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Program Details
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| Practice Type: |
Model |
| Program Name: |
Public Health - Seattle and King County FL Model Preparedness or Access and Integrated Services |
| Organization: |
Public Health - Seattle and King County |
| Web site: |
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| Overview: |
The public health issue addressed in this project is the gap in regional emergency response capacity and capability to care for pediatric patients in disaster. In a large-scale medical emergency, critically ill or injured children may present to any and all hospitals in the region. Their anatomical, physiological and developmental differences from adults require different medical management. Transfer by emergency responders to pediatric-specific hospitals may be impossible due to a shortage of vehicles, impassable roads and bridges or the instability of the patient. Pediatric hospitals may be unable to receive patients due to overwhelmed capacity or structural damage. All hospitals should be prepared to receive pediatric patients in a mass casualty incident and to provide appropriate short-term acute care and more definitive management, depending upon the nature of the emergency and the extent of its impact on the region. Goal: All King County hospitals that provide emergency services will be prepared to provide age-appropriate medical management of pediatric patients in a mass casualty incident (MCI). Objective 1: The Pediatric Workgroup Triage and Critical Care Task Force will assess triage systems currently used in an MCI by King County hospitals with emergency services by September 2008. Objective 2: The Task Force will develop a “pediatric toolkit” to provide basic information and guidelines for emergency management of pediatric patients to all King County hospitals that provide emergency services by December, 2009. In July 2008 the Task Force conducted a web-based survey to assess triage systems used in an MCI by King County hospital emergency departments. Response rate was 94%. Analysis of the survey showed a need for consistency in the approach to triage and assessment of pediatric patients in an emergency, prompting the proposal to develop a “pediatric toolkit.” Development of the toolkit was an iterative process that included streamlining a document used as the framework and adapting it to local practice and resources. After peer review, the toolkit, “Hospital Guidelines for Management of Pediatric Patients in Disaster,” was introduced to regional hospital emergency managers in December 2009. In January 2010, hospital pediatric emergency planners met with members of the Task Force and the Healthcare Coalition to learn more details about the toolkit and its rationale and to discuss content of a proposed workshop to be held in March 2010. Hospital planners were encouraged to move forward with steps 1 and 2 of the implementation guidelines: 1) “surveying hospital staff to identify in-house pediatric expertise” and 2) “creating pediatric leadership positions for key personnel,” in order to identify individuals to send as delegates to the workshop. |
| Year Submitted: |
2010 |
| Responsiveness and Innovation: |
The local public health issue addressed in this project is the gap in regional emergency response capacity and capability to care for pediatric patients in disaster. In 2007, a member of the Triage Task Force conducted a study of hospital pediatric resources in King County. (King, Prehospital and Disaster Medicine, publication pending) The author determined that while most hospital-based pediatric staff, beds, supplies and equipment are concentrated in the City of Seattle, the majority of children and teenagers live in outlying areas of the county. King County is prone to earthquakes and weather-related disasters that can disrupt transportation routes, including vulnerable bridges over long stretches of water, impeding access to pediatric-specific hospital care. In a mass casualty incident that involves children, emergency responders might be unable to transport them to the hospitals with pediatric specialty services. In the case of a natural disaster, those services might be overwhelmed or the pediatric-specific hospitals might be structurally damaged and uninhabitable. In addition, the Healthcare Coalition recently completed an annex to the regional hospital evacuation plan to include specific planning for pediatric patients of all ages. In the process, which involved participation and input from representatives of all hospitals that provide any type of pediatric service, including intensive care units, it became apparent that hospitals which currently do not have designated pediatric beds will be called upon to surge to accommodate pediatric patients, depending on the nature of the emergency.In July 2008, the Task Force conducted a needs assessment of King County hospitals that provide emergency services to determine currently used triage systems in an MCI and use of the length-based resuscitation tape (e.g., Broselow Tape®), a tool that assists in rapidly determining appropriate dosage of medications and size of equipment for pediatric patients. The survey response rate was 94% (17 of 18 hospitals). Although all responding hospitals indicated that they have such a tape in their emergency departments, its usage varies according to condition