RESUMO
OBJECTIVE: To assess the performance of a hemolytic uremic syndrome (HUS) severity score among children with Shiga toxin-producing Escherichia coli (STEC) infections and HUS by stratifying them according to their risk of adverse events. The score has not been previously evaluated in a North American acute care setting. STUDY DESIGN: We reviewed medical records of children <18 years old infected with STEC and treated in 1 of 38 participating emergency departments in North America between 2011 and 2015. The HUS severity score (hemoglobin [g/dL] plus 2-times serum creatinine [mg/dL]) was calculated using first available laboratory results. Children with scores >13 were designated as high-risk. We assessed score performance to predict severe adverse events (ie, dialysis, neurologic complication, respiratory failure, and death) using discrimination and net benefit (ie, threshold probability), with subgroup analyses by age and day-of-illness. RESULTS: A total of 167 children had HUS, of whom 92.8% (155/167) had relevant data to calculate the score; 60.6% (94/155) experienced a severe adverse event. Discrimination was acceptable overall (area under the curve 0.71, 95% CI 0.63-0.79) and better among children <5 years old (area under the curve 0.77, 95% CI 0.68-0.87). For children <5 years, greatest net benefit was achieved for a threshold probability >26%. CONCLUSIONS: The HUS severity score was able to discriminate between high- and low-risk children <5 years old with STEC-associated HUS at a statistically acceptable level; however, it did not appear to provide clinical benefit at a meaningful risk threshold.
Assuntos
Regras de Decisão Clínica , Serviço Hospitalar de Emergência , Infecções por Escherichia coli/diagnóstico , Síndrome Hemolítico-Urêmica/diagnóstico , Índice de Gravidade de Doença , Escherichia coli Shiga Toxigênica , Adolescente , Criança , Pré-Escolar , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/mortalidade , Feminino , Síndrome Hemolítico-Urêmica/complicações , Síndrome Hemolítico-Urêmica/mortalidade , Humanos , Lactente , Recém-Nascido , Masculino , América do Norte , Prognóstico , Estudos Retrospectivos , Medição de Risco , Sensibilidade e EspecificidadeRESUMO
ABSTRACT: A growing number of adolescents are being diagnosed with acute myocarditis following mRNA COVID-19 vaccinations. This case describes an adolescent who presented to the emergency department with chest pain and tachycardia following the Pfizer-BioNTech COVID-19 vaccination. Point-of-care ultrasound was performed prior to the return of laboratory studies and revealed depressed left ventricular systolic function. Point-of-care ultrasound may be a tool used to rapidly diagnose or risk stratify patients with potential post-COVID-19 vaccine myocarditis.
Assuntos
COVID-19 , Miocardite , Adolescente , Vacinas contra COVID-19 , Humanos , Miocardite/diagnóstico , Miocardite/etiologia , RNA Mensageiro , SARS-CoV-2RESUMO
BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care. METHODS: We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible. RESULTS: Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69-.85] per year), leukocyte count ≥13.0 × 103/µL (2.54 [1.42-4.54]), higher hematocrit (1.83 [1.21-2.77] per 5% increase) and serum creatinine (10.82 [1.49-78.69] per 1 mg/dL increase), platelet count <250 × 103/µL (1.92 [1.02-3.60]), lower serum sodium (1.12 [1.02-1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14-5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI, .54-.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14-4.50]), younger age (0.83 [.74-.92] per year), lower serum sodium (1.15 [1.04-1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/µL (2.35 [1.17-4.72]) and creatinine (7.75 [1.20-50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18-6.21]). CONCLUSIONS: The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring.
