpatient services. It provides guidance that facilities and regions can follow to plan for pediatric patients in a mass casualty event.

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* Minnesota Department of Health. (n.d.). Pediatric Surge. (Accessed 9/25/2024.)

This webpage includes links to Minnesota's Pediatric Surge Plan, toolkit, assessment tools, educational tools (e.g., videos for healthcare workers), and exercise tools and templates.

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New York City Pediatric Disaster Coalition. (n.d.). Pediatric Disaster Coalition PICU Surge Template Plan. (Accessed 9/25/2024.)

This customizable plan template focuses on increasing surge capacity and capabilities for the PICU, the pediatric inpatient unit, other inpatient units, and the emergency department.

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* New York State Department of Health, Health Emergency Preparedness Program, and Division of Family Health Office of the Medical Director. (2017). Pediatric and Obstetric Emergency Preparedness Toolkit.

This revised version of a previously released toolkit is targeted to “hospitals that do not have pediatric intensive care services or obstetric or newborn services and must prepare for such patients during the time of a disaster.” The document discusses: planning guidelines; staffing considerations; training; security; infection control; hospital-based pediatric triage; decontamination; prophylaxis; transportation of pediatric patients; surge considerations; equipment considerations; disaster preparedness for childbirth; psychosocial needs of children; and family information and support centers.

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Rady Children's Hospital, San Diego (2011). Pediatric Surge Planning: Train the Trainer.

This online course provides an in-depth overview of the special considerations associated with pediatric surge planning. The authors describe hospital incident command system activation, specify tools and actions linked to pediatric surge, and provide tips for developing a surge plan.

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Region V for Kids, the Western Regional Alliance for Pediatric Emergency Medicine, and Gulf-7-Pediatric Disaster Network. (2024). Joint PDCOE Pediatric Surge Report. Administration for Strategic Preparedness and Response.

This report illustrates how Pediatric Disaster Centers of Excellence (PDCOEs) have developed resources and capabilities to respond to medical surge events. It specifically highlights how PDCOEs functioned before and during the pediatric “tripledemic" experienced between October 2022 and January 2023.

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* Rucks, A., Baldwin, S., Beeman, K., et al. (2010). Multi-State, Multi-Organizational Solution to Limited Regional Pediatric Medical Surge Capacity in the Southeastern United States. Alabama Department of Public Health.

The speakers in this 90-minute webcast share strategies for addressing obstacles associated with pediatric surge.

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* Stanislaus County Health Services Agency. (2019). Stanislaus County Healthcare Emergency Preparedness Coalition Pediatric Disaster Surge Plan.

This county-specific pediatric disaster surge plan supports the Stanislaus County Healthcare Emergency Preparedness Coalitions’ (SCHEPC) Medical Health Surge Plan. Integration of the hospitals with the State of California through multi-agency coordination mechanisms is demonstrated.

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Toltzis, P., Soto-Campos, G., Kuhn, E., et al. (2015). Evidence-Based Pediatric Outcome Predictors to Guide the Allocation of Critical Care Resources in a Mass Casualty Event. Pediatric Critical Care Medicine. 16(7): e207–e216.

The authors created an evidence-based crisis standards of care triage allocation scheme specifically for children. Results gathered from studying virtual pediatric intensive care unit (PICU) subjects indicated improved population outcomes on "patients likely to benefit from short-duration ICU interventions."

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* Various Authors. (2009). Pediatric Surge Pocket Guide. California Hospital Association.

This pocket guide contains clinical checklists, guides, and just-in-time references to manage a surge of pediatric patients. It includes the following sections: Normal Values; Triage and Assessment; Treatment and Medications; Equipment; Decontamination; Mental Health; and Pediatric Safe Areas.

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* WRAP-EM. (2022). Radiation Surge Annex Pediatric Workshop Modules.

WRAP-EM hosted this workshop to provide pediatric-specific information for healthcare coalitions to include in their radiation surge annexes. Information is provided in three modules: Pediatric Considerations after a Dirty Bomb, Medical Countermeasures, and Additional Resources

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Plans, Tools, and Templates

Administration for Strategic Preparedness and Response. (2023). HHS Child and Adolescent Health Emergency Planning Toolkit. U.S. Department of Health and Human Services.

