Pediatric Online Disaster Preparedness Training for Medical and Non-Medical Personnel: A Multi-Level Modeling Analysis.

IntroductionTerrorism and natural catastrophes have made disaster preparedness a critical issue. Despite the documented vulnerabilities of children during and following disasters, gaps remain in health care systems regarding pediatric disaster preparedness. This research study examined changes in knowledge acquisition of pediatric disaster preparedness among medical and non-medical personnel at a children's hospital who completed an online training course of five modules: planning, triage, age-specific care, disaster management, and hospital emergency code response. METHODS: A multi-disciplinary team within the Pediatric Disaster Resource and Training Center at Children's Hospital Los Angeles (Los Angeles, California USA) developed an online training course. Available archival course data from July 2009 to August 2012 were analyzed through linear growth curve multi-level modeling, with module total score as the outcome (0 to 100 points), attempt as the Level 1 variable (any module could be repeated), role in the hospital (medical or non-medical) as the Level 2 variable, and attempt by role as the cross-level effect. RESULTS: A total of 44,115 module attempts by 5,773 course participants (3,686 medical personnel and 2,087 non-medical personnel) were analyzed. The average module total score upon first attempt across all participants ranged from 60.28 to 80.11 points, and participants significantly varied in how they initially scored. On average in the planning, triage, and age-specific care modules: total scores significantly increased per attempt across all participants (average rate of change ranged from 0.59 to 1.84 points) and medical personnel had higher total scores initially and through additional attempts (average difference ranged from 13.25 to 16.24 points). Cross-level effects were significant in the disaster management and hospital emergency code response modules: on average, total scores were initially lower among non-medical personnel compared to medical personnel, but non-medical personnel increased their total scores per attempt by 3.77 points in the disaster management module and 6.40 points in the hospital emergency code response module, while medical personnel did not improve their total scores through additional attempts. CONCLUSION: Medical and non-medical hospital personnel alike can acquire knowledge of pediatric disaster preparedness. Key content can be reinforced or improved through successive training in an online course. PhamPK, BeharSM, BergBM, UppermanJS, NagerAL. Pediatric online disaster preparedness training for medical and non-medical personnel: a multi-level modeling analysis Prehosp Disaster Med. 2018;33(4):349-354.

Factors associated with preparedness of the US healthcare system to respond to a pediatric surge during an infectious disease pandemic: Is our nation prepared?

OBJECTIVE: Recent incidents have demonstrated that the US health system is unprepared for infectious pandemics resulting in a pediatric surge. Development of efficient plans and a structured and coordinated regional response to pediatric pandemic surge remains an opportunity. To address this gap, we conducted a literature review to assess current efforts, propose a response plan structure, and recommend policy actions. DESIGN: A literature review, utilizing MEDLINE and PubMed, through March 2017 identified articles regarding infectious disease pandemics affecting the US pediatric population. After review of current literature, a proposed response plan structure for a pediatric pandemic surge was designed. RESULTS: Inclusion and exclusion criteria reduced an initial screening of 1,787 articles to 162 articles. Articles ranged in their discussion of pediatric pandemic surge. Review of the articles led to the proposal of organizing the results according to 4 S's; (1) Structure, (2) Staff, (3) Stuff (Resources), and (4) Space. CONCLUSION: The review has supported the concern that the US health system is unprepared for a pediatric surge induced by infectious disease pandemics. Common themes suggest that response plans should reflect the 4Ss and national guidelines must be translated into regional response systems that account for local nuances.

Academic-Community Partnership to Develop a Novel Disaster Training Tool for School Nurses: Emergency Triage Drill Kit.

As children spend approximately 28% of their day in school and disasters may strike at any time, it is important for school officials to conduct emergency preparedness activities. School nurses, teachers, and staff should be prepared to respond and provide support and first aid treatment. This article describes a collaborative effort within the Los Angeles Unified School District to enhance disaster preparedness. Specifically, the article outlines the program steps and tools developed to prepare staff in mass triage through an earthquake disaster training exercise.

Assessing American Red Cross First Aid mobile app user trends: Implications for resilience.

OBJECTIVE: Disasters have devastated communities, impacted the economy, and resulted in a significant increase in injuries. As the use of mobile technology increasingly becomes a common aspect of everyday life, it is important to understand how it can be used as a resource. The authors examined the use of American Red Cross mobile apps and aimed to characterize user trends to better understand how mobile apps can help bolster individual and community preparedness, resilience, and response efforts. DESIGN/MAIN OUTCOME MEASURES: Tornado data were obtained from the National Oceanic and Atmospheric Administration and the National Weather Service. Data for the mobile apps were provided by the American Red Cross. All data were reviewed for 2013, 2014, and three specific tornado events. Data were organized in Microsoft Excel spreadsheets and then graphed or mapped using ArcMap 10.2(™). RESULTS: Between 2013 and 2014, 1,068 tornado watches and 3,682 tornado warnings were issued. Additionally, 37,957,560 Tornado app users and 1,289,676 First Aid app users were active from 2013 to 2014. Overall, there was an increase in the use of American Red Cross mobile apps during tornado occurrences. Yet the increase does not show a consistent correlation with the number of watches and warnings issued. CONCLUSIONS: Mobile apps can be a resourceful tool. This study shows that mobile app use increases during a disaster. The findings indicate that there is potential to use mobile apps for building resilience as the apps provide information to support individuals and communities in helping before, during, and after disasters.