Assuntos
Infecções por Escherichia coli , Síndrome Hemolítico-Urêmica , Escherichia coli Shiga Toxigênica , Adolescente , Criança , Estudos de Coortes , Diarreia/epidemiologia , Infecções por Escherichia coli/epidemiologia , Feminino , Síndrome Hemolítico-Urêmica/epidemiologia , Síndrome Hemolítico-Urêmica/terapia , Humanos , Terapia de Substituição RenalAssuntos
Doenças do Pênis , Masculino , Humanos , Criança , Doenças do Pênis/diagnóstico , Edema/etiologiaRESUMO
OBJECTIVE: This study aimed to assess if Michigan child care directors have created disaster management plans, and if local resources were used to develop and implement plans. METHODS: From December 2013 to March 2014, the Early Childhood Investment Corporation conducted a survey of licensed child care programs in Michigan. An online survey regarding disaster preparedness and training resources was distributed to the directors of a convenience sample of registered child care centers among the Early Childhood Investment Corporation's statewide network of 11 resource centers. RESULTS: A total of 210 child care programs responded. Most (91%) of respondents had a disaster plan, but 40% did not include accommodations for special needs children, 51% did not have a family/child identification or reunification plan, and 67% did not have car safety devices and a predetermined route for evacuation. Fewer than 9% made disaster plans available online. Few collaborated with local fire (22%), police (27%), or pediatric or emergency medicine organizations (11%). Online modules were the most desirable training format. CONCLUSIONS: In a state without mandated child care guidelines for disaster preparedness, a substantial proportion of child care programs were missing critical components of disaster planning. Future interventions must focus on increasing partnerships with local organizations and developing guidelines and training to include plans for special needs children, family/child identification and reunification, and evacuation/relocation.
Assuntos
Cuidado da Criança/estatística & dados numéricos , Planejamento em Desastres/estatística & dados numéricos , Alocação de Recursos/estatística & dados numéricos , Criança , Cuidado da Criança/normas , Pré-Escolar , Desastres , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , Recém-Nascido , MichiganRESUMO
OBJECTIVE: Children's summer camps are at risk for multiple pediatric casualties during a disaster. The degree to which summer camps have instituted disaster preparedness is unknown. We assessed disaster preparedness among selected camps nationally for a range of disasters. METHODS: We partnered with a national, web-based electronic health records system to send camp leadership of 315 camp organizations a 14-question online survey of disaster preparedness. One response from each camp was selected in the following order of importance: owner, director, physician, nurse, medical technician, office staff, and other. The results were analyzed using descriptive statistics. RESULTS: A total of 181 camps responses were received, 169 of which were complete. Camp types were overnight (60%), day (21%), special/medical needs (14%), and other (5%). Survey respondents were directors (52%), nurses (14%), office staff (10%), physicians (5%), owners (5%), emergency medical technicians (2%), and other (12%). Almost 18% of camps were located >20 mi from a major medical center, and 36% were >5 mi from police/fire departments. Many camps were missing emergency supplies: car/booster seats for evacuation (68%), shelter (35%), vehicles for evacuation (26%), quarantine isolation areas (21%), or emergency supplies of extra water (20%) or food (17%). Plans were unavailable for the following: power outages (23%); lockdowns (15%); illness outbreaks (15%); tornadoes (11%); evacuation for fire, flood, or chemical spill (9%); and other severe weather (8%). Many camps did not have online emergency plans (53%), plans for children with special/medical needs (38%), methods to rapidly communicate information to parents (25%), or methods to identify children for evacuation/reunification with parents (40%). Respondents reported that staff participation in disaster drills varied for weather (58%), evacuations (46%), and lockdowns (36%). The majority (75%) of respondents had not collaborated with medical organizations for planning. CONCLUSIONS: A substantial proportion of camps were missing critical components of disaster planning. Future interventions must focus on developing summer camp-specific disaster plans, increasing partnerships, and reassessing national disaster plans to include summer camp settings.
Assuntos
Planejamento em Desastres/normas , Instalações Esportivas e Recreacionais , Canadá , Criança , Necessidades e Demandas de Serviços de Saúde , Humanos , Estações do Ano , Inquéritos e Questionários , Estados UnidosRESUMO
Serious blunt scrotal trauma in the pediatric population is rare and can pose significant danger to the viability of the testes. The following case describes an adolescent boy who presented with a single testis in his scrotum after low-impact perineal trauma, consistent with testicular dislocation. The literature regarding scrotal trauma includes few cases of testicular dislocation from low-impact perineal trauma. Included is a brief review of the most recent data including epidemiology, differential diagnosis, acute management, and complications pertinent to the pediatric emergency clinician.