of the patient, staff’s familiarity with proper usage or indications for use as well as simply remembering that it is available and being able to locate it. The Task Force interpreted these findings to suggest that, in a mass casualty incident involving children, King County hospital emergency departments would have varying degrees of experience and confidence in dealing with pediatric patients. The concept of bringing pediatric expertise and management consistency in a "pediatric toolkit" to all hospitals was proposed and, subsequently, presented to the region’s hospital emergency planners and trauma council for endorsement.The toolkit, “Hospital Guidelines for Management of Pediatric Patients in Disaster,” is a 42-page document with guidelines for response to an influx of pediatric patients, designed to be integrated into the hospital incident command structure. Topics related to pediatric disaster preparedness include the following: staffing and training, equipment and supplies, pharmaceutical planning, dietary planning, security and psychosocial support, transportation issues (both internal and external), inpatient bed planning, decontamination of children and hospital-based triage. Practical job aids include job action sheets for pediatric leadership positions, checklists, sample menus, patient tracking, and evacuation forms and information for medical staff and parents about psychological first aid and possible reactions of children after a disaster. The guidelines are intended to provide hospitals with consistent basic information and tools to become better prepared to receive and manage large numbers of injured or critically ill pediatric patients, along with a suggested 10-step plan for implementation. In addition, the Task Force plans to provide technical support, starting with a workshop for identified pediatric leadership from each hospital, with ongoing train-the-trainer opportunities, such as mock pediatric codes with simulation equipment and demonstration models of triage and pediatric safe areas. Review of the literature confirms long-standing concern about emergency care of children in a disaster, traced back to a report of the Institute of Medicine in 1993, “Emergency Medical Services for Children.” A decade later, the report of a national consensus conference, “Pediatric Preparedness for Disasters and Terrorism” included the following as a priority recommendation: “Ensure preparedness in all hospitals, with children’s hospitals playing a crucial role in educating the community, training health care providers, and directing the care of children in general hospitals when the numbers of children or logistics prevent transport to a children’s hospital.” In 2006, the Institute of Medicine confronted the issue once again in a Consensus Report, “Emergency Care for Children: Growing Pains,” and the American Academy of Pediatrics, in cooperation with the Agency for Health Research and Quality, published “Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians.” Most recently, we have seen the October 2009 “Interim Report” of the National Commission on Children and Disasters. All of these reports highlight the unique health, behavioral and psychosocial needs of children and the gaps in emergency response capacity and capability to care for children in a large-scale medical emergency in the United States. However, a recent review of the literature to identify evaluated pediatric emergency preparedness training programs reveals that virtually none currently exist. (Ablah, J of Trauma, 2009) The article concludes with recommendation for evaluation of existing training programs and development of standardized training guidelines. The basic framework and inspiration for the pediatric toolkit was a document published by New York City’s Department of Health and Mental Hygiene (NYC), “Children in Disasters: Hospital Guidelines for Pediatric Preparedness,” available at: http://www.nyc.gov/html/doh/downloads/pdf/bhpp/hepp-peds-childrenindisasters-010709.pdf . The Task Force made the calculated decision that King County hospitals would more likely accept a streamlined version which was adapted to local needs and current medical practice. Consequently, one of the guiding principles in development of “Hospital Guidelines for Management of Pediatric Patients in Disaster” was to include the most basic and essential information for the sake of brevity, with attribution to NYC’s document, should any facility want to seek out more detail. It is a 42-page document, one-third the size of NYC’s, and is formatted, when possible and appropriate, to be reproduced as a source of practical information for quick reference, such as by enlarging tables and algorithms for posting in the emergency department and distributing relevant sections to specific planners and leadership positions. Since the process of implementation of these guidelines might seem daunting to hospitals that do not have pediatric-specific services, a 10-step approach is suggested, starting with identification of in-house pediatric expertise and interest, in order to involve more individuals in the planning process. Implementation of a straightforward and consistent system to manage pediatric patients in hospitals across the county in the event of a large-scale emergency will enhance regional connectivity and communication and will, in essence, result in formation of a pediatric response