Pediatric Emergency Readiness and Pandemic Influenza Steven E. Krug, MD Head, Division of Emergency Medicine Children’s Me...
Disclosures <ul><li>I have no relevant financial relationships with the manufacturers of any commercial products and/or pr...
Objectives <ul><li>Describe the fundamental link between day-to-day emergency preparedness and disaster (aka pandemic) rea...
Pediatric Disaster Preparedness: 101 <ul><li>Preparation for a pandemic, or any type of disaster, begins with basic prepar...
A ‘Blueprint’ for Disaster Readiness }-  }- Day-to-day  emergency  readiness All-hazard mass casualty  event readiness “ T...
So, How’s The Foundation of Our Nation’s Emergency Care System?  <ul><li>Existing public safety systems (EMS, fire, etc) a...
Emergency Care: At the Breaking Point <ul><li>ED visits grew by 26% between  1993 and 2003  (90    114 million) </li></ul...
Pediatric Readiness: “Growing Pains” <ul><li>Although children make up at least 1/4 of all ED visits nationwide </li></ul>...
Pediatric Emergency Care:  The Experience Gap <ul><li>Children account for 5 to 10% of all EMS patients </li></ul><ul><ul>...
POLICY STATEMENT Pediatrics 2007;  120(1): 200-12 Preparation for Emergencies in the Offices of Pediatricians and Pediatri...
Pediatrics - October 2009; 124(4):1233-43. Guidelines for Care of Children in the ED  Gausche-Hill M, Krug S, and the Amer...
POLICY STATEMENT Pediatrics 2006;  117(2): 560-65 The Pediatrician and Disaster Preparedness Committee on Pediatric Emerge...
School Readiness Concerns
 
Children’s Memorial Hospital, Chicago, IL
Children’s Memorial Hospital ED Visits
Spring 2009 – Lessons Learned <ul><li>Disconnect between federal and local pandemic planning and management recommendation...
H1N1 Preparedness:  10 Steps  You  Can Take <ul><li>1. Develop a business/practice continuity plan </li></ul><ul><ul><li>C...
H1N1 Preparedness:   10 Steps  You  Can Take <ul><li>5. Plan for a patient surge and an increased demand for services </li...
H1N1 Preparedness:  10 Steps  You  Can Take <ul><li>7. Take steps to protect your workforce  </li></ul><ul><ul><li>Promote...
Being Aware    Being Prepared <ul><li>Local epidemiology/prevalence of H1N1 </li></ul><ul><li>Viral screening/testing </...
http://www.cdc.gov/h1n1flu/update.htm
 
 
 
Updated Interim Recommendations for the Use of  Antiviral Medications in the Treatment and Prevention  of Influenza for th...
Antiviral Therapy Recommendations <ul><li>Patients at risk for H1N1 related complications </li></ul><ul><ul><li>People wit...
Which Children Are at High Risk? <ul><li>Neurological disorders </li></ul><ul><ul><li>Epilepsy or cerebral palsy especiall...
Which Children Are at High Risk? <ul><li>Moderate to profound intellectual disability or developmental delay when associat...
Interim Guidance on Infection Control Measures for  2009 H1N1 Influenza in Healthcare Settings, Including  Protection of H...
http://www.cdc.gov/h1n1flu/clinicians/pdf/childalgorithm.pdf October 16, 2009
<ul><li>Disaster Planning Resources for Pediatricians </li></ul><ul><ul><li>Needle:  A Disaster Preparedness Plan for Pedi...
http://www.aap.org/disasters/pdf/DisasterPrepPlanforPeds.pdf
Pediatrics - October 2009; 124(4):1216-26. Policy Statement—Recommendations for the Prevention and Treatment of Influenza ...
AAP DPAC Disaster Preparedness Advisory Council <ul><li>Steven Krug, MD, FAAP - Chairperson  </li></ul><ul><li>Sarita Chun...
New doll available at the American Girl Store: ‘Suzy Swine Flu’….
 