Assuntos
Escroto/lesões , Testículo/lesões , Ferimentos não Penetrantes , Adolescente , Serviço Hospitalar de Emergência , Tratamento de Emergência , Humanos , Masculino , Escroto/cirurgia , Testículo/cirurgia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgiaRESUMO
INTRODUCTION: We aimed to describe current nursing practice and clarify the safest and most effective dose of milk and molasses enemas used to relieve constipation in pediatric patients presenting to a suburban pediatric emergency department. METHODS: We surveyed emergency nurses about current practice in administration of milk and molasses enemas. In addition, we identified consecutive patients aged 2 to 17 years with a discharge diagnosis of constipation or abdominal pain between 2009 and 2012. Stable patients were included from the emergency department, in the absence of chronic medical conditions. For each patient, we recorded demographic characteristics, chief complaint, nursing administration technique, stool output, patient tolerance, side effects, amount of enema given, and patient disposition. RESULTS: We identified 500 patients with abdominal pain or constipation, 87 of whom were later excluded. Milk and molasses enemas were found to be effective at relieving constipation in our population, with a success rate averaging 88% in patients given 5 to 6 mL/kg with an institutional guideline maximum of 135 mL. The success rate was found to vary with age, along with the amount of enema given. DISCUSSION: Our nursing survey showed that varying practice exists regarding technique and dosing of milk and molasses enemas. Historical chart review showed that milk and molasses enemas in our emergency department were safe and effective with minimal side effects.
Assuntos
Constipação Intestinal/enfermagem , Serviço Hospitalar de Emergência , Enema/enfermagem , Leite , Melaço , Adolescente , Animais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
BACKGROUND: Historically, the child care industry has been unprepared for emergencies. A previous study identified gaps in Michigan's child care programs' emergency plans. Study objectives were to reassess programs' preparedness plans after introduction of state-mandated emergency plans and to examine the effect of the coronavirus disease 2019 (COVID-19) pandemic on programs' operations. METHODS: A 29-question survey was sent to â¼500 child care programs across Michigan in 2020 to assess emergency plans and response to COVID-19. Data were analyzed using descriptive statistics and qualitative methods. RESULTS: A total of 346 programs (70%) responded. Most (92%) reported having a written plan, but one-third reported having no infectious outbreak plan pre-pandemic. One-third of programs lacked plans for special needs children (vs 40% in 2014); 62% lacked plans for child reunification (vs 60% in 2014); 46% reported staff received no preparedness training. COVID-19 impacted programs substantially: 59% closed, 20% decreased capacity, 27% changed disinfecting protocols. Several themes related to the pandemic's effect on programs were identified: (1) changes in learning, (2) changes in socialization, (3) increased family burden, (4) financial challenges, (5) lack of guidance. CONCLUSIONS: Significant preparedness gaps remain among Michigan's child care programs, suggesting the need for increased support and addition of emergency preparedness to programs' quality ratings.
Assuntos
COVID-19 , Defesa Civil , Planejamento em Desastres , Desastres , Humanos , Criança , Michigan/epidemiologia , Pandemias/prevenção & controle , Cuidado da Criança , COVID-19/epidemiologiaRESUMO
BACKGROUND: Systematic monitoring of exanthema is largely absent from public health surveillance despite emerging diseases and threats of bioterrorism. Michigan Child Care Related Infections Surveillance Program (MCRISP) is the first online program in child care centers to report pediatric exanthema. METHODS: MCRISP aggregated daily counts of children sick, absent, or reported ill by parents. We extracted all MCRISP exanthema cases from October 1, 2014 through June 30, 2019. Cases were assessed with descriptive statistics and counts were used to construct epidemic curves. RESULTS: 360 exanthema cases were reported from 12,233 illnesses over 4.5 seasons. Children ages 13-35 months had the highest rash occurrence (45%, n = 162), followed by 36-59 months (41.7%, n = 150), 0-12 months (12.5%, n = 45), and kindergarten (0.8%, n = 3). Centers reported rashes of hand-foot-mouth disease (50%, n = 180), nonspecific rash without fever (15.3%, n = 55), hives (8.1%, n = 29), fever with nonspecific rash (6.9%, n = 25), roseola (3.3%, n = 12), scabies (2.5%, n = 9), scarlet fever (2.5%, n = 9), impetigo (2.2%, n = 8), abscess (1.95, n = 7), viral exanthema without fever (1.7%, n = 6), varicella (1.7%, n = 6), pinworms (0.8%, n = 3), molluscum (0.6%, n = 2), cellulitis (0.6%, n = 2), ringworm (0.6%, n = 2), and shingles (0.2%, n = 1). CONCLUSION: Child care surveillance networks have the potential to act as sentinel public health tools for surveillance of pediatric exanthema outbreaks.