network. Seattle Children’s Hospital is a regional pediatric-specific facility and provides care to children, teens and young adults throughout the Pacific Northwest. As is the usual case with availability of a regionalized pediatric-specific medical center, general hospitals care for minor illness and trauma or stabilize a seriously ill or injured child, then transfer the patient to the hospital with pediatric-specific beds. To increase access to regionalized pediatric-specific care in an emergency, some jurisdictions have chosen to increase prehospital emergency responder capacity and capability. King County is prone to earthquakes and weather-related disasters that can disrupt transportation routes, including vulnerable bridges over long stretches of water, impeding access to pediatric specialty care. In a mass casualty incident that involves children, emergency responders may be unable to transport them to the hospitals with pediatric-specific services. In addition, pediatric specialty services may be overwhelmed or the pediatric-specific hospitals may be structurally damaged and unavailable. Although this scenario may have been considered by some area hospitals, regional pediatric-specific planning for management of a mass casualty event involving children, minus the option of transferring patients to a pediatric-specific hospital, has not happened. The pediatric toolkit provides each hospital with the basic information and guidelines to establish a response system that is consistent across the county to manage a surge in pediatric patients. In a large-scale medical emergency, this pediatric-specific surge capacity and capability will be crucial. To make the process less daunting, the toolkit guidelines suggest a 10-step approach to develop pediatric-specific response capability. The plan to promote implementation of the toolkit in all King County hospitals with emergency services serves multiple purposes: • Suggests a consistent approach to pediatric-specific response across the region • Provides more opportunities and planning efficiencies in training and exercises that can be shared among participating hospitals • Fosters development of a communication and collaboration network • Facilitates planning and coordination with prehospital emergency responders and emergency management agencies • Builds pediatric capability and capacity across region • Redefines relationship with regional pediatric-specific hospital which, in a large-scale disaster, might be called to serve in a consulting capacity, e.g., in the form of telemedicine N/AN/APublic Health – Seattle & King County provides technical support to the Coalition through its staff which is housed in the Public Health’s Preparedness Division. As Coalition members, representatives of healthcare agencies, including all King County hospitals, participate in regular regional planning meetings, trainings and exercises, which are coordinated through Public Health. In addition, Public Health is responsible for activating the Health & Medical Area Command (HMAC) to direct, coordinate and mobilize health and medical resources, information and personnel during emergencies and disasters. It is comprised of various personnel with disaster planning and response expertise, including Public Health emergency preparedness staff, local government staff, liaisons to local emergency management, emergency medical reserve corps, and healthcare providers with expertise in logistics, planning and emergency response, which includes Emergency Medical Services (EMS), a division of Public Health. The Task Force presented the proposal for development of the pediatric toolkit to the regional EMS and Trauma Council for endorsement and verified that the triage scheme suggested in the toolkit guidelines is consistent with that currently used for pediatric patients by EMS and paramedics in the field, assuring a seamless transition from prehospital to hospital-based triage. The Coalition organization includes the Pediatric Workgroup, comprised of community pediatricians and pediatric healthcare workers. Within the Workgroup, there are currently three active task forces, each of which is comprised of community healthcare providers: Mental Health, Perinatal and Triage & Critical Care. Public Health has recently facilitated development of a Neonatal & Pediatric Evacuation Annex to the Regional Medical Evacuation and Patient Tracking Mutual Aid Plan that included on-site meetings at all hospitals with inpatient pediatric services of any type, including NICU and PICU, to assess tiered surge capacity. During that planning, meetings were held with regional emergency services and transportation providers to determine capabilities and capacity for transport of pediatric patients. This information will support and augment pediatric surge capacity and capability planning on a regional basis as the toolkit becomes widely implemented. |
| Agency and Community Roles: |
