National Commission on Children and Disasters. 2010 Report to the ...

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As highlighted in the <strong>Commission</strong>’s Interim Report, NDMS’ pediatric capabilities are limited, even though children constitute a substantial percentage of DMAT patients. 117 For example, only two of the 53 DMATs are Pediatric Specialty Teams 118 and less than 6 percent of NDMS clinical practitioners have subspecialty training in pediatrics. 119 Findings from the <strong>Commission</strong>’s April 2010 field visit to Florida to examine the domestic impact from the Federal response to the Haiti earthquake highlighted the need to supplement DMATs with pediatric specialty health care providers, expand NDMS’ hospital network to include more pediatric health care facilities, and improve Federal capability to transport pediatric patients. 120 In its Interim Report, the <strong>Commission</strong> made specific recommendations for improving NDMS’ pediatric capabilities, including: adding core competencies on treatment and care of children to NDMS national credentialing standards; providing pediatric education and training to all DMAT members; equipping DMATs with appropriate pediatric supplies and equipment prior to deployments; establishing protocols for delivering care; and developing new pediatric “strike teams” for responding to disasters in which large numbers of children are injured. 121 In response to the Interim Report recommendations, NDMS hired a Deputy Chief Medical Officer for Pediatric Care. Also, ASPR plans to address the recommendations by: 1) developing a reserve pool of qualified professionals who have the credentials and competence to provide a service, but cannot commit to “full-time” NDMS membership 122 ; 2) initiating a cache development program to define a cache standard for pediatrics; and 3) developing objectives and guidelines for a standard pediatric training curriculum for NDMS response teams. 123 The <strong>Commission</strong> recommends HHS develop a detailed plan for accomplishing these objectives. 117 Katherine A. Gnauck, Kevin E. Nufer, Jonathon M. LaValley, Cameron S. Crandall, Frances W. Craig, and Gina B. Wilson-Ramirez, "Do Pediatric and Adult Disaster Victims Differ? A Descriptive Analysis of Clinical Encounters from Four Natural Disaster DMAT Deployments," Prehospital and Disaster Medicine 22, no. 1 (2007): 67, http://pdm.medicine.wisc.edu/Volume_22/issue_1/nufer.pdf. 118 PSTs are specialty DMATs, composed of “individuals specifically trained in the care of children and pediatric-specific equipment, supplies, and pharmaceuticals.” Debra Weiner, Shannon Manzi, Mark Waltzman, Michele Morin, Anne Meginniss, and Gary Fleisher, “FEMA's Organized Response with a Pediatric Subspecialty Team: The <strong>National</strong> Disaster Medical System Response: A Pediatric Perspective,” Pediatrics 117, no.5 (2006): S406, http://pediatrics.aappublications.org/cgi/reprint/117/5/S2/S405. 119 Nicole Lurie, Testimony of Nicole Lurie before the U.S. Senate, Committee on Homeland Security and Governmental Affairs, Ad Hoc Subcommittee on Disaster Recovery, “Children and Disasters: The Role of HHS in Evacuation Planning and Mental Health Recovery,” Washington, DC, August 4, 2009, http://hsgac.senate.gov/public/index.cfm?FuseAction=Hearings.Hearing&Hearing_ID=aa8241f6-6f0e-41a5-87c3- 07c9a58ecbfa. 120 <strong>National</strong> <strong>Commission</strong> on Children and Disasters, “Summary Report: Field Visit, Miami, Florida,” (Washington, DC: NCCD, 2010), 2, http://www.childrenanddisasters.acf.hhs.gov/Summary_FLFieldVisit_FINAL.pdf. 121 <strong>National</strong> <strong>Commission</strong> on Children and Disasters, Interim Report, 18-19. 122 NDMS uses individuals with specific expertise in medical or public health services, emergency management, forensic sciences, and other related fields. These individuals must meet prerequisite training requirements applicable to their positions before being eligible to participate on an NDMS team and be available for interstate deployment. If accepted, individuals become intermittent Federal employees, compensated when deployed on an NDMS mission. Office of the Assistant Secretary for Preparedness and Response, “Recruitment Information: <strong>National</strong> Disaster Medical System,” http://www.phe.gov/Preparedness/responders/ndms/teams/Pages/recruitment.aspx. 123 U.S. Department of Health and Human Services, Memorandum to the <strong>National</strong> <strong>Commission</strong> on Children and Disasters: Response to the <strong>National</strong> <strong>Commission</strong> on Children and Disasters Interim Report, 27-28. 52 NATIONAL COMMISSION ON CHILDREN AND DISASTERS: 2010 REPORT
The <strong>Commission</strong> recommends that NDMS form a pre-credentialed reserve pool of pediatric professionals to supplement DMATs. DMATs often do not have members with expertise in key pediatric specialties, such as individuals who provide surgical, intensive care, nursing, or neonatology services. Difficulty in recruiting pediatric health care providers to DMATs is often due to the significant time commitment for travel, training, and exercises. As an alternative to recruiting pediatric specialists as full-time DMAT members, a reserve pool of pediatric specialists could provide individuals to supplement a DMAT if there is a high demand during an emergency for their particular expertise. For example, many health care workers—including more than 1,200 pediatricians and children’s hospital personnel 124 — spontaneously volunteered to work in Haiti after the 2010 earthquake. Despite their good intentions, many of these professionals could not participate because they had not been previously trained and credentialed by emergency response organizations. NDMS would identify reserve pool members before a disaster to ensure they receive proper credentials, liability coverage, and basic disaster training. NDMS is working with pediatric organizations such as the <strong>National</strong> Association of Children's Hospitals and Related Institutions and the American Academy of Pediatrics to encourage membership in DMATs and reserve pools. The NDMS should assess the current state of its network and work with stakeholder groups to further expand participation by pediatric centers. This would serve to increase the available bed capacity—and particularly critical care beds—and awareness and management of that limited resource. The <strong>Commission</strong> also recommended that a Pediatric Health Care Coordinator be designated on each federally funded medical response team, 125 with responsibility for developing strategies for enhancing pediatric medical expertise within the team. In response, the U.S. Public Health Service’s Office of Force Readiness and Deployment (OFRD), which oversees U.S. <strong>Commission</strong> Corps teams 126 that deploy in response to public health emergencies, established Pediatric Health Care Coordinators. 