Assuntos
Exantema , Doença de Mão, Pé e Boca , Criança , Cuidado da Criança , Pré-Escolar , Surtos de Doenças/prevenção & controle , Exantema/diagnóstico , Exantema/epidemiologia , Exantema/etiologia , Doença de Mão, Pé e Boca/epidemiologia , Humanos , Lactente , MichiganRESUMO
Despite clear testing recommendations for herpes simplex virus (HSV) infection in infants, few data exist on the comprehensiveness of HSV testing in practice. In a 23-center study of 112 infants with confirmed HSV disease, less than one-fifth had all recommended testing performed, highlighting the need for increased awareness of and adherence to testing recommendations for this vulnerable population.
Assuntos
Herpes Simples , Simplexvirus , Estudos de Coortes , Herpes Simples/diagnóstico , Herpes Simples/epidemiologia , Humanos , LactenteRESUMO
Children with altered mental status who present to the emergency department have a broad differential diagnosis. We report a case of a 19-month-old girl who presented in coma and who was later found to have a fentanyl patch adhered to her back. She was found to have changes on brain magnetic resonance imaging consistent with a toxic spongiform leukoencephalopathy but had a good neurologic outcome. This case report illustrates the importance of a thorough physical examination in children in coma and a rarely reported magnetic resonance imaging finding that has been seen in opioid intoxication and is usually associated with severe morbidity and mortality.
Assuntos
Fentanila/intoxicação , Leucoencefalopatias/induzido quimicamente , Acidentes Domésticos , Administração Cutânea , Apneia/induzido quimicamente , Pré-Escolar , Coma/induzido quimicamente , Estado de Descerebração/induzido quimicamente , Diagnóstico Tardio , Emergências , Feminino , Fentanila/administração & dosagem , Humanos , Hiperglicemia/induzido quimicamente , Imageamento por Ressonância Magnética , Miose/induzido quimicamente , Intoxicação/diagnóstico , Reflexo Anormal/efeitos dos fármacos , Procedimentos DesnecessáriosRESUMO
OBJECTIVES: To identify independent predictors of and derive a risk score for invasive herpes simplex virus (HSV) infection. METHODS: In this 23-center nested case-control study, we matched 149 infants with HSV to 1340 controls; all were ≤60 days old and had cerebrospinal fluid obtained within 24 hours of presentation or had HSV detected. The primary and secondary outcomes were invasive (disseminated or central nervous system) or any HSV infection, respectively. RESULTS: Of all infants included, 90 (60.4%) had invasive and 59 (39.6%) had skin, eyes, and mouth disease. Predictors independently associated with invasive HSV included younger age (adjusted odds ratio [aOR]: 9.1 [95% confidence interval (CI): 3.4-24.5] <14 and 6.4 [95% CI: 2.3 to 17.8] 14-28 days, respectively, compared with >28 days), prematurity (aOR: 2.3, 95% CI: 1.1 to 5.1), seizure at home (aOR: 6.1, 95% CI: 2.3 to 16.4), ill appearance (aOR: 4.2, 95% CI: 2.0 to 8.4), abnormal triage temperature (aOR: 2.9, 95% CI: 1.6 to 5.3), vesicular rash (aOR: 54.8, (95% CI: 16.6 to 180.9), thrombocytopenia (aOR: 4.4, 95% CI: 1.6 to 12.4), and cerebrospinal fluid pleocytosis (aOR: 3.5, 95% CI: 1.2 to 10.0). These variables were transformed to derive the HSV risk score (point range 0-17). Infants with invasive HSV had a higher median score (6, interquartile range: 4-8) than those without invasive HSV (3, interquartile range: 1.5-4), with an area under the curve for invasive HSV disease of 0.85 (95% CI: 0.80-0.91). When using a cut-point of ≥3, the HSV risk score had a sensitivity of 95.6% (95% CI: 84.9% to 99.5%), specificity of 40.1% (95% CI: 36.8% to 43.6%), and positive likelihood ratio 1.60 (95% CI: 1.5 to 1.7) and negative likelihood ratio 0.11 (95% CI: 0.03 to 0.43). CONCLUSIONS: A novel HSV risk score identified infants at extremely low risk for invasive HSV who may not require routine testing or empirical treatment.
