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Surge Capacity and Health System Preparedness

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Pediatric Disaster and Terrorism Preparedness

Slide Presentation by David Markenson, M.D

On July 13, 2004, David Markenson, M.D., made a presentation in a Web Conference entitled Surge Capacity and Health System Preparedness: Facilities and Equipment.

This is the text version of Dr. Markenson's slide presentation. Select to access the PowerPoint® slides (1.1 MB).

Slide 1:

Pediatric Disaster and Terrorism Preparedness

David Markenson, M.D.
Director, The Program for Pediatric Preparedness
Deputy Director, National Center for Disaster Preparedness
Mailman School of Public Health, Columbia University
New York, NY

Slide 2:

Unique Anatomy and Physiology

  • Increased Surface Area/Volume
    • More absorptive surface.
    • More susceptible to volume losses.
  • Increased Minute Ventilation/Lower Breathing Zone.
  • Thinner Epidermis/Under-keratinized Epidermis.
  • Immature Blood-brain Barrier.
  • Procedural Difficulties.
  • Psychological Immaturity.

Slide 3:

Importance of Pediatric Considerations

  • Children are part of the population:
    • 26% of the U.S. population are children and youth.
    • More than 20 million are under the age of 6 years.
  • Ignoring children may compromise entire preparedness plan:
    • August 2003 Survey:
      • 90% nationally and 92% in New York City, reported that they would not comply with an official evacuation order.
      • 66% of the national sample; 62% of New Yorkers listed concern for their children as the main reason.

Slide 4:

Pediatric Terrorism Exposure

  • Inadvertently (Classic Thinking)
    • Secondary victims in terrorist attack.
    • Catastrophic event at chemical/ nuclear plant.
  • Intentionally targeted (New Thinking)

Slide 5:

What is Pediatric Surge?

  • Secondary Victims:
    • Proportion of normal census.
  • Uniquely Pediatric Event:
    • Out of proportion to normal census.
    • School, day care, school bus, camp.
  • Family Unit:
    • Ability to care for family without separating children and adults.

Slide 6:

Pediatric Surge Planning

  • Address Pediatrics out of Proportion to Normal Numbers:
    • Emergency operations plans.
    • Providers.
    • Equipment and pharmaceuticals.
    • Drills and exercises.
  • Plans for Care of Children:
    • Adult providers.
    • Adult units.
    • Adult equipment.
  • Plans for Care of Adults in Pediatric Units.

Slide 7:

Federal and State Resources

  • Strategic National Stockpile (SNS)
    • Improved but limited pediatric content.
    • Restricted to FDA indicated usages.
  • Disaster Medical Assistance Team/ National Disaster Medical System (DMAT/NDMS)
    • No pediatric requirements:
      • Staff.
      • Pharmaceuticals.
      • Equipment.
    • 2 Self-certified pediatric teams.

Slide 8:

Federal and State Resources

  • State Stockpiles
    • Based on SNS.
  • Medical Reserve Corps (MRC)
    • No defined pediatric capability.
    • Questionable functionality.
  • Time Delay
    • Federal:
      • 6-48 hours.
    • Pediatric Alternative:
      • Unknown.

Slide 9:


  • Water pressure:
    • Will it injure child?
  • Water temperature:
    • Hypothermia.
  • Non-ambulatory child:
    • Infants and toddlers.
    • Children with special healthcare needs.
  • Mental health concerns:
    • Will children follow instructions?
    • Long term effects.

Slide 10:

What Are Some Of The Solutions?

  • National Advisory Committee on Children and Terrorism.
  • Pediatric Disaster and Terrorism Preparedness: National Consensus Guidelines.
  • Pediatric Expert Advisory Panel.

Slide 11:

Pediatric Disaster and Terrorism Preparedness: National Guidelines

  • Preparedness and Treatments:
    • Biologic.
    • Chemical.
    • Radiologic.
    • NPS.
    • Decontamination.
  • Natural Disasters.
  • Hospital Preparedness.
  • Mental Health Schools.
  • Primary Care Providers.
  • Displaced Children.
  • National Disaster Medical System.
  • Training.
  • Drills and Simulations.

Slide 12:

Pediatric Expert Advisory Panel

  • The purpose of the Pediatric Expert Advisory Panel (PEAP) is to:
    • Discuss and analyze current issues:
      • Multi-disciplinary.
      • Governmental and non-governmental bridge.
      • On-going program.
      • Ability for rapid analysis.
      • Dissemination of findings:
        • Web.
        • InfoBrief.
        • Conference or Symposia.

Slide 13:

Pediatric Expert Advisory Panel

  • Pediatric Dosage AtroPen®
    • Approved by FDA in past few months.
    • Questions regarding:
      • Indications.
      • Role.
      • Pediatric AtroPen or Mark I:
        • Indications.
        • Protocols.
        • Stockpile.

Current as of October 2004

Internet Citation:

Pediatric Disaster and Terrorism Preparedness. Text version of a slide presentation at a Web conference. Agency for Healthcare Research and Quality, Rockville, MD.

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