This toolkit can help healthcare, public health, and social services providers address the needs of children and youth with special health care needs in emergency preparedness, response, recovery, mitigation, and community resilience activities.

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* Alameda County Public Health Department. (2017). Alameda County Operational Area Pediatric Medical Surge Plan and Resources.

This concise plan describes a tiered approach to meeting surge capacity needs during incidents with a disproportionately high number of pediatric patients. Jurisdictions may consider this approach when conducting their related planning activities.

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American Academy of Pediatrics. (2013). Pediatric Preparedness Resource Kit.

This resource kit was designed to address issues that occurred during 2009 H1N1 planning and allows for pediatricians, public health leaders, and other pediatric care providers to assess what is already happening in their community or state, and help determine what needs to be done before an emergency or disaster. It promotes collaborative discussions and decision making about pediatric preparedness planning at the local and state level and encourages integration of pediatric providers into disaster planning. It also contains a link to the Joint Policy Statement—Guidelines for Care of Children in the Emergency Department, as well as a Preparedness Checklist for Pediatric Practices and guidance for prioritizing vaccination during pandemics.

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* American Academy of Pediatrics. (2013). Preparedness Checklist for Pediatric Practices.

This document offers checklists and steps that office-based pediatricians or their practice staff can take to improve office preparedness. It allows for advanced preparedness planning that can mitigate risk, ensure financial stability, strengthen the medical home, and help promote the health of children in the community.

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American Academy of Pediatrics. (2016). Family Readiness Kit.

Providers can share this kit with families to assist them with preparing for disasters.

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American Academy of Pediatrics. (2018). Pediatric and Public Health Preparedness Exercise Resource Kit.

This resource kit was developed through a collaboration between the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Its purpose is to “provide the tools and templates to make it easier for states, communities, hospitals, or healthcare coalitions to conduct a pediatric tabletop exercise, which provides participants with the opportunity to discuss and assess preparedness plans and capabilities for a disaster that affects children.”

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American Academy of Pediatrics. (2018). Post-Disaster Considerations for Pediatricians in Practice.

This resource reviews considerations for pediatricians in practice following a disaster. Topics include: first 48 hours after disaster; medical services (i.e., what you can and cannot provide post-disaster); communications; staff; space; insurance; vaccine loss; medical billing; personal care; and long-term recovery.

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American Academy of Pediatrics, in collaboration with Massachusetts General Hospital, Center for Disaster Medicine. (2018). Family Reunification Following Disasters: A Planning Tool for Health Care Facilities.

This planning tool was created to assist hospitals with their plans to provide information, support services, and safe reunification assistance to family members of patients who have experienced disasters. It provides potential solutions to reunification-related challenges, including: planning for the secure reception, tracking, and care of large numbers of children who may present to a hospital following a mass-casualty event; identifying injured and unaccompanied children in a disaster; tracking unaccompanied children during their hospital stay; and what legal authority a hospital has to administer care to minors when the parent/guardian is unavailable to participate in the informed consent process.

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* American Academy of Pediatrics, Remick, K., Gausche-Hill, M., Joseph, M.M., at al. (2018). Pediatric Readiness in the Emergency Department. Pediatrics. 142(5).

This comprehensive Policy Statement defines the recommended resources Emergency Departments need to be prepared to treat pediatric patients including policies, leadership, staff training, and equipment. Though aimed at daily emergency care it is a very valuable resource for overall pediatric emergency care planning.

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* Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois Emergency Medical Services for Children. (2018). Pediatric Disaster Preparedness Guidelines for Hospitals (Third Edition).

These comprehensive guidelines (now in their 3rd edition) were developed as a resource to assist hospitals and healthcare entities address the needs of children in disaster planning. This document outlines the specific needs of children during and after a disaster event and lists strategies and logistical requirements for addressing those needs across a wide variety of topic areas.

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ASPR TRACIE. (2019). Healthcare Coalition Pediatric Surge Annex Template.

