Disaster Preparedness and Response for the Pediatrician: How to Get Involved Session S1082 Lou Romig MD, FAAP Michele R.
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Disaster Preparedness and Response for the Pediatrician: How to Get Involved Session S1082 Lou Romig MD, FAAP Michele R. McKee MD, FAAP Photo courtesy of www.photolibrary.fema.gov Disclosure: Michele McKee Faculty Disclosure Information In the past 12 months, I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation. Disclosure: Lou Romig I have no relevant financial relationship with the manufacturers of any commercial product and/or providers of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product or device. Disclaimer: Lou Romig I am a federal intermittent disaster employee under government salary only when deployed to a federallydeclared disaster. Opinions expressed in this session are strictly personal and shall not be construed as representing the opinion of any federal agency or other federal personnel. Objectives Learn about federal disaster planning programs Learn about disaster planning and preparedness issues for children and families Learn how to get involved in disaster planning and response Session presentation available at www.jumpstarttriage.com “More lectures” page Federal Disaster Planning and Response Photos courtesy of www.photolibrary.fema.gov National Response Framework • All hazards response • Local through federal levels • Includes common terminology through NIMS • Scalability • Flexibility • Adaptability www.fema.gov/nrf National Planning Scenarios Improvised Nuclear Device Aerosol Anthrax Pandemic Influenza Plague Blister Agent Toxic Industrial Chemicals Nerve Agent Chlorine Tank Explosion Major Earthquake Major Hurricane Radiological Dispersal Device Improvised Explosive Device Food Contamination Foreign Animal Disease Cyber Attack Disasters are local events Disaster Occurs Local County First Alert Executive Responders Requests Governor Aid From Informs FEMA Regional Director Field Operations THE National RESPONSE 15 Emergency Support Functions (ESFs) Declares Disaster Advises Requests Assistance FEMA Director Contacts Framework President Provides Emergency Response Team Sets Up Disaster Field Office Federal CoordinatingAppoints Officer Joins State Coordinating Officer National Response Framework EMERGENCY SUPPORT FUNCTIONS DOE USDA DOT Energy Food EPA NCS Hazardous Materials 11 12 1 10 Urban Search FEMA and Rescue 2 ESF 9 8 Health and Medical Communication 3 Public Works (USACE) 4 7 6 5 Firefighting HHS Resource Support Information Mass Care & Planning GSA FEMA ARC Opportunities for involvement DOD USDA & FS National Response Framework EMERGENCY SUPPORT FUNCTIONS ESF 13: Public Safety and Security (DOJ) ESF 14: Long-Term Community Recovery (FEMA) ESF 15: External Affairs (DHS) NOTE Photo from www.photolibrary.fema.gov There is no agency charged with assuring the welfare of children and families during and after disasters. ESF - 8 We’re from the Feds, and we’re here to help… Photos from www.photolibrary.fema.gov Lead Agency for ESF-8 Office of the Assistant Secretary for Preparedness and Response (ASPR) Office of Preparedness and Emergency Operations (OPEO) Roles of Emergency Support Function #8 Assessment of Health and Medical Needs Health Surveillance Medical Care Personnel Health/Medical Equipment and Supplies Patient Evacuation In-Hospital Care Food/Drug/Medical Device Safety Worker Health/Safety Roles of Emergency Support Function #8 Radiological, Chemical, and Biological Hazards Mental Health Public Health Information Vector Control Potable Water/Wastewater & Solid Waste Disposal Victim Identification/Mortuary Services Veterinary Services NDMS is a public/private sector partnership Federal partners - HHS, DOD, VA, DHS/FEMA NDMS Resource Teams DMATs – Disaster Medical Assistance Teams DMORTs – Disaster Mortuary Teams NVRTs – National Veterinary Response Teams NNRTs – National Nurse Response Teams NPRTs – National Pharmacy Response Teams So who’s watching out for kids and families? Photo from www.photolibrary.fema.gov Federal agencies with advisory roles National Institute of Child Health and Human Development (NICHD) Obstetric and Pediatric Section for Biodefense Activity Best Pharmaceuticals for Children Act of 2002 and 2007 Chemical, biological, radiological/nuclear weaponry Federal agencies with advisory roles Centers for Disease Control The Coordinating Office for Terrorism Preparedness & Emergency Response (COTPER) Represented on most federal-level advisory committees, including those with family/pediatric focus Grant dollars www.emergency.cdc.gov Federal agencies with