Public Health – Seattle & King County (Public Health) is a founding member of the King County Healthcare Coalition, a network of more than 150 healthcare agencies and partners, established in 2005 with the goal of coordination of response and utilization of resources in a healthcare emergency. Public Health provides technical support to the Coalition through its Preparedness Division, which houses the Coalition Program Manager and a team of program planners. The planner for the Pediatric Workgroup of the Coalition, a Public Health employee who is a pediatrician and medical epidemiologist in the Communicable Disease Section, provided planning and technical support for the Task Force, which developed the pediatric toolkit. Coalition and Public Health staff also coordinates trainings and exercises for Coalition members. The workshop planned for hospital pediatric response planners in the spring will be sponsored and coordinated by Coalition and Public Health staff. The Coalition’s Pediatric Triage & Critical Care Taskforce, which developed the pediatric toolkit, includes community physicians and nursing from four community hospitals in the county, representing pediatric expertise in outpatient, critical care and emergency medicine. The final document was reviewed by a critical care expert at Seattle Children’s hospital and by the Disaster Committee of Harborview Medical Center, the designated regional trauma center. During the planning phase, members of the Task Force made two separate presentations to the Healthcare Coalition’s Hospital Emergency Planning Committee, which represents all county hospitals, and to the regional Emergency Medical Services (EMS) and Trauma Care Council. The first presentation concerned the proposal of the survey of King County hospitals regarding currently used hospital-based triage systems for mass casualty incidents and the second presented the proposal for the concept of developing a pediatric toolkit. A general hospital in the south region of the county hosted the January meeting to introduce the toolkit to emergency planning representatives of all King County hospitals with emergency services. Those individuals were charged with promoting the toolkit to their individual hospital’s leadership and selecting pediatric planning leadership to attend a workshop for orientation to the guidelines, discussions regarding implementation and opportunity for technical support, provided by members of the Task Force. Future training opportunities will be identified at the workshop, including interface and planning with the emergency responder community. The ultimate responsibility for implementation of the pediatric management system remains with each individual hospital, although there will be ample avenues for Coalition support, from the well-established Hospital Emergency Planning Committee to the Coalition Executive Leadership Council. The cooperative relationships established within the Coalition will foster full participation. The Task Force welcomes an opportunity for collaboration among hospital pediatric response planners to identify barriers to implementation of the toolkit as well as opportunities for efficient management of pediatric resources in creation of a regional pediatric response network |
| Costs and Expenditures: |
The King County Healthcare Coalition is a network of more than 150 healthcare organizations and healthcare partners, established in 2005 to collaborate in a medical emergency to provide an effective and efficient response. The Coalition’s Pediatric Workgroup focuses on issues specific to children and adolescents and has acknowledged particular concern regarding the geographic distribution of the pediatric population in greater King County, Washington, compared with accessibility to pediatric hospital services, which are concentrated in the City of Seattle. In a region-wide emergency, such as an earthquake, large regions of the county could become “islands of healthcare” that have no access to pediatric-specific services. The Pediatric Triage and Critical Care Task Force, an active committee of the Workgroup, is comprised of emergency medicine, outpatient and critical care pediatric physicians and pediatric nursing. The Task Force initially conducted an assessment of triage systems used by King County hospitals in a mass casualty incident. Considering that information, the Task Force proposed to develop a “pediatric toolkit” to provide area hospitals with basic guidelines and resources to respond in the event of a large-scale medical emergency that involves children, floating that concept to the Coalition’s Hospital Emergency Planning Strategy Group and the regional EMS and Trauma Council. In its research into disaster triage systems, the Task Force was fortunate to find a recently published comprehensive document, “Children in Disasters: Hospital Guidelines for Pediatric Preparedness,” commissioned by the New York City Department of Health and Mental Hygiene (NYC). After contacting NYC to obtain permissions, the Task Force used the document as a framework, streamlining its content, adapting guidelines, equipment and supply lists to local practice and creating a 10-step approach for hospitals to move forward with implementation. After a year of deliberations, the final draft of “Hospital Guidelines for Management of Pediatric Patients in Disaster” was submitted for peer review. The completed document was introduced to a meeting of hospital emergency planners to give a broad overview of the guidelines and to discuss plans for implementation, which include an introductory workshop for pediatric planners from each hospital in March 2010. Time of support staff for Task Force $ 35,000 (includes benefits) Time of members of Pediatric Workgroup Triage Task Force (in kind) Time of hospital survey responders (in kind) Time of document reviewers (in kind) A Public Health salaried staff member provided both planning and technical support for the Task Force. Funding for that position was derived from two sources: 78% of funding was provided through an NIH/NIAID grant to University of Washington’s Northwest Regional Center of Excellence for Biodefense and Emerging Infectious Diseases Research. The additional 22% of funding was provided through federal “PHEPR LHJ Funding” to Public Health – Seattle & King County. |
