Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

Surge capacity. Most of our medical systems operate at near capacity in normal times. Pre-event
planning and preparedness are essential to develop local capacity and expand health care
resources to respond to increased needs. Surge capacity should be created on all levels, including
the following:
• Emergency department space.
• Decontamination equipment.
• Antitoxins and medications.
• Hospital bed capacity.
• Extra provider capacity.
• Increased integration back into a community that can provide mental health services.
In general, hospitals should plan to be self-sufficient for the first day or two after an incident.
Most victims in the first 24 hours will be anxious or worried individuals who may or may not
need decontamination before medical treatment. Assessment of hospital capacity for these
victims is essential. Several teams in small areas can perform triage and rapid treatment. A
system should be established to initially treat victims and then assign them to other facilities
(away from the main site) for definitive treatment. There should also be followup to ensure that
appropriate care is available at the other facilities. A system should also be established to rotate
and supplement staff for the first 24–48 hours (or longer) until additional medical help can
arrive.
The following points should be considered in measurement and management of surge capacity:
• Surge capacity expressed in terms of beds is not specific enough. Specific pediatric surge
capacity that is somewhat intervention-specific is preferable. For example, there may be
1,000 hospital beds available in a large community but only 10 pediatric intensive care
unit beds. If these types of pediatric-specific resources are needed, the actual surge
capacity is only 10 beds.
• Non-disaster-related patients must be cared for in addition to disaster victims. Surge
capacity and overall planning should accommodate both sets of patients.
• Surge capacity and capabilities are determined by many factors (e.g., facilities, human
resources, patients’ needs, legal and regulatory issues, policies, process design, supplies,
equipment, etc.). Each factor should be systematically considered and optimized. A
“bottleneck” in any factor can become the limiting condition. Poor management of these
issues can affect outcomes more than the skill of the health professionals caring for
individual patients.
• Assumptions that pediatric patients will be cared for by adult health providers and
facilities are not universally true or necessary in at least some situations.
• Local contexts differ regarding inpatient capacity for high-acuity pediatric patients. In
large urban areas, there are likely multiple pediatric hospitals within a short distance of
each other. They can collaborate and probably handle patients from all but the largest of
disasters. However, many communities have only one facility that may be a significant
distance that is capable of handling high-acuity pediatric cases. These facilities often
operate near or even above capacity many days each year. So, surge capacity and
capability for pediatric but not adult disaster victims may be critically limited.
Transporting pediatric patients to facilities outside of the region may be beneficial or
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