This template provides general headers and descriptions for a sample healthcare coalition (HCC) Pediatric Surge Annex Template. The resources used to develop this template include sample HCC plans and the Health Care Preparedness and Response Capabilities.

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ASPR TRACIE. (2020). Step by Step Guide to Implementing the Pediatric Surge Annex TTX Template (PDF).

This guide can be used by healthcare coalitions (HCCs) to enhance operational area awareness and capability in order to effectively address the needs of children as part of a whole community emergency response framework. It can also be utilized to satisfy Funding Opportunity Announcement (FOA) requirements for the Hospital Preparedness Program (HPP) Cooperative Agreement.

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Burke, R.V., Lehman-Huskamp, K., Whitney, R.E., et al. (2015). Checklist Use in Evaluating Pediatric Disaster Training. (Abstract only; free registration required.) American Journal of Disaster Medicine. 10(4).

The authors tested the use of a premade checklist of care intervention requests by residents at four different academic pediatric residency programs who participated in a tabletop simulation of a pediatric disaster scenario requiring them to properly triage and manage simulated patients. They concluded that checklists are a valuable tool for use in medical education, and give users immediate feedback on their decisions.

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* Central Valley, CA. (2012). Regional Pediatric Disaster Surge Framework. California Hospital Association.

This document provides a framework for community collaboration to develop regional, comprehensive, integrated pediatric preparedness response plans.

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DeAtley, C. (2019). NCR Plan for Management of Pediatric Patients in an Emergency.

This draft plan can inform health care personnel responding to an incident including many pediatric patients.

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Emergency Medical Services for Children Innovation and Improvement Center. (2024). Pediatric Hazard Vulnerability Analysis Template.

This downloadable Excel template can help regions determine hazards’ impacts on a region and how prepared regions and/or hospitals are for the pediatric consequences of each hazard. The tool categorizes hazard impact along three dimensions, each with specific pediatric considerations, allowing users to produce an overall vulnerability and risk score for each hazard. This tool is not meant to be a thorough checklist of preparation, but instead spur the inclusion of general pediatric considerations into risk analysis, disaster planning, and emergency response. It is not intended to replace a hospital HVA with facility-specific processes.

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Emergency Medical Services for Children National Resource Center. (2022). Checklist of Essential Pediatric Domains and Considerations for Every Hospital's Disaster Preparedness Policies.

This checklist, developed by subject matter experts and organized into eleven domains, can help hospital administrators and leadership incorporate essential pediatric considerations into existing hospital disaster policies.

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EMS for Children Innovation and Improvement Center. (n.d.). Be Ready: Tips for Families of Children and Youth with Special Healthcare Needs. (Accessed 9/25/2024.)

This toolkit describes planning for emergencies for families, especially for children with access and functional needs. It includes infographics and information on building an emergency kit, sheltering in place, and evacuation.

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EMSC Innovation and Improvement Center. (2020). National Pediatric Readiness Project Toolkit.

This toolkit provides resources for pediatric emergency care providers to better understand and achieve the components of pediatric readiness in their emergency department. The toolkit also provides support and recommendations for other stakeholders involved in pediatric emergency care such as hospital directors, quality improvement leaders, family advisory network personnel, caregivers, and patients.

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Health Resources and Services Administration, Maternal and Child Health Bureau. (2019). Critical Crossroads: Pediatric Mental Health Care in the Emergency Department. U.S. Department of Health and Human Services.

Hospital staff can use the tools and references in this document to create care pathways to improve the identification and management of pediatric patients who present to the emergency department in a mental health crisis. This interactive toolkit includes sections on the screening, assessment, and disposition stages as well as case studies.

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* Illinois Department of Public Health. (2020). Pediatric and Neonatal Surge Annex.

This plan provides a detailed framework for various stakeholders involved in an emergency response within the State of Illinois and surrounding states in order to protect children and provide appropriate pediatric medical care during a disaster. The plan can be used to guide a state-level response and provides local medical services guidance on the care of children, including patient movement, system decompression, recommendations for care, and resource allocation during a surge of pediatric patients. It includes several tools such as transfer forms and algorithms.