| Implementation: |
The local public health issue addressed in this project is the gap in regional emergency response capacity and capability to care for pediatric patients in disaster. In 2007, a member of the Triage Task Force conducted a study of hospital pediatric resources in King County. (King, Prehospital and Disaster Medicine, publication pending) The author determined that while most hospital-based pediatric staff, beds, supplies and equipment are concentrated in the City of Seattle, the majority of children and teenagers live in outlying areas of the county. King County is prone to earthquakes and weather-related disasters that can disrupt transportation routes, including vulnerable bridges over long stretches of water, impeding access to pediatric-specific hospital care. In a mass casualty incident that involves children, emergency responders might be unable to transport them to the hospitals with pediatric specialty services. In the case of a natural disaster, those services might be overwhelmed or the pediatric-specific hospitals might be structurally damaged and uninhabitable. In addition, the Healthcare Coalition recently completed an annex to the regional hospital evacuation plan to include specific planning for pediatric patients of all ages. In the process, which involved participation and input from representatives of all hospitals that provide any type of pediatric service, including intensive care units, it became apparent that hospitals which currently do not have designated pediatric beds will be called upon to surge to accommodate pediatric patients, depending on the nature of the emergency.In July 2008, the Task Force conducted a needs assessment of King County hospitals that provide emergency services to determine currently used triage systems in an MCI and use of the length-based resuscitation tape (e.g., Broselow Tape®), a tool that assists in rapidly determining appropriate dosage of medications and size of equipment for pediatric patients. The survey response rate was 94% (17 of 18 hospitals). Although all responding hospitals indicated that they have such a tape in their emergency departments, its usage varies according to condition of the patient, staff’s familiarity with proper usage or indications for use as well as simply remembering that it is available and being able to locate it. The Task Force interpreted these findings to suggest that, in a mass casualty incident involving children, King County hospital emergency departments would have varying degrees of experience and confidence in dealing with pediatric patients. The concept of bringing pediatric expertise and management consistency in a "pediatric toolkit" to all hospitals was proposed and, subsequently, presented to the region’s hospital emergency planners and trauma council for endorsement.The toolkit, “Hospital Guidelines for Management of Pediatric Patients in Disaster,” is a 42-page document with guidelines for response to an influx of pediatric patients, designed to be integrated into the hospital incident command structure. Topics related to pediatric disaster preparedness include the following: staffing and training, equipment and supplies, pharmaceutical planning, dietary planning, security and psychosocial support, transportation issues (both internal and external), inpatient bed planning, decontamination of children and hospital-based triage. Practical job aids include job action sheets for pediatric leadership positions, checklists, sample menus, patient tracking, and evacuation forms and information for medical staff and parents about psychological first aid and possible reactions of children after a disaster. The guidelines are intended to provide hospitals with consistent basic information and tools to become better prepared to receive and manage large numbers of injured or critically ill pediatric patients, along with a suggested 10-step plan for implementation. In addition, the Task Force plans to provide technical support, starting with a workshop for identified pediatric leadership from each hospital, with ongoing train-the-trainer opportunities, such as mock pediatric codes with simulation equipment and demonstration models of triage and pediatric safe areas. Review of the literature confirms long-standing concern about emergency care of children in a disaster, traced back to a report of the Institute of Medicine in 1993, “Emergency Medical Services for Children.” A decade later, the report of a national consensus conference, “Pediatric Preparedness for Disasters and Terrorism” included the following as a priority recommendation: “Ensure preparedness in all hospitals, with children’s hospitals playing a crucial role in educating the community, training health care providers, and directing the care of children in general hospitals when the numbers of children or logistics prevent transport to a children’s hospital.” In 2006, the Institute of Medicine confronted the issue once again in a Consensus Report, “Emergency Care