advisory roles National Biodefense Science Board Established under the Pandemic and All-Hazards Preparedness Act, 2007 Guidance to HHS One voting member is pediatric ID specialist (Dr Andrew Pavia) Working groups may have pediatric specialists http://www.dhhs.gov/aspr/omsph/nb sb/index.html Federal commissions with advisory roles National Advisory Committee on Children and Terrorism Public Health Security and Bioterrorism Preparedness and Response Act of 2002 Established 2003 by Sen. Clinton Hosted by CDC 34 broad recommendations to the Secretary of HHS http://www.bt.cdc.gov/children/PDF/ working/Recommend.pdf Federal commissions with advisory roles National Commission on Children and Disasters H.R. 3495: Kids in Disasters Wellbeing, Safety, and Health Act of 2007 (WiSH Act) Still pending in the Senate Focuses on evaluating existing law and policy and incorporating lessons learned into new law and policy. Federal commissions with advisory roles National Commission on Children and Disasters Establishes a national resource center on children and disasters Report to Congress and the President http://www.govtrack.us/congress/bill. xpd?bill=h110-3495&tab=summary http://www.ncdp.mailman.columbia.edu/index.html AAP Disaster Preparedness Advisory Council 3-5 yr strategic action plan for AAP Oversee/support AAP initiatives Strengthen AAP advocacy efforts http://www.aap.org/disasters/dpac.cfm The bottom line: Significant engagement at federal/national level No oversight Little accountability Disaster preparedness must start at home. If not us, who? Incident Command for the Community and Family Centered Planning Hierarchy/Roles Response Ground Zero Family Planning Special Needs Populations Child and Family Focused Needs Advocacy Roles Community Advisory Boards State Involvement Regional Response Teams Family Focused Planning Family Pediatrician Local State Federal Incident Command for the Community Roles Family Pediatrician Local State Federal Incident Command for the Community Roles Federal Level Agency Set requirements Provide: Family Pediatrician guidance response capability (NDMS) Local recovery resources (FEMA) financial resources to State and Local communities Support research Stockpiling and distribution of medical countermeasures, equipment State Federal Incident Command for the Community Roles State Level Set Requirements Provide: Pass through for funding Family Pediatrician Local resources to local communities response and surge capacity (National Guard, MRC’s) resources and guidance for recovery Governor can request Federal aid State Federal Incident Command for the Community Roles Emerging Concept Local communities, intrastate regions, private sector, states forming linkages/partnerships for preparedness and response activities Family Pediatrician Local State Federal Emerging Concepts Family Pediatrician Federal Local: private and public sectors State: single and intrastate Emerging Concepts Family Pediatrician What is my role? How can I prepare my patients? Federal Local: private and public sectors State: single and intrastate The Pediatrician: Pre-Event Planning Have I provided my patients with a tool to plan for their survival and well being? Are my special needs patients part of the global plan? Do I have a role within my local community? Do I have a role in an Incident Command System? Tools for Families Multiple internet resources available, personalize the plan Real time communication regarding clinic availability Internet Available Plans: US Department of Homeland Security http://www.ready.gov/kids/sesame/index.html Let’s Get Ready! http://www.sesameworkshop.org/initiatives/emotion/re ady Download: Parent or Caregiver Magazine, ©2008 Sesame Workshop Contents: TALK ABOUT IT IT’S A PLAN! OUR FAMILY’S HEALTH AND CONTACT INFORMATION Make an Emergency Plan With Your Family Help Your Child Learn and Practice Personal Information Create a Family Emergency Kit LET’S GET PERSONAL OUR FAMILY’S EMERGENCY KIT TOGETHER, WE CAN BE READY! Internet Available Plans: AAP http://www.aap.org/family/frk/frkit.htm http://www.aap.org/family/frk/aapfrkfull.pdf Overview Booklet, 2nd Edition Four Focus Areas: 1. Understanding Disasters 2. Families As The First Resource For Preparation, Protection and Recovery 3. Making Your Neighborhood Disaster Ready 4. Community and National Resources Emergency Information Form http://www.aap.org/advo cacy/blankform.pdf Emergency Information Form http://www.aap.org/advoc acy/blankform.pdf Prepare Your Patients and Your Practice http://www.aap.org/disasters/pediatricians.cfm Clinic Availability Telephone triage Clinic hours and services Signs for those presenting to clinic