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Illinois Emergency Medical Services for Children. (2016). Addressing the Needs of Children in Disaster Preparedness Exercises, 2nd Edition.

This document includes guidance and tools to assist planners with including pediatric-focused scenarios and considerations in their disaster preparedness exercises. It includes discussion of exercise components by setting; how to incorporate children into disaster exercises; and sample exercise scenarios.

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Illinois Emergency Medical Services for Children. (2018). Hospital Pediatric Preparedness Checklist.

This checklist in this document (on page 26) can help hospitals determine their level of pediatric preparedness and identify opportunities for improvement.

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* Li, J. (n.d.). Comprehensive Care Bundle. (Accessed 9/25/2024.) Emergency Medical Services for Children Innovation and Improvement Center.

This toolkit contains documents which may be of use to healthcare professionals providing care to children experiencing behavioral health symptoms. It includes an emergency department (ED) intake form, a tracking and behavioral health handoff form for continuity of care between shifts, documents for ensuring patient safety, and talking points for discussing what to expect in the ED with patients.

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* Los Angeles County Emergency Medical Services Agency. (2012). Pediatric Surge Quick Reference Guide. California Hospital Association.

This document contains summaries of critical information for managing the care of children during emergencies or disasters, including vital signs; risks during disasters; signs of respiratory distress; equipment sizes; and fluid resuscitation.

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* Los Angeles County Emergency Medical Services Agency. (2016). Los Angeles County Pediatric Surge Plan. California Hospital Association.

This plan provides details on how each hospital within Los Angeles County would support a pediatric surge of patients, including surge targets, supplies, and patient types. This plan also includes parameters for transporting children from prehospital field operations to healthcare facilities and transferring patients among hospitals.

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* Minnesota Department of Health. (2019). Minnesota Pediatric Surge Primer.

This primer is geared for small community hospitals that do not usually provide pediatric trauma or inpatient services. It provides guidance that facilities and regions can follow to plan for pediatric patients in a mass casualty event.

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Minnesota Department of Health. (n.d.). Pediatric Surge. (Accessed 9/25/2024.)

This webpage includes links to various resources in support of pediatric surge planning, including a Pediatric Surge Toolkit with assessment tools, planning tools, response tools, training tools, and exercise tools.

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* Minnesota Department of Health. (n.d.). Pediatric Surge. (Accessed 9/25/2024.)

This webpage includes links to Minnesota's Pediatric Surge Plan, toolkit, assessment tools, educational tools (e.g., videos for healthcare workers), and exercise tools and templates.

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MotherToBaby. (2024). MotherToBaby.

This website provides information on the risks/benefits of medications and other exposures (e.g., during environmental or natural disasters) during pregnancy and while breastfeeding.

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* National Child Traumatic Stress Network. (2014). Pediatric Medical Traumatic Stress Toolkit for Health Care Providers.

This resource consists of a compendium of tools to help providers address the emotional, as well as the physical side of trauma. Included are guidebooks on implementing trauma-informed care, with case studies and examples, as well as complementary patient handouts for children and parents with evidence-based tips and activities.

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* New York State Department of Health, Health Emergency Preparedness Program, and Division of Family Health Office of the Medical Director. (2017). Pediatric and Obstetric Emergency Preparedness Toolkit.

This revised version of a previously released toolkit is targeted to “hospitals that do not have pediatric intensive care services or obstetric or newborn services and must prepare for such patients during the time of a disaster.” The document discusses: planning guidelines; staffing considerations; training; security; infection control; hospital-based pediatric triage; decontamination; prophylaxis; transportation of pediatric patients; surge considerations; equipment considerations; disaster preparedness for childbirth; psychosocial needs of children; and family information and support centers.

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Northwest Healthcare Response Network. (2020). Planning and Caring for Pediatric and Neonatal Patients in Disasters: Inpatient and Outpatient Guidelines.

This toolkit provides considerations and guidelines for pediatric dietary and pharmacy needs, pediatric security issues, infection control, emergent neonatal care and resuscitation, and online pediatric training resources. It also includes attachments with multiple job action sheets, checklists, and templates.