for Children: Growing Pains,” and the American Academy of Pediatrics, in cooperation with the Agency for Health Research and Quality, published “Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians.” Most recently, we have seen the October 2009 “Interim Report” of the National Commission on Children and Disasters. All of these reports highlight the unique health, behavioral and psychosocial needs of children and the gaps in emergency response capacity and capability to care for children in a large-scale medical emergency in the United States. However, a recent review of the literature to identify evaluated pediatric emergency preparedness training programs reveals that virtually none currently exist. (Ablah, J of Trauma, 2009) The article concludes with recommendation for evaluation of existing training programs and development of standardized training guidelines. The basic framework and inspiration for the pediatric toolkit was a document published by New York City’s Department of Health and Mental Hygiene (NYC), “Children in Disasters: Hospital Guidelines for Pediatric Preparedness,” available at: http://www.nyc.gov/html/doh/downloads/pdf/bhpp/hepp-peds-childrenindisasters-010709.pdf . The Task Force made the calculated decision that King County hospitals would more likely accept a streamlined version which was adapted to local needs and current medical practice. Consequently, one of the guiding principles in development of “Hospital Guidelines for Management of Pediatric Patients in Disaster” was to include the most basic and essential information for the sake of brevity, with attribution to NYC’s document, should any facility want to seek out more detail. It is a 42-page document, one-third the size of NYC’s, and is formatted, when possible and appropriate, to be reproduced as a source of practical information for quick reference, such as by enlarging tables and algorithms for posting in the emergency department and distributing relevant sections to specific planners and leadership positions. Since the process of implementation of these guidelines might seem daunting to hospitals that do not have pediatric-specific services, a 10-step approach is suggested, starting with identification of in-house pediatric expertise and interest, in order to involve more individuals in the planning process. Implementation of a straightforward and consistent system to manage pediatric patients in hospitals across the county in the event of a large-scale emergency will enhance regional connectivity and communication and will, in essence, result in formation of a pediatric response network. Seattle Children’s Hospital is a regional pediatric-specific facility and provides care to children, teens and young adults throughout the Pacific Northwest. As is the usual case with availability of a regionalized pediatric-specific medical center, general hospitals care for minor illness and trauma or stabilize a seriously ill or injured child, then transfer the patient to the hospital with pediatric-specific beds. To increase access to regionalized pediatric-specific care in an emergency, some jurisdictions have chosen to increase prehospital emergency responder capacity and capability. King County is prone to earthquakes and weather-related disasters that can disrupt transportation routes, including vulnerable bridges over long stretches of water, impeding access to pediatric specialty care. In a mass casualty incident that involves children, emergency responders may be unable to transport them to the hospitals with pediatric-specific services. In addition, pediatric specialty services may be overwhelmed or the pediatric-specific hospitals may be structurally damaged and unavailable. Although this scenario may have been considered by some area hospitals, regional pediatric-specific planning for management of a mass casualty event involving children, minus the option of transferring patients to a pediatric-specific hospital, has not happened. The pediatric toolkit provides each hospital with the basic information and guidelines to establish a response system that is consistent across the county to manage a surge in pediatric patients. In a large-scale medical emergency, this pediatric-specific surge capacity and capability will be crucial. To make the process less daunting, the toolkit guidelines suggest a 10-step approach to develop pediatric-specific response capability. The plan to promote implementation of the toolkit in all King County hospitals with emergency services serves multiple purposes: • Suggests a consistent approach to pediatric-specific response across the region • Provides more opportunities and planning efficiencies in training and exercises that can be shared among participating hospitals • Fosters development of a communication and collaboration network • Facilitates planning and coordination with prehospital emergency responders and emergency management agencies • Builds pediatric capability and capacity across region • Redefines relationship with regional pediatric-specific hospital which, in a large-scale disaster, might be called to serve in a consulting capacity, e.g., in the form of telemedicine N/AN/APublic Health – Seattle & King County provides technical support to the Coalition through its staff which is housed in the Public Health’s Preparedness Division. As Coalition members, representatives of healthcare agencies, including all King County