The Pediatrician: Pre-Event Planning Have I provided my patients with a tool to plan for their survival and well being? Are my special needs patients part of the global plan? Do I have a role within my local community? Do I have a role in an Incident Command System? Special Needs Patients Definition of “special needs population” in the National Response Framework “Before, during and after an incident, members of the special-needs population may have additional needs in one or more of the following functional areas: maintaining independence, communication, transportation, supervision and medical care” Special Needs Patients Category Definition Elderly Children Pregnant women Disabled Hearing/sight impaired People with Chronic Illnesses Low socio-economic status Home-bound Low English proficiency Tourists Pandemic and All Hazards Preparedness Act (S. 3678) “The term ‘at-risk individual’ means children, pregnant women, senior citizens and other individuals who have special needs in the event of a public health emergency as determined by the Secretary.” Federal Maternal and Child Health Bureau Definition Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. Mc Pherson M, Arango P, et al. A New Definition of Children With Special Health Care Needs. Pediatrics 1998;102;137-139 Pediatric Special Needs 20 million children with special healthcare needs Excluding Asthma: 12 million children with special health care needs Are the needs due to physical handicaps, maturational or cognitive level of functioning, technology needs (ventilator, oxygen), chronic medications The Pediatrician: Pre-Event Planning Have I provided my patients with a tool to plan for their survival and well being? Are my high risk or special needs patients part of the global plan? Do I have a role within my local community? Do I have a role in an Incident Command System? Incident Command System A standardized management protocol Meant to provide a common framework for all entities to respond cohesively to an all-hazard event Objectives include Reduce miscommunication Avoid redundancy Incident Command System: 5 major functions Command staff, general staff with branches and divisions. Incident Command Flexible to suit any given incident. Operations Section Planning Section Logistics Section Finance/ Administration Section Incident Command System: 5 major functions For the community physician you will most likely be absorbed into the operations section. Operations Section Incident Command Planning Section Logistics Section Finance/ Administration Section Incident Command System • • • • • • • Where do I report? Who is my supervisor? What is my role? Am I urgently or emergently credentialed at this locale? Are there generic computer accounts provided for volunteers? Pediatrics Critical Care Medicine Operations Section In-patient Casualty Clinical Support Staff/Victim Safety Surgical Nursing Ambulatory Care OB Family Centered Planning Provisions Identification and reunification Post-event recognition and treatment Provisions Routine Age or developmental appropriate food, hygiene, recreation, sleep For special needs or at-risk patients Pre-identify and target during first round of family readiness planning during well or ill visits Electrical or mechanical needs, medications, special dietary needs, transportation, communication Identification and Reunification Developmentally immature Shelter in place vs. relocation Transportation and communication Picture boards or other identifiers HIPAA compliant? Withstand the test of time? Identification and Reunification Facility plans Childcare http://www.naccrra.org/disaster/docs/Disaster_Guide_MEC H.pdf School Group living structure Foster care • Who has medical and/or legal guardianship? • Is there a special caveat during an acute event even when there isn’t a life threatening issue? Post-Event Stress Sensitive to adult responses Long lasting response; may be delayed How does it manifest Depression, PTSD, Acting out, Regression, Somatic complaints School performance changes Sleep disturbances Post-Event Stress Screening Augmentation of existing protocols, staffing At scene group screening Treatment PostEvent Stress http://www.aap. org/disasters/pd f/psychosocialimplications.pdf PostEvent Stress http://www.aap. org/disasters/p df/chem-bioterrorism.pdf Anticipatory Guidance Family Readiness Refer to internet resources Handouts Did the school/child care facility ask for a plan? Does my county have its own plan? Advocacy roles for pediatric and family disaster preparedness Children and Disasters http://www.aap.org/disasters/ AAP Strategic Plan for Disaster Preparedness Activities Advocacy