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Pediatric Hospital Surge Capacity in Public Health Emergencies

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Preparation by General Health Care Facilities for a Surge of Critically Ill Children

All health care facilities, not simply pediatric hospitals, must be prepared for a surge of critically ill children.19 Although emergency medical service (EMS) field efforts will attempt to match the victims' needs with the nearest appropriate hospital, the most recent disaster literature suggest that up to 50 percent of the victims arriving at a hospital under surge (mass casualty) scenario will arrive by other means. To accommodate a possible surge of pediatric patients, hospitals that care for adult patients should ensure that adequate, up-to-date stocks of pediatric supplies—Broselow tapes, endotracheal tubes, intravenous catheters, interosseous needles, ambu bags, and other equipment—are on site.19 Lastly, adult-only hospitals should diligently practice pediatric disaster drills.  These activities should also include all staff who may be called on to deliver care to children, including respiratory technicians, radiologists, and others. 

A surge of ill children may present considerable staffing challenges to general and adult-only hospitals. Although physicians who have undergone residency training in emergency medicine are prepared to manage acutely ill children, many general hospitals have limited numbers of pediatricians and pediatric support staff (e.g., child life specialists) on staff. Consequently, adult-only hospitals should develop lists with accompanying contact information (e.g., pager numbers, office phone numbers, home phone numbers, and cell phone numbers) of locally available pediatricians and nurses who will report to the hospital in the event of a surge. In metropolitan areas, adult-only hospitals should draft memoranda of understanding with local pediatric hospitals. These memoranda should:

  1. Delineate protocols for patient transfers and other direct patient-care activities between the two facilities.
  2. Provide for pediatric hospital clinicians to staff inpatient locations such as intensive care units and operating suites.
  3. Extend emergency staff privileges to pediatricians who are acutely needed to provide medical care in adult-only facilities.

The last two points are vitally important; patients from a bioterror attack may not be appropriate for transfer and therefore must remain in the receiving facility. Since inpatient care is closely linked to that provided in the emergency department (ED), sufficient numbers of pediatricians are required to staff inpatient beds, otherwise an ED will never decant its existing patient load and prepare for the arrival of more.  

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Security Concerns Unique to Children

Children caught up in a surge may be separated from parents. Siblings/families should be treated together whenever possible. If separation occurs, or if members are triaged to different levels of care, hospitals will need to establish a plan to ensure the security of these patients until the family can take custody.20

Hospitals should designate and staff a holding area to supervise and support unaccompanied children.20 General staffing guidelines—one adult per four infants or 10 preschool children or 20 school-aged children—may be superseded by local licensing standards for daycare.

To help track children, a Radio Frequency Identification Device (RFID) or barcode-based tracking system is optimal, but obtaining digital images of unaccompanied children is an alternative. In the event that cameras are unavailable, simply writing a description of general age, physical characteristics, clothing, and possessions can facilitate identification. Finally, the American Red Cross' Patient Connection Program can facilitate a focus on the delivery of medical care.20

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Emergency Credentialing

Surges that overwhelm a medical system may impel clinicians to offer temporary services. Even if hospitals can accomplish the unlikely goal of increasing capacity by 20-30 percent, these additional beds require staffing. Granting emergency privileges may alleviate staffing demands.21

Each hospital in a given geographical region may consider creating a database that includes all credentialed physicians, nurses, pharmacists, and ancillary staff. Once created, all databases can be combined into a master file that is stored centrally. In the event of a surge, medical personnel from unaffected areas can receive temporary credentialing for the duration of an emergency.21 Such an approach is inexpensive, accurate, and Joint Commission-compliant.21

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