The importance of caring for children plays a significant role in emergency planning; however, children's medical needs are often drastically different than the needs of adults. Children have different vital sign norms and anatomical/physiological characteristics that require a specific age-appropriate approach to emergency care. Children also have mental health and communication needs that correspond to their level of development, and they depend on adults for basic necessities.
The North Carolina Division of Public Health (NC DPH) developed a program to increase surveillance for potential bioterrorist or infectious disease events by placing public health epidemiologists in 10 of the state's largest hospital systems. Increased partnerships between public health and hospitals, along with the enhanced surveillance skills epidemiologists bring to large healthcare systems, led to a program with great potential for responding quickly to an emerging health crisis.
This city-wide planning document provides detailed information on varied aspects of fatality management during a pandemic and other mass fatality events. Specifically, it defines the local and state jurisdictional responsibilities and identifies key assumptions for handling pandemic influenza-related deaths. The guidance discusses several features of mass fatality planning in seven Attachments, which address issues such as establishment of a temporary morgue, identification and tracking of remains, coordination of planning with local laws, and standards of death scene investigation.
Many of the events and responses involved in this practice are still undergoing investigation, so the description below pertains only to local mitigation efforts.
On November 5, 2009, an active shooter at the Fort Hood military base endangered the lives of both military personnel and civilians. During approximately 45 minutes, 26 people were wounded, and 13 people were killed. Some of the injured were treated at a nearby Level 1 trauma center, while others were cared for at local hospitals.
As part of the 2009-2010 Hospital Preparedness Program (HPP) grant, the Colorado Department of Public Health and Environment (CDPHE) partnered with the Colorado Hospital Association (CHA) to design and conduct the three-day Colorado Hospital Mass Fatality Summit to prepare Colorado hospitals for managing a mass fatality event. HPP funds were used to purchase conference materials, food, and hospital registrations for the 205 participants representing 74 hospitals and community partners in all nine all-hazard regions in Colorado.
The South Central Center for Public Health Preparedness (SCCPHP) is collaborating with the Alabama Department of Public Health, the Mississippi State Department of Health, and more than 40 agencies and institutions to establish a regional pediatric disaster preparedness network across 5 states, including Alabama, Florida, Louisiana, Mississippi, and Tennessee. This voluntary pediatric response network functions within the larger emergency response system.
The Acute Care Services Tools provide the following: 1) a triage protocol for patients who may need critical care; 2) an assessment form and triage protocols for patients who may have pandemic influenza; 3) a hospital admission form for influenza patients; and 4) standing admission orders for influenza patients. The triage protocol outlines inclusion and exclusion criteria for evaluating patients who are being considered for critical care.
Fraser Health's toolkit outlines key parameters for establishing alternate triage and care centers by providing guidance for selecting a site, organizing personnel, conducting triage and process flow, and discharging patients. The materials are still in draft form, and any triage or care site would need to modify the materials to fit its individual needs. The tools can easily be adapted to state, local, or private health organizations or departments that are beginning to plan how alternative triage and care sites should be selected, staffed, and supplied.
A NIMS-based approach provides a framework to establish an acute care center (ACC) for a bioterrorism event, but much of the information could easily be extrapolated to a pandemic situation. The materials describe a coordinated approach between local hospitals and acute care centers by including scenarios for which an ACC might be needed and defining the level of care provided outside of a hospital. For instance, the document limits ACCs to the provision of basic care, hydration, antibiotics, and possibly oxygen.
Gaps exist in the ability for local and state public health to capture the impact of the current H1N1 pandemic on in-patient hospital census statewide. In an effort to gather this important data without increasing the burden on hospitals, five questions specific to Influenza-Like Illness (ILI) were developed, vetted with hospital partners, and integrated into the current electronic data collection system in all Michigan hospitals.