Appointments Comments Educational Presentations Partnership for Children's Disaster Preparedness Publications Representation at Meetings Testimony AAP Policies and Resources http://www.aap.org/disasters/advocacy.cfm Bioterrorism and Other Public Health Emergencies Pediatric Terrorism and Disaster Preparedness A Resource for Pediatricians Report or Summary is available Author: AAP for AHRQ Community Advisory Boards Is there a physician on the board? Emergency School Home Management System health care Is the board sensitive to the special needs and issues children present? Service Opportunities: Getting involved as a disaster responder Getting involved as a disaster responder Responding outside of a disaster area Responding inside a disaster area Be a part of the system Pre-credentialing Resource-typing Training (including Incident Command/NIMS) Liability/ Worker’s comp coverage Support of family, coworkers and employers Response Networks Medical Reserve Corps ESAR-VHP Disaster Medical AssistanceTeams CHILDisaster NETWORK Medical Reserve Corps Part of US Citizen Corps Local initiatives with local/regional responsibilities Options to respond outside of local area (through state or federal activation) Medical and non-medical personnel Medical Reserve Corps > 500 MRC units, about 100,000 volunteers Often housed within Public Health Departments Roles in public health initiatives and emergencies as well as disasters Often support Red Cross missions www.medicalreservecorps.gov ESAR-VHP Emergency System for Advance Registration of Volunteer Health Professionals Federally subsidized, administered by state government Federal program within DHHS Health Resources and Services Administration (HRSA) ESAR-VHP Not a response team or program Acts as advance registration and credentialing tool to facilitate use of medical volunteers Feds are developing guidelines for composition of state-level standardized/specialty response teams MA System for Advance Registration (MSAR) http://www.massmed.org/AM/Template.cfm?Section=Preparedness&CON TENTID=17715&TEMPLATE=/CM/ContentDisplay.cfm MRC/ESAR-VHP Federally subsidized with oversight by DHHS Standardize the volunteer process Replace previous volunteering through professional organizations Reduce freelance volunteering MRC/ESAR-VHP Not paid when deployed No federal employment protection Liability/Worker’s comp covered by state law/regs unless federally deployed The NDMS and DHHS Disaster Medical Assistance Teams DMATs Oversight by DHHS Office of Emergency Preparedness Deployed to federally-declared disasters and security events Volunteers become temporary federal employees when deployed Workmen’s comp, liability, salary, expenses covered while on deployment No geographic restriction to practice when deployed The Legalities: USERRA Deployment is voluntary for the individual An employer must let the employee deploy if they choose to respond The employee should give their employer as much advance notice as possible except when urgency prevents timely notice. The volunteer cannot be required to take vacation or other leave time to deploy. DMATs Have drills and training throughout the year May have local and state agreements for service in a nonfederal disaster and for special security or mass gathering events. Some states are sponsoring state- level DMAT-equivalent teams DMAT Missions Field emergency care facility Medical standby for mass gatherings Disaster shelter sick call/clinics Neighborhood outreach Fill in hospital and EMS staff Medical care for responders Other federal missions (refugee health screening and care, Points of Distribution) What’s the down side of DMAT? Food and Shelter Environment/Hygiene Working hours Working outside your comfort zone Safety Uncertainty Isolation (The YOYO Principle) Hurry up and wait! The pay… FL5 DMAT photos http://www.hhs.gov/aspr/opeo/ndms/join/index.html CHILDisaster NETWORK Alliance of the AAP, the Johnson and Johnson Pediatric Institute and the International Pediatric Association Registry of medical professionals with pediatric training and experience who are willing to deploy internationally Deploy at the request of other agencies (NGOs) CHILDisaster NETWORK Must complete a basic course in complex humanitarian emergencies Be willing to be on call and deployable at 48hrs notice Must be able to deploy for at least 2 weeks http://www.aap.org/disaster/ Summary If we don’t do our part, children and families may be overlooked Disasters are local Disaster preparedness is a personal and professional responsibility There’s a job that matches your desire to contribute Join us! [email protected] www.jumpstarttriage.com [email protected]