Assuntos
Herpes Simples/diagnóstico , Fatores Etários , Temperatura Corporal , Estudos de Casos e Controles , Serviço Hospitalar de Emergência , Exantema/epidemiologia , Feminino , Herpes Simples/epidemiologia , Humanos , Lactente , Recém-Nascido Prematuro , Leucocitose/líquido cefalorraquidiano , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Convulsões/epidemiologia , Sensibilidade e Especificidade , Trombocitopenia/epidemiologiaRESUMO
OBJECTIVE: We evaluated the accuracy of a non-contact infrared thermometer compared with a rectal thermometer. METHODS: Two hundred patients, ages 1 month to 4 years, were included in the study. Each child underwent contemporaneous standard rectal thermometry and mid forehead non-contact infrared thermometry. Clinical features, including chief complaint, recently administered antipyretic agents, and ambient temperature at the time of measurement, were included. ANALYSIS: Linear models were used to compare agreement between the 2 techniques, as well as to determine bias of infrared thermometry at different rectal temperatures. Multivariate linear models were used to evaluate the impact of clinical variables and ambient temperature. RESULTS: A linear relationship between rectal and infrared temperature measurements was observed; however, the coefficient of determination (r(2)) value between was only 0.48 (P < 0.01). Infrared thermometry tended to overestimate the temperature of afebrile children and underestimate the temperature of febrile patients (P < .01). Ambient temperature and child age did not affect the accuracy of the device. CONCLUSION: In this study, non-contact infrared thermometry did not sufficiently agree with rectal thermometer to indicate its routine use.
Assuntos
Serviço Hospitalar de Emergência , Febre/diagnóstico , Termografia , Pré-Escolar , Enfermagem em Emergência , Humanos , Lactente , Recém-Nascido , Michigan , Sensibilidade e Especificidade , TermômetrosRESUMO
INTRODUCTION: Application of cricoid pressure (CP) is an important step during rapid sequence intubation. Previous surveys of anesthesia personnel showed a knowledge deficiency in the recommended level of cricoid force. There has been no previous attempt to assess the adequacy of knowledge of ED personnel in the application of CP. The objective of this study was to assess the theoretic knowledge of ED personnel about CP. METHODS: We carried out a convenience sample of all ED personnel present at the morbidity and mortality meeting of a major US teaching hospital. A questionnaire-based survey was distributed; respondents were unaware of the questions or the nature of the survey before participating. RESULTS: In total, 83 completed questionnaires were returned by 38 residents, 25 attending physicians, and 20 nurses. Many of the respondents knew the anatomic structure to which CP is applied. However, 24 respondents (14 nurses and 10 residents) thought that CP is applied to both the cricoid and thyroid cartilage. Interestingly, 70% of the nurses in this survey gave an incorrect response to the question on the anatomic localization of CP. Many of the participants in this survey either were unsure of the recommended amount of cricoid force in the asleep patient or quoted values that were too low. The majority of respondents rated their training in CP application as either poor or nonexistent. Most were able to name 2 contraindications to the application of CP. DISCUSSION: The theoretic knowledge about CP is poor in this survey from staff at a major US teaching hospital. Poor theoretic knowledge could lead to poor technique in the application of CP. More specific education and training are needed to improve the clinical use of CP and possibly increase patient safety.
Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Cartilagem Cricoide , Tratamento de Emergência/métodos , Conhecimentos, Atitudes e Prática em Saúde , Intubação Intratraqueal/métodos , Competência Clínica/normas , Medicina de Emergência/educação , Medicina de Emergência/métodos , Enfermagem em Emergência/educação , Enfermagem em Emergência/métodos , Tratamento de Emergência/enfermagem , Necessidades e Demandas de Serviços de Saúde , Hospitais de Ensino , Humanos , Internato e Residência , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/enfermagem , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/psicologia , Michigan , Pesquisa em Educação em Enfermagem , Pesquisa Metodológica em Enfermagem , Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/psicologia , Pressão , Aspiração Respiratória/etiologia , Aspiração Respiratória/prevenção & controle , Inquéritos e QuestionáriosRESUMO
Children can be victims of mass casualty or illness, but their needs, with respect to their care and recovery are substantially different from adults. Emergency or urgent care physicians must be prepared to evaluate and manage child victims presenting to their facility in numbers or acuity that could significantly overwhelm normal operations. This article presents the general approach to pediatric disaster preparation in the United States, the expectations of emergency department providers, and different methods of disaster triage, and introduces the most likely types of mass illness (some of which are bioweapons or chemical agents) and their management.