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Seattle and King County Public Health Department. (2010). Hospital Guidelines for Management of Pediatric Patients in Disasters.

This toolkit is based on an earlier version developed by the New York City Department of Health and Mental Hygiene and includes considerations for staffing and training, resources, security, transportation, decontamination, hospital-based triage, and inpatient bed planning.

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* Stanislaus County Health Services Agency. (2019). Stanislaus County Healthcare Emergency Preparedness Coalition Pediatric Disaster Surge Plan.

This county-specific pediatric disaster surge plan supports the Stanislaus County Healthcare Emergency Preparedness Coalitions’ (SCHEPC) Medical Health Surge Plan. Integration of the hospitals with the State of California through multi-agency coordination mechanisms is demonstrated.

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* Starke, E. and Cheung, E. (2023). How to Perform Patient Decontamination: A Picture Guide. Children's Hospital Los Angeles.

Health care providers and emergency responders can use this picture book (with information provided in five languages) to ease fear and explain each step of the pediatric decontamination process.

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Texas Trauma Service Area (TSA) B. (2016). Trauma Service Area - B (BRAC): Regional Pediatric Plan.

This plan provides prehospital and hospital providers with regional standardized procedures for the treatment of pediatric patients. It addresses various issues to include: prehospital triage, helicopter activation, inter-hospital transfers, pediatric trauma triage/ transfer decision scheme, among others topics.

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U.S. Department of Health and Human Services, Administration for Children and Families, Office of Child Care. (2015). Resource Guide: Emergency Preparedness and Response Resources for Child Care Programs.

This resource guide provides emergency preparedness and response resources for child care programs, and can help these programs develop emergency plans or update their current plans.

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* Various Authors. (2009). Pediatric Surge Pocket Guide. California Hospital Association.

This pocket guide contains clinical checklists, guides, and just-in-time references to manage a surge of pediatric patients. It includes the following sections: Normal Values; Triage and Assessment; Treatment and Medications; Equipment; Decontamination; Mental Health; and Pediatric Safe Areas.

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* Watkins, K., Ghasemzadeh, R., and Fatch, S. (2021). Just In Time Handbook: A Quick Pediatric Reference Guide for Adult Healthcare Providers. Western Regional Alliance for Pediatric Emergency Management (WRAP-EM).

This handbook can help adult healthcare providers care for pediatric patients in a disaster or public health emergency. Links to related resources are included throughout.

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WRAP-EM. (2023). Pediatric Surge Playbook.

This playbook can serve as a reference tool for pediatric surge management activities before or during a surge incident. Information is categorized into three domains: hospitals and hospital systems; interagency (for ESF #8 agencies); and pediatric medical operations coordination centers. An accompanying Excel file includes links to related resources.

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Trauma Care and Triage

American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons Committee on Trauma, et al. (2013). Equipment for Ground Ambulances. Prehospital Emergency Care. 18: 92-97.

This article highlights recommendations for pediatric equipment supplies for basic and advanced life support for U.S. emergency ground ambulance services.

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* American Academy of Pediatrics, Remick, K., Gausche-Hill, M., Joseph, M.M., at al. (2018). Pediatric Readiness in the Emergency Department. Pediatrics. 142(5).

This comprehensive Policy Statement defines the recommended resources Emergency Departments need to be prepared to treat pediatric patients including policies, leadership, staff training, and equipment. Though aimed at daily emergency care it is a very valuable resource for overall pediatric emergency care planning.

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Bobko, J.P., Callaway, D.W., and Smith, E.R. (2014). Tactical Emergency Casualty Care Pediatric Guidelines. (Abstract only.) Journal of Special OPerations Medicine.

This article summarizes the tactical emergency casualty care pediatric guidelines issued by the Committee for Tactical Emergency Casualty Care (C-TECC), comparing them to the adult guidelines issued previously, and noting how they apply to Emergency Medical Services (EMS) personnel. The article includes a list of strategies for communicating with children during trauma, and a list of strategies for post-trauma management of children.

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Bohn, D., Kanter, R., Burns, J., et al. (2011). Supplies and Equipment for Pediatric Emergency Mass Critical Care. Pediatric Critical Care Medicine. 12(6 0): S120–S127.