hospitals, participate in regular regional planning meetings, trainings and exercises, which are coordinated through Public Health. In addition, Public Health is responsible for activating the Health & Medical Area Command (HMAC) to direct, coordinate and mobilize health and medical resources, information and personnel during emergencies and disasters. It is comprised of various personnel with disaster planning and response expertise, including Public Health emergency preparedness staff, local government staff, liaisons to local emergency management, emergency medical reserve corps, and healthcare providers with expertise in logistics, planning and emergency response, which includes Emergency Medical Services (EMS), a division of Public Health. The Task Force presented the proposal for development of the pediatric toolkit to the regional EMS and Trauma Council for endorsement and verified that the triage scheme suggested in the toolkit guidelines is consistent with that currently used for pediatric patients by EMS and paramedics in the field, assuring a seamless transition from prehospital to hospital-based triage. The Coalition organization includes the Pediatric Workgroup, comprised of community pediatricians and pediatric healthcare workers. Within the Workgroup, there are currently three active task forces, each of which is comprised of community healthcare providers: Mental Health, Perinatal and Triage & Critical Care. Public Health has recently facilitated development of a Neonatal & Pediatric Evacuation Annex to the Regional Medical Evacuation and Patient Tracking Mutual Aid Plan that included on-site meetings at all hospitals with inpatient pediatric services of any type, including NICU and PICU, to assess tiered surge capacity. During that planning, meetings were held with regional emergency services and transportation providers to determine capabilities and capacity for transport of pediatric patients. This information will support and augment pediatric surge capacity and capability planning on a regional basis as the toolkit becomes widely implemented. |
| Sustainability: |
The King County Healthcare Coalition was established in 2005 with the purpose of coordinating healthcare agency response and efficient and effective utilization of resources in a healthcare emergency. Over the past years, the network has tripled in size and now consists of more than 150 healthcare agencies and healthcare partners, including all King County hospitals. Agencies have experienced many benefits of regional emergency planning and exercise, including compliance with a healthy percentage of Joint Commission emergency management standards in the process. There are regular monthly meetings of emergency planners that include not only hospitals, but also regional healthcare partners. The leadership body of the Coalition has increasingly played a decisive role in urgent healthcare system issues, including the recent 2009 H1N1 Influenza spring outbreak and subsequent pandemic. Two processes over recent years have convinced Coalition members that there is a significant gap in regional emergency planning for pediatric patients: the 2007 survey of distribution of hospital pediatric resources and the development of the Neonatal & Pediatric Evacuation Annex to the Regional Medical Evacuation and Patient Tracking Mutual Aid Plan. Both confirmed the limited ability of most hospitals in the region to accommodate and manage a surge of pediatric patients in a disaster. Evacuation planning permitted hospitals to envision their potential to surge in pediatric bed capacity. The toolkit takes the next step and provides guidelines to create a system for basic management of an influx of pediatric patients. It gives each hospital a set of tools to move forward with pediatric-specific response planning. Development of the pediatric toolkit has received support from regional stakeholders, including the Coalition hospital emergency planners, regional emergency responders, and members of the pediatric healthcare community. Since its introduction in December 2009, emergency planners in an adjacent county have expressed interest and have requested permission to use the guidelines. Coalition planners have agreed that it is important to include pediatric planners from north and south adjacent counties in the March workshop. Another sign of regional acceptance is incorporation of many of the guidelines in pediatric planning for Alternate Care Facilities, which would be activated in the event of a large scale emergency, such as this winter’s threat of significant regional flooding in the Green River Valley. The toolkit is designed to facilitate development of a practical system within each hospital, utilizing internal pediatric expertise and integrating with the hospital’s incident command structure. Pediatric specialists who have developed the guidelines have committed to provide technical support, with the backing of Coalition planners, in order to promote collaboration among hospitals to overcome commonly identified barriers to implementation and to seize opportunities to achieve regional efficiencies in assuring access to pediatric-specific supplies and equipment. A regional pediatric medical disaster preparedness network that works in conjunction with the broader emergency response system is the ultimate goal. |
| Lessons Learned: |
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