The state of disaster preparedness in this country hardly breeds confidence.
Since 9/11, there has been haunting national anxiety around the issue and tremendous media coverage for federal efforts to quell it. But clear away the emotion, eliminate the dramatic headlines, and there is disappointingly little evidence to suggest that U.S. healthcare providers are significantly more prepared today to respond to a large-scale disaster than they were a decade ago.
The mission of the Childrens Hospital Los Angeles Pediatric Disaster Resource and Training Center is to quickly, carefully and effectively help fill the dangerous gaps in pediatric disaster preparedness that continue to loom over the 4,000 square miles of Los Angeles County. Within this vast area, there are hundreds of accredited hospitals and trauma centers. What’s more, the Joint Commission on Accreditation of Healthcare Organizations mandates that all of them develop and maintain a written disaster plan. Yet the little data that exists on the subject indicates that very few hospitals—in L.A. County or elsewhere—emphasize the importance of having a realistic plan, one that can be followed in a real disaster.
In 2006 the Society for Academic Emergency Medicine Disaster published data on a survey of overall preparedness within the County.
To no one’s surprise, this survey study identified a number of readiness gaps. Among them:
Confusion over roles and responsibilities
Many problems faced during disasters result not from a shortage of medical resources but from a failure to coordinate their distribution. The truth is, many skilled medical practitioners voluntarily arrive at disaster scenes or at the hospital emergency departments closest to where they occur. Ironically, however, this “convergent volunteerism” can actually compound the disaster because doctors and nurses are most effective when providing the kind of care they know best. Unless specially trained in emergency medical services or disaster response, they are ill-equipped to function effectively in the chaotic aftermath of a major incident.
Lack of planning
Retrospective research indicated that, as of 2001, fewer than one-in-five hospitals had response plans for biological or chemical weapons incidents; and only 12 percent had one or more self-contained breathing apparatuses. A separate survey found that nearly three out of every four hospital administrators interviewed by the Federal Emergency Management Agency (Region III) felt unprepared to manage a biological, chemical or nuclear event. Fewer than half reported that they were able to perform a hospital-wide security lockdown. Even among hospitals designated Level 1 trauma centers, only 30 percent had complete hazardous materials response plans (as of 1996) and only 58 percent had performed a disaster drill during the preceding year.
Lack of hospital integration into community disaster planning
Because hospitals do not function in isolation, emergency medical service providers and hospitals plans must integrate their disaster plans. As the study points out:
Pre-established relationships between hospitals and other community response entities (such as fire safety, law enforcement, public health and local government administration) increase the likelihood of an effective response during a large-scale emergency.
Yet, among study survey respondents, relatively few had mutual aid agreements with other hospitals or with long-term care facilities. And while the vast majority of hospitals had participated in drills that involved multiple agencies, only 16 percent had actually conducted disaster training with even one other agency.
Narrow the focus to pediatric preparedness, and the state of readiness becomes a veritable twilight zone of unknowns.
Quite literally, there is currently no research data assessing disaster preparedness for children in California. And there are no existing survey instruments appropriate for making such an assessment. Indeed, these shocking gaps, in and of themselves, provide testament to the need for the Childrens Hospital project.
What is known is this: When hospitals asses their disaster capability, their pediatric capacity is not separately addressed.
Last year, the California Emergency Medical Services Authority published the results of a pediatric disaster preparedness survey.
The purpose of the study was to assess the capabilities, vulnerabilities and unmet needs of emergency medical services systems in caring for youngsters during times of disaster. The Authority found that:
Care of pediatric patients in disasters requires skills, equipment, and a system of response that addresses their needs as well as the needs of their families. Children require special attention because they are more vulnerable than adults to the effects of biological or chemical agents, to infections agents, to burns, and to blood loss. Their development levels may also limit their abilities to identify themselves, escape from danger, and communicate their situation to others.
Despite these facts, first responders are grossly under-prepared to care for pediatric populations in the event of a large-scale emergency.
These are only a few of the unsettling findings of the 2006 study…
The majority of California providers do not address pediatric preparedness as a distinct readiness issue. Children are not miniature adults. Their bodies work in unique ways and, when ill or injured, require very particular medical care. Nevertheless, a staggering 77 percent of survey respondents do not know of, or reported not having written plans that specially address triage of pediatric patients.
Pediatric emergency care training and drill staging is a significant problem.
Only 31 percent of the survey respondents had participated (as instructors or learners) in disaster training that included the needs of pediatric populations during the past year. And even fewer—just 21 percent—had participated in a multi-agency disaster drill in the last two years that addressed the needs of children
There is very little disaster planning devoted to ensuring the reunification of children with their families. Only 10 percent of respondents report having written plans to address reunification of pediatric patients with their families. And fewer than 20 percent of those who have participated in any pediatric disaster training report that reunification has been addressed.
Fewer than half of respondents report that their operational area has a designated position for addressing the disaster medical needs of pediatric populations. Fully 96 percent say that their operational area participates in a multidisciplinary disaster planning committee that meets annually; but only 33 percent say there is pediatric nursing or medical representation on the committee.
And fewer than one-in-five say that the committee has addressed pediatric disaster response planning during the past year.
Fewer that half of all respondents report that their area’s disaster plan addresses the acquisition of pediatric disaster resources. Another 27 percent do not know if this issue is addressed in their plan.
Exactly half report having no plans to obtain additional pediatric equipment in the event of a disaster. An additional 30 percent do not know if such plans exist.
In the immediate aftermath of a disaster, temporary shelters are needed for the care of homeless and dislocated children. Yet 62 percent of respondents do not have, or do not know of, plans to acquire such resources.
And as to meeting the needs of children with special needs… Only 45 percent of respondents report that they have written plans for children with physical disabilities; just 23 percent are prepared to provide services for children with mental health disabilities.
Faced with such staggering gaps in preparedness, it is easy to become immobilized.
Granted, the task is enormous. But Childrens Hospital Los Angeles has spent more than 100 years preparing to assume a leadership role in improving the level of pediatric readiness in L.A. County. Childrens Hospital is a full-service medical institution and research center dedicated solely to improving children’s health. It has the largest pediatric specialty group in the region and was among the first hospitals to be designated a Level One Trauma Center by Los Angeles County. Careful to maintain this designation for almost 25 years, Childrens Hospital is singularly qualified to care for even the most critically injured children.
Should the worst happen in Los Angeles County, adults will frantically turn to local emergency services for help and survival.
How much more vulnerable are youngsters—who do not even know to rely on these service providers for protection and care? If we wait until the need arises, it will be too late. Now is the time to prepare. Children do not know to lobby for themselves. One of the great charms of youth is that it simply assumes its own safety. If the moral integrity of a society rests in how it treats its youth, then we must rise to the challenge of pediatric disaster preparedness. To shirk this responsibility would be to forfeit our place among the civilized nations of the world. And to relinquish some of what is finest inside us.