The authors share the consensus opinion of Pediatric Emergency Mass Critical Care Task Force regarding supplies and equipment that would be required during a pediatric mass critical care crisis.

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Christian, M., Toltzis, P., Kanter, R., et al. (2011). Treatment and Triage Recommendations for Pediatric Emergency Mass Critical Care. (Abstract only.) Pediatric Critical Care Medicine. 12(6 Suppl):S109-19.

The authors discuss issues related to developing triage algorithms and protocols, and the allocation of scarce resources, during pediatric emergency mass critical care.

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Committee for Tactical Emergency Casualty Care. (2023). Pediatric Tactical Emergency Casualty Care.

This resource provides guidelines for the immediate on-scene stabilization of victims, depending on whether or not there is an ongoing threat to safety.

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Cruz, A.T., Tittle, K.O., Smith, E.R., and Sirbaugh, P.E.. (2012). Increasing Out-of-Hospital Regional Surge Capacity for H1N1 2009 Influenza A Through Existing Community Pediatrician Offices: A Qualitative Description of Quality Improvement Strategies. (Abstract only.) Disaster Medicine and Public Health Preparedness. 6(2):113-116.

This article discusses communication, interventions and coordination of community resources for low-acuity pediatric patients and their families as a mechanism to increase community surge capacity during the H1N1 pandemic and for future disease outbreaks. Strategies to support access to primary medical home practitioners that include increasing clinical staffing, longer office hours and identifying additional office space can help to mitigate surge on local emergency centers.

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Heffernan, R., Lerner, E.B., McKee, C., et al. (2018). Comparing the Accuracy of Mass Casualty Triage Systems in a Pediatric Population. Prehospital Emergency Care.

The authors compared the accuracy of 4 different mass casualty triage systems (SALT, JumpSTART, Triage Sieve, and CareFlight) when used for 115 children presenting to a pediatric specialty hospital/Level 1 trauma center. All were found to be 56%-59% accurate, and all had an under-triage percentage ranging from 33%-39%, which the authors called “unacceptable.” For each triage system, the most common error was designating a patient as “minimal” when they should have been triaged as “delayed.”

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Kiragu, A.W., Dunlop, S.J., Mwarumba, N., et al. (2018). Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions. Frontiers in Pediatrics. Frontiers in Pediatrics.

This article reviews the epidemiology, evaluation, and management of pediatric trauma injuries in low-and-middle-income countries. Information on the management of specific system-based injuries (e.g., traumatic brain injuries; abdominal injuries; thoracic injuries; orthopedic injuries; and burn injuries) may be useful to providers treating pediatric trauma in the United States.

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Koziel, J.R., Meckler, G., Brown, L., et al. (2014). Barriers to Pediatric Disaster Triage: A Qualitative Investigation. (Abstract only.) Prehospital Emergency Care Journal. 19(2).

The authors conducted a qualitative evaluation of paramedics’ self-reported obstacles to pediatric disaster triage performance using a 10-victim, multiple-family house fire simulation. Respondents indicated difficulty with triaging multiple child disaster victims “due to emotional obstacles; unfamiliarity with pediatric physiology; and struggles with triage rationale and efficiency.”

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Tegtmeyer, K., Conway, E., Upperman, J., et al. (2011). Education in a Pediatric Emergency Mass Critical Care Setting. (Abstract only.) Pediatric Critical Care Medicine. 12(6 Suppl):S135-40.

This article describes recommendations made by the Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields. They met in 2010 and emphasized the identification of educational needs to prepare for a pediatric emergency mass critical care event for all healthcare organizations.

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Toida, C. (2018). Introduction of Pediatric Physiological & Anatomical Triage Score in MCIs.

This 33-minute video discusses the Pediatric Physiological and Anatomical Triage score (PPATS), which was developed as a new secondary triage method.

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* Watts, J. (2018). Pediatric Injuries Treated at a Level 1 Trauma Center After an F5 Tornado. (Abstract only.) Pediatric Emergency Care. 34(11):783-786.