Using mixed methods to assess pediatric disaster preparedness in the hospital setting.

INTRODUCTION: Children are particularly vulnerable during disasters and mass-casualty incidents. Coordinated multi-hospital training exercises may help health care facilities prepare for pediatric disaster victims. PROBLEM: The purpose of this study was to use mixed methods to assess the disaster response of three hospitals, focusing on pediatric disaster victims. METHODS: A full-functional disaster exercise involving a simulated 7.8-magnitude earthquake was conducted at three Los Angeles (California USA) hospitals, one of which is a freestanding designated Level I Pediatric Trauma Center. Exercise participants provided quantitative and qualitative feedback regarding their perceptions of pediatric disaster response during the exercise in the form of surveys and interviews. Additionally, trained observers provided qualitative feedback and recommendations regarding aspects of emergency response during the exercise, including communication, equipment and supplies, pediatric safety, security, and training. RESULTS: According to quantitative participant feedback, the disaster exercise enhanced respondents' perceived preparedness to care for the pediatric population during a mass-casualty event. Further, qualitative feedback from exercise participants and observers revealed opportunities to improve multiple aspects of emergency response, such as communication, equipment availability, and physician participation. Additionally, participants and observers reported opportunities to improve safety and security of children, understanding of staff roles and responsibilities, and implementation of disaster triage exercises. CONCLUSION: Consistent with previous investigations of pediatric disaster preparedness, evaluation of the exercise revealed several opportunities for all hospitals to improve their ability to respond to the needs of pediatric victims. Quantitative and qualitative feedback from both participants and observers was useful for comprehensively assessing the exercise's successes and obstacles. The present study has identified several opportunities to improve the current state of all hospitals' pediatric disaster preparedness, through increased training on pediatric disaster triage methods and additional training on the safety and security of children. Regular assessment and evaluation of supplies, equipment, leadership assignments, and inter-hospital communication is also suggested to optimize the effectiveness and efficiency of response to pediatric victims in a disaster.

Meeting children's needs: a mixed-methods approach to a regionalized pediatric surge plan-the Los Angeles County experience.

INTRODUCTION: Children are one of the most vulnerable populations during mass casualty incidents because of their unique physiological, developmental, and psychological attributes. The objective of this project was to enhance Los Angeles County's (LAC) pediatric surge capabilities. The purpose of this study was threefold: (1) determine gaps in pediatric surge capacity and capabilities; (2) double pediatric inpatient capacity; and (3) document a plan to address gaps and meet pediatric inpatient surge. We hypothesized that LAC would be able to meet the identified pediatric surge target by leveraging resources of hospitals within the region. Deliverables included a pediatric surge plan for LAC, pediatric surge training resources, and pediatric supplies for hospitals participating in LAC's Hospital Preparedness Program (HPP). METHODS: After Institutional Review Board approval, the authors used a mixed-methods approach to explore gaps in hospital capacity and capabilities in a large urban county. Hospitals were surveyed via Qualtrics® on 38 questions regarding capacity, staffing, availability of pediatric supplies, and existing pediatric surge plans. Publicly available inpatient bed data were collected from the Office of Statewide Health Planning and Development for the year ending June 2010 and supplemented by hospital survey responses. Population data was used from US Census 2010. This combined dataset was analyzed for capacity, pediatric designations, and capabilities. To supplement this data, three focus groups were conducted between April 2011 and May 2012. Focus group topics included: supplies and training needed for pediatric surge, surge targets, and plan development and functionality. RESULTS: Hospitals varied in pediatric capacity and capability. Forty-six percent of facilities provide inpatient pediatric services. Forty-one hospitals are designated as an Emergency Department Approved for Pediatrics. Identified gaps included: limited pediatric bed capacity, geographic variability, limited pediatric intensive care unit capacity, limited pediatric specialty physician resources, varying availability of pediatric trained staff, less availability of pediatric critical care supplies, and limited ability to accept and receive children. Focus group stakeholders requested advance and just-in-time training and reference guides to supplement the plan. CONCLUSION: LAC was able to create a pediatric surge plan that doubles pediatric acute and pediatric intensive care bed capacity by using participating HPP hospitals. A tiered system was created based on capacity and capability with varying surge targets and guidance on types of patients that could be cared for at each tier. This plan will assist the LAC Emergency Medical Services Agency distribute pediatric patients during a surge event that disproportionately impacts children.

A mixed-methods pilot study of disaster preparedness and resiliency among faith-based organizations.