Assuntos
Planejamento em Desastres/métodos , Triagem/métodos , Criança , Desastres , Serviço Hospitalar de Emergência , Humanos , Médicos , Estados UnidosRESUMO
Although disasters can affect anyone in a given community or region, those with access and functional needs have the highest rates of morbidity and mortality during an emergency or disaster. There are many unique and complex issues that should be considered when dealing with these individuals in a disaster situation. Who are these individuals, what specific issues should be addressed, and what recommendations can be made in order to address their unique needs? How can we include them as part of the all-hazard, comprehensive approach to disaster management? The first part of this three-part series identifies who is included in this population and what are the legal considerations that arise in caring for not only this unique group but also all of the members of the community in a disaster. The second part considers evacuation, sheltering, sheltering in place, communication, medical needs, independence, supervision, and transportation (CMIST) with a focus on mental health. The third part deals with the medical aspect of CMIST and with recommendations that may aid disaster responders and planners in caring for these high-risk individuals in a disaster.
Assuntos
Comunicação , Pessoas com Deficiência , Planejamento em Desastres , Desastres , Meios de Transporte , Emergências , HumanosRESUMO
Although disasters can affect anyone in a given community or region, those with access and functional needs have the highest rates of morbidity and mortality during an emergency or disaster. There are many unique and complex issues that should be considered when dealing with these individuals in a disaster situation. Who are these individuals, what specific issues should be addressed when considering these members of the population, and what recommendations can be made in order to address their unique needs? How can we include them as part of the all-hazard, comprehensive approach to disaster management? The first part of this three-part series identifies who is included in this population and what are the legal considerations that arise in caring for not only this unique group but also all of the members of the community in a disaster. The second part considers evacuation, sheltering, sheltering in place, communication, medical needs, independence, supervision, and transportation (CMIST) with a focus on mental health. The third part deals with the medical aspect of CMIST and with recommendations that may aid disaster responders and planners in caring for these high-risk individuals in a disaster.
Assuntos
Comunicação , Planejamento em Desastres/métodos , Desastres , Serviços Médicos de Emergência/organização & administração , Transferência de Pacientes , Emergências , Necessidades e Demandas de Serviços de Saúde , Humanos , Meios de TransporteRESUMO
Although disasters can affect anyone in a given community or region, those with access and functional needs have the highest rates of morbidity and mortality during an emergency or disaster. There are many unique and complex issues that should be considered when planning and caring for these individuals in a disaster situation. Who are these individuals, what specific issues should be addressed when considering these members of the population, and what recommendations can be made to address their unique needs? How can we include them as part of the all-hazard, comprehensive approach to disaster management? The first part of this three-part series identifies who is included in this population and what are the legal considerations that arise in caring for, not only this unique group but also all the members of the community in a disaster. The second part considers evacuation, sheltering, sheltering in place, communication, medical needs, independence, supervision, and transportation (CMIST) with a focus on mental health. The third part deals with the medical aspect of CMIST and with recommendations that may aid disaster responders and planners in caring for these high-risk individuals in a disaster.
Assuntos
Pessoas com Deficiência , Planejamento em Desastres , Serviços Médicos de Emergência/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Voluntários/legislação & jurisprudência , Comunicação , Vítimas de Desastres , Serviços Médicos de Emergência/economia , Humanos , Responsabilidade Legal , Meios de Transporte , Estados UnidosRESUMO
OBJECTIVE: Children in early learning settings are vulnerable to site-specific emergencies because of physical and developmental limitations. We examined parents' knowledge of disaster plans in their child's early learning settings. METHODS: In May 2015, we conducted a nationally representative online household survey, including parents of children ages 0-5 years in child care settings. Parents were asked about their center's disaster plans and key components: evacuation, special needs children, and disaster supplies. Bivariate analyses and logistic regression were conducted to identify factors associated with parental awareness of disaster plans. RESULTS: Overall, 1,413 of 2,550 parents responded (rate = 55 percent). Sample included 1,119 parents of children 0-5 years old, with 24 percent (n = 264) requiring child care. Parents' reported knowledge of five types of disaster plans: evacuation (66 percent), power outage (63 percent), severe weather (62 percent), lock-down (57 percent), and delayed parent pick-up (57 percent). Only 21 percent reported if plans included all four key components of evacuation (child identification, parent identification, rapid communication, and extra car seats). One-third (36 percent) reported plans accommodating special needs children. Parents' knowledge of disaster supplies varied: generator (31 percent), radio (42 percent), water (57 percent), food (60 percent), and first aid (82 percent). Parents attending any disaster training events (34 percent) were more likely to be aware of all five types of disaster plans compared with parents who had not attended. CONCLUSIONS: Many parents were unaware of disaster plans at their children's early learning settings. Although few parents attended training events, such participation was associated with higher levels of parental awareness.