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

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Recommendation 3.3: HHS should ensure that health professionals who may treat children during a disaster have adequate pediatric disaster clinical training. 54 - The President should direct the Federal Education and Training Interagency Group for Public Health and Medical Disaster Preparedness and Response (FETIG) to prioritize the development of pediatric core competencies, core curricula, training, and research. - The FETIG should support the formation of a Pediatric Disaster Clinical Education and Training Working Group to establish core clinical competencies and a standard, modular pediatric disaster health care education and training curriculum. Health professionals, whether responding to a disaster scene or treating survivors in a hospital, must have appropriate training to provide needed medical care to children. Children are a significant portion of the population and are as likely as adults, if not more likely, to sustain serious injuries during disasters. In 2009 and 2010, Federal disaster response teams were deployed to disaster sites in American Samoa and Haiti, where children constitute approximately 40 percent of the population. In Haiti, children sustained serious crushing injuries, in many cases requiring amputations. 128 Emergency managers and health professionals should plan and train for an anticipated number of pediatric survivors requiring medical care after a disaster based on the demographics of their community. Pediatric training provided to emergency medical responders varies in content and quality primarily due to the absence of national standards for pediatric disaster education and training. 129 As noted previously, few DMAT members have formal subspecialty training in pediatrics. 130 Also, the <strong>National</strong> Guard Bureau staff reported that there is very limited pediatric training for emergency responders who are not already pediatric specialists. 131 128 Daniel Green, “Public Comment at the <strong>National</strong> <strong>Commission</strong> on Children and Disasters Public Meeting, February 2, 2010,” 4-6, http://www.childrenanddisasters.acf.hhs.gov/20100202_PublicComment_DGreen.pdf. 129 Elizabeth Ablah, Annie M. Tinius, and Kurt Konda, “Pediatric Emergency Preparedness Training: Are We on a Path toward <strong>National</strong> Dissemination?,” The Journal of Trauma 67, no. 2 (2009): S156. 130 While 68 percent of the clinical practitioners comprising DMATs have pediatric-specific training, only 5.6 percent have formal subspecialty training in pediatrics (e.g., pediatricians, pediatric nurse practitioners, pediatric emergency medicine, and pediatric critical care), and 47 percent have formal training specific to pregnant women. “Pediatric-specific training” refers to boarded or licensed providers who have received formalized training in pediatric care as well as training for other age groups (e.g., Emergency Medicine and Family Medicine). “Subspecialty training in pediatrics” refers to physicians and nurse practitioners who have received formalized training limited to pediatrics. Allen Dobbs, Chief Medical Officer, NDMS, personal communication to Christopher Revere, August 19, 2009. 131 MAJ Julie Carpenter, Medical Operations Officer, <strong>National</strong> Guard Bureau, personal communication to <strong>Commission</strong>er Michael Anderson, July 23, 2010. NATIONAL COMMISSION ON CHILDREN AND DISASTERS: 2010 REPORT
The <strong>Commission</strong> recommends that the President direct the Federal Education and Training Interagency Group for Public Health and Medical Disaster Preparedness and Response (FETIG) 132 to address these deficiencies. As part of this effort, the <strong>Commission</strong> recommends that FETIG, working through the <strong>National</strong> Center for Disaster Medicine and Public Health (NCDMPH), should prioritize the development of pediatric core competencies, core curricula, training, and research in the NCDMPH’s work plan. The <strong>Commission</strong> recommends that all Federal agencies represented on the FETIG, particularly HHS as the coordinating agency for Emergency Support Function (ESF) #8, 133 provide the resources necessary to support the mission and continuation of the FETIG. To complete this work, the FETIG should support the formation of a Pediatric Disaster Clinical Education and Training Working Group with appropriate pediatric subject matter experts to complete this work. The <strong>Commission</strong>’s Interim Report recommended forming this working group to: establish detailed core competencies and skill sets for different types of responders and health care professionals; develop a national training curriculum based on those core competencies; review existing training materials; provide guidance on how to incorporate children into exercises and drills; and build continuing education requirements into licensing and re-certification processes. 