127 OFRD also committed to evaluating the feasibility of expanding its Readiness and Response Program to include rostered Pediatric Strike Teams within existing resources and funding. However, OFRD noted that funding is not provided in the Fiscal Year (FY) 2011 budget request for OFRD pediatric teams or pediatric-specific field training or exercises. The <strong>Commission</strong> recommends that Congress appropriate funds to support these activities and that HHS include funds in the FY 2012 budget request. Furthermore, the <strong>Commission</strong> urges HHS and other Federal agencies, particularly the Department of Defense (DoD), to establish and appropriately resource Pediatric Health Care Coordinators on their medical response teams. 124 <strong>National</strong> <strong>Commission</strong> on Children and Disasters, personal communication with the American Academy of Pediatrics, July 15, 2010. 125 Federally funded medical response teams include DMATs, Public Health Service <strong>Commission</strong>ed Corps teams, DoD teams, and Medical Reserve Corps teams. 126 OFRD’s teams include Rapid Deployment Force Teams and Mental Health Teams, as well as recently developed Services Access Teams, which are specifically designed to assist those affected by a disaster, including children and youth, by connecting them with local service providers. United States Public Health Service, “Office of Force Readiness and Deployment,” http://ccrf.hhs.gov/ccrf/. 127 U.S. Department of Health and Human Services, Memorandum to the <strong>National</strong> <strong>Commission</strong> on Children and Disasters: Response to the <strong>National</strong> <strong>Commission</strong> on Children and Disasters Interim Report, 27. NATIONAL COMMISSION ON CHILDREN AND DISASTERS: 2010 REPORT 53
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NATIONAL COMMISSION ON CHILDREN AND
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ii The 2010 Report to the President
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Each new disaster presents distinct
Page 8 and 9: Contents Abbreviations.............
Page 10 and 11: EMSC Emergency Medical Services for
Page 12 and 13: Background The National</st
Page 14 and 15: Recommendation 1.2: The President s
Page 16 and 17: - Include pediatric expertise on th
Page 18 and 19: Recommendation 4.3: HHS should deve
Page 20 and 21: 8. Child Welfare and Juvenile Justi
Page 22 and 23: 11. Evacuation Recommendation 11.1:
Page 25 and 26: 1. Disaster Management and Recovery
Page 27 and 28: A major impediment to the prioritiz
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Page 31 and 32: Recommendation 1.2: The President s
Page 33 and 34: Recommendation 1.3: DHS/FEMA should
Page 35 and 36: The Commission rec
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Page 43 and 44: Recommendation 2.4: DHS/FEMA and SA
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Page 54 and 55: children are largely unavailable or
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Page 60 and 61: Recommendation 3.3: HHS should ensu
Page 62 and 63: Recommendation 3.4: The Executive B
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Page 66 and 67: Finally, the Commission</st
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Page 83: Not all disasters will involve disa
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102 NATIONAL COMMISSION ON CHILDREN
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. Respond to new child welfare case
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Recommendation 8.2: Ensure that Sta
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The Commission sup
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Toward the goal of ensuring that ju
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evisions to the standards were need
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10. Housing Recommendation 10.1: Pr
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10. Housing Recommendation 10.1: Pr
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corresponding tasks related to the
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Finally, the Commission</st
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evacuees. 382 States also have the
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The Commission sup
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Recommendation 11.2: Disaster plans
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planning for the evacuation of scho
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Appendix A. Study Approach The <str
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Appendix B: Index to Recommendation
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• Include bereavement support and
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Relevant Federal Agencies President
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• DHS/FEMA should clarify the tra
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● Relevant Federal Agencies Presi
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• Congress should authorize DHS/F
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Appendix C: Model Executive Order o
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2. Children and Disasters Advisory
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• Support disaster plans, trainin
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• When children exhibit signs of
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Appendix F. Supplies for Infants an
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Non-Perishable Supplies & Equipment
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Supplemental Information Descriptio
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Appendix G. Subcommittee Members an
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Richard Muth, National</str
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Also, the Commission</stron
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Children’s Research Center^ Churc
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Planning and Learning Technologies,
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Honorable Sheila Leslie Appointed t
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Honorable Mark K. Shriver, MPA Chai
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NATIONAL COMMISSION ON CHILDREN AND
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