INTRODUCTION: Faith-based organizations represent a source of stability and are an established presence in a community. They frequently serve their community following disasters. They are not formally included or identified as a disaster resource; thus, there is an opportunity to increase the effectiveness with which faith-based organizations prepare for and respond to disasters. Problem This pilot study aimed to assess perceptions of the level of disaster preparedness and resiliency among faith-based organizations as a first step in understanding how to improve disaster preparedness and resiliency among these organizations and their communities. METHODS: Survey and semi-structured interviews were conducted with six faith-based organizations, one with a leader and one with a staff member. Frequency distributions of survey questions were obtained. Interviews were transcribed and thematic analysis was supported by analytical software, ATLAS. ti. RESULTS: Results of the survey indicated strong social networks among congregation and community members. However, half of the members indicated that they did not socialize often with other races and other neighborhoods. Additionally, trust of other groups of people was generally low. Themes that emerged from qualitative analysis were: (1) perceived disaster preparedness and resiliency; (2) barriers to community preparedness and resiliency; (3) lessons learned from past disasters; (4) social services and networks; and (5) willingness to be prepared. CONCLUSIONS: The results suggest that there is a need for interventions to improve disaster preparedness and resiliency among faith-based organizations.

Disaster preparedness education in South Los Angeles faith-based organizations: a pilot study in promoting personal and community preparedness and resiliency.

INTRODUCTION: Faith-based organizations (FBOs) often provide crucial services to their communities during and after disasters, but they largely operate outside of the formal structures that manage disaster preparedness and response. Their status within communities and ability to reach broad populations make them potentially powerful groups to lead and promote health and safety initiatives. Thus, there is opportunity to reduce health and knowledge disparities and increase disaster resiliency by providing disaster preparedness education through FBOs. PROBLEM: This pilot study aims to assess and enhance the current level of disaster knowledge and preparedness of congregation members from six FBOs in the Los Angeles County South Service Planning Area (SPA 6) to promote their community's disaster resiliency. METHODS: A structured basic disaster education curriculum was implemented at six FBOs, and participants completed a questionnaire, pre-test and post-test, and satisfaction survey. Frequency distributions of survey questions and mean differences of pre- and post-test scores were obtained. RESULTS: Results of the questionnaire indicated that more than half of the participants had previous experience with disaster preparedness and had taken some steps toward stockpiling supplies but showed gaps in making concrete evacuation plans and meeting places. The mean disaster knowledge test score increased from 5.15 for the pre-test to 8.04 for the post-test (p < 0.0001). The participants reported high satisfaction with the seminar. CONCLUSIONS: This pilot study demonstrated that there is interest, as well as need, within the faith-based community to increase personal and community disaster preparedness. The implementation of a structured disaster education seminar for congregation members showed significant immediate improvement in disaster knowledge of the participants.

Pediatric Surge Pocket Guide: review of an easily accessible tool for managing an influx of pediatric patients.

As seen in recent disasters, large-scale crisis events have the potential to cause significant pediatric death and injury. During such disaster situations, both distance and decreased mobility will likely limit access to pediatric hospitals. Thus, all hospitals, regardless if they regularly treat children or not, should anticipate an influx of pediatric patients in the event of a disaster. The Pediatric Surge Pocket Guide was developed for and distributed at a Pediatric Medical Surge Workshop held by the Los Angeles County Department of Public Health in June 2009. Designed both as a supplement to the workshop training and as an effective stand-alone resource, the Guide provides comprehensive pediatric-specific recommendations for hospitals experiencing a surge in pediatric capacity. Because of its unique pocket-size format, the Guide has the potential to be a readily accessible tool with application to a wide range of disaster or nondisaster situations, for use in hospital or nonhospital settings, and by pediatric specialists, nonspecialists, and nonclinicians alike.

Using robotic telecommunications to triage pediatric disaster victims.

PURPOSE: During a disaster, hospitals may be overwhelmed and have an insufficient number of pediatric specialists available to care for injured children. The aim of this study was to determine the feasibility of remotely providing pediatric expertise via a robot to treat pediatric victims. METHODS: In 2008, Los Angeles County held 2 drills involving telemedicine. The first was the Tri-Hospital drill in which 3 Los Angeles County hospitals, one being a pediatric hospital, participated. The disaster scenario involved a Metrolink train crash, resulting in a large surge of traumatic injuries. The second drill involved multiple agencies and was called the Great California Shakeout, a simulated earthquake exercise. The telemedicine equipment installed is an InTouch Health, Inc, Santa Barbara, CA robotic telecommunications system. We used mixed-methods to evaluate the use of telemedicine during these drills. RESULTS: Pediatric specialists successfully provided remote triage and treatment consults of victims via the robot. The robot proved to be a useful means to extend resources and provide expert consult if pediatric specialists were unable to physically be at the site. CONCLUSION: Telemedicine can be used in the delayed treatment areas as well as for training first receivers to collaborate with specialists in remote locations to triage and treat seriously injured pediatric victims.