The authors retrospectively reviewed records on 10 pediatric patients in the trauma registry following the 2011 F5 tornado in Joplin, MO to characterize their injuries. They found that traumatic brain injury was the most common diagnosis followed by orthopedic and maxillofacial injuries. Seven patients required surgical procedures in the operating room, and 8 patients were intubated and in the pediatric intensive care unit.

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Agencies and Organizations

American Academy of Pediatrics. Council on Children and Disasters (COCD).

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American Academy of Pediatrics. Disasters and Children.

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California Hospital Association. Pediatric Disaster Planning Considerations.

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Centers for Disease Control and Prevention. Caring for Children in a Disaster.

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Children's Hospital Los Angeles. National Center on School Crisis and Bereavement.

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Coalition to Support Grieving Students.

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Federal Emergency Management Agency. Emergency Planning with Children.

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Florida Department of Health. Children's Disaster Preparedness.

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Illinois Emergency Medical Services for Children. EMS for Children (EMSC) Program.

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National Pediatric Disaster Coalition. Homepage.

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Ready.gov. Ready Kids.

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The National Child Traumatic Stress Network. Homepage.

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U.S. Department of Health and Human Services, Administration for Children and Families, Office of Child Care. Emergency Preparedness.

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U.S. Department of Health and Human Services, Administration for Children and Families, Office of Human Services Emergency Preparedness and Response. Early Childhood Disaster-Related Resources.

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Western Regional Alliance for Pediatric Emergency Management (WRAP-EM).

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This ASPR TRACIE Topic Collection was refreshed and comprehensively reviewed in May 2019 by the following subject matter experts (listed in alphabetical order): Laura Aird, MS, Senior Manager, Emerging Threats and Disaster Management, American Academy of Pediatrics, Department of Healthy Resilient Children, Youth and Families; Eric R. Alberts, CEM, CHS-V, FPEM, FPEM-HC, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); Sean Diederich, Program Manager, Pandemic Influenza and Disaster Planning, American Academy of Pediatrics, Department of Healthy Resilient Children, Youth and Families; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Sarah O’Donnell, MPH, Public Health Analyst/Project Officer, Emergency Medical Services for Children Program, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau, (MCHB); and Mary Russell, EdD, MSN, Healthcare Emergency Response Coalition of Palm Beach County, Florida.

It was comprehensively reviewed in November 2015 by the following subject matter experts (listed in alphabetical order): Eric Alberts, BS, FPEM, CHS-V, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); LCDR Eric Dziuban, MD, DTM, FAAP, Team Lead, Children’s Preparedness Unit, and Chief Medical Officer, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention; Pat Frost, RN, MS, PNP, Director Emergency Medical Services, Contra Costa Health Services; Anthony Gilchrest, MPA, EMT-P, EMS Program Manager, EMSC National Resource Center, Division of Emergency Medicine, Children’s National Medical Center; Stephanie Griese, MD, MPH, FAAP, Lieutenant Commander, USPHS, and Medical Epidemiologist, Office of Science and Public Health Practice, Office of Public Health Preparedness and Response, U.S. Centers for Disease Control and Prevention; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Mary King, MD, MPH, Pediatric Critical Care Medicine, Medical Director, PICU, Harborview Medical Center, and Assistant Professor, University of Washington; Lauralee Koziol, National Advisor on Children and Disasters, Federal Emergency Management Agency; Diane Pilkey, RN, MPH, Nursing Consultant, U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Emergency Medical Services for Children and Injury Prevention Branch; Wendy Ruben, MS, CHES, Health Communication Specialist, Children’s Preparedness Unit, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention; and Mary Russell, EdD MSN, Emergency Services, Boca Raton Regional Hospital. Additional assistance provided by Sean Diederich, Program Coordinator, Disaster Preparedness and Response, American Academy of Pediatrics, Department of Child Health and Wellness; and Joelle N. Simpson, MD, MPH, Medical Director for Emergency Preparedness, Children's National Health System, and Assistant Professor of Pediatrics & Emergency Medicine, The George Washington University, School of Medicine and Health Sciences, Emergency Medicine and Trauma Center.

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