134 The importance of training is reflected in the HHS 2009 <strong>National</strong> Health Security Strategy (NHSS), which outlines actions for ensuring the Nation’s health in the event of a major disaster or incident. One of NHSS’ 10 strategic objectives is to “develop and maintain the workforce needed for national health security.” 135 The lack of training and certification standards is noted as one obstacle to achieving this objective. 136 A companion NHSS Implementation Guide outlines specific activities to be accomplished in 2010, including prioritizing areas of investment and developing workforce competencies. 137 The <strong>Commission</strong> recommends that HHS explicitly address the needs of children in its efforts to expand workforce training and development. 132 FETIG is an advisory group with representatives from Federal agencies, academia, and the private sector that coordinates public health, medical disaster preparedness, and response core curricula, training standards, and education for use by Federal agencies and non-governmental organizations. Office of the Assistant Secretary for Preparedness and Response, Charter for the Federal Education and Training Interagency Group, (Washington, DC: HHS, March 13, 2008), 1-3. 133 ESF #8, Public Health and Medical Services, coordinates all Federal assistance in support of State, local, tribal, and regional response to public health and medical disasters, incidents requiring a coordinated Federal public health or medical response, and developing public health or medical emergencies. U.S. Department of Homeland Security, Federal Emergency Management Agency, “<strong>National</strong> Response Framework, Emergency Support Function #8 – Public Health and Medical Services Annex,” http://www.fema.gov/pdf/emergency/nrf/nrf-esf-08.pdf. 134 <strong>National</strong> <strong>Commission</strong> on Children and Disasters, Interim Report, 19-20. 135 U.S. Department of Health and Human Services, <strong>National</strong> Health Security Strategy of the United States of America, (Washington, DC: HHS, 2009), 8, http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdf. 136 Ibid., 9. 137 U.S. Department of Health and Human Services, Interim Implementation Guide for the <strong>National</strong> Health Security Strategy of the United States of America, (Washington, DC: HHS, 2009), 4, http://www.phe.gov/Preparedness/planning/authority/nhss/implementationguide/Documents/iig-final.pdf. NATIONAL COMMISSION ON CHILDREN AND DISASTERS: 2010 REPORT 55
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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
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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
Page 29 and 30: children are a core consideration i
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
Page 37 and 38: 2. Mental Health Recommendation 2.1
Page 39 and 40: 2. Mental Health Recommendation 2.1
Page 43 and 44: Recommendation 2.4: DHS/FEMA and SA
Page 45 and 46: urden on affected States and commun
Page 47 and 48: types of [enhanced] crisis counseli
Page 49: elated adjustment difficulties such
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Page 54 and 55: children are largely unavailable or
Page 56 and 57: children may take several years, th
Page 58 and 59: As highlighted in the Commi
Page 62 and 63: Recommendation 3.4: The Executive B
Page 64 and 65: Notwithstanding the need for greate
Page 66 and 67: Finally, the Commission</st
Page 69 and 70: 4. Emergency Medical Services and P
Page 71 and 72: 4. Emergency Medical Services and P
Page 73 and 74: Recommendation 4.2: Improve the cap
Page 75 and 76: In addition, the Commission
Page 77 and 78: NDMS and DoD are not the only entit
Page 79 and 80: 5. Disaster Case Management Recomme
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Page 83: Not all disasters will involve disa
Page 90 and 91: In response to the Commissi
Page 92 and 93: Finally, the Commission</st
Page 94 and 95: eport, the chronic shortage of pedi
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Page 100 and 101: Recommendation 7.2: Congress and ED
Page 102 and 103: Recommendation 7.3: Ensure that sch
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Page 106 and 107: sources. 303 Without comprehensive
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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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112 NATIONAL COMMISSION ON CHILDREN
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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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