 
Pediatrics 2007; 120(6): 1229-37   Pediatric Preparedness of US Emergency Departments: A 2003 Survey  Marianne Gausche-Hil...
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Pediatric Emergency Readiness and Pandemic Influenza

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  • Reflect that this presentation will be based upon an assumption made regarding the forum – pediatric grand rounds at a leading children’s hospital and the likely audience: medical students, residents and fellows, pediatric sub-specialists and hopefully some general pediatricians, nurses, administrators. As this should be a somewhat ‘enlightened’ audience – I will not dwell as much as I might if I was giving this presentation to a more general audience of health care providers or a group of laypersons, where I would likely spend the lion’s share of my time educating on what makes children unique. The literature and the internet are full of resources on the issue of disaster readiness. I will offer only some, and will tend to use those from the AAP and EMSC program due to my intimate involvement in both.
  • This drawing of an elevated house, designed to sustain the impact of hurricanes on the Gulf Coast is a great model for the relationship between day-to-day emergency readiness and disaster readiness. For this specially fortified house to survive the tidal surge accompanying the storm, it must be built upon an appropriate foundation – in this case – a series of elevated steel posts. Without the proper foundation, the design fails. Thus, the same is true for disaster readiness, the house, which must be built upon a sufficiently strong foundation, namely day-to-day emergency readiness. Interestingly, the insert is a photograph of such a house (admittedly taken after it had completed some minor repair) that actually survived Hurricane Katrina.
  • So, before we discuss the status of patient safety in pediatric emergency care, we must first examine the “foundation” of our emergency medical services systems. Regrettably, like the foundation beneath the Leaning Tower, the support base for emergency services nationwide is somewhat deficient……. Read slide
  • In response to growing ED overcrowding and evidence of distress in our emergency medical services systems, the Institute of Medicine commissioned a study of the US emergency care system in 2004. The IOM panel released its three part report, the “Future of Emergency Care” in 2006. “ At the breaking point” was the title for the portion of the report which addressed hospital-based emergency care. The report noted………. Read slide………………. Number of EDs decreased by 425, hospitals decreased by 700, inpatient beds decreased by 198,000 Overcrowding and boarding used to be a problem limited to certain hospital types: large academic centers, certain urban settings, trauma centers, etc Over 90% of hospitals report overcrowding as a problem 40% report that it is a daily problem Ambulance diversion equals one per minute 70% of urban hospitals go on diversion
  • How big a problem is this pediatric care gap – well it may be fairly substantial. The 2006 IOM report on pediatric care “Growing Pains” underscored numerous short falls in the ability of a system designed to meet the care needs of adults. Read slide Mention AAP/ACEP guidelines
  • Children make 25M ED visits per year in the US. While children represent 25% of all ED visits, and 5 to 10% of EMS runs, both hospital and pre-hospital based care providers may not be well prepared to care for children. Professional training programs tend to shortchange the amount of didactic and hands on training in pediatric care. Once out in the field, these providers may have limited exposure to critically ill or injured children. Therefore, pediatric care skills, such as those that might have been obtained during training, or from a PALS course, diminish as they are not practiced.
  • This is an excellent resource – in addition to guidelines for recommended medications, equipment and supplies, this also contains a number of appendices, including a self-assessment tool for office readiness, mock codes scenarios and evaluation form, protocols for activating EMS….. Emergency preparedness plan should reflect a review of experiences for common emergent or acute conditions, including the population of CSHCN served, and the capabilities and response time for local EMS
  • “ Before a disaster, pediatricians need to: Take part in local community response team planning Anticipate and prepare for loss of community services Be involved in EMS, proficient in CPR and first aid Assure the availability of pediatric resources” “ During a disaster, pediatricians need to: Institute office and home disaster plans Participate in the community or hospital disaster plan” “ During the disaster recovery period, pediatricians need to Be prepared to deal with continued disruption of services Provide on-site emergency and primary health care at emergency shelters Continue to implement the plan as needed to address inpatient and outpatient treatment, infectious disease control . . .” Finally, Pediatricians have a key role in advising families on disaster readiness. Likewise, they can play a pivotal role in helping families to support their children post-disaster. Special considerations for families with CSHCN……. Notification of utility companies to provide emergency support Maintenance of medications and equipment to assure they are not disrupted Training for families to support care needs during disaster
  • The influenza activity reported by state and territorial epidemiologists indicates geographic spread of both seasonal influenza and 2009 influenza A (H1N1) viruses and does not measure the severity of influenza activity. During week 39, the following influenza activity was reported: Widespread influenza activity was reported by 37 states (Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Texas, Tennessee, Virginia, Washington, and Wyoming). Regional influenza activity was reported by Guam and 11 states (Connecticut, Maine, Massachusetts, Michigan, Montana, New Jersey, North Dakota, Rhode Island, Utah, West Virginia, and Wisconsin).. Local influenza activity was reported by the District of Columbia, Puerto Rico, and two states (Hawaii and Vermont). The U.S. Virgin Islands did not report.
  • Nationwide during week 40, 6.1% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.3%. On a regional level, the percentage of outpatient visits for ILI ranged from 1.8% to 12.9% during week 40, and increased in nine of the 10 surveillance regions compared to the previous week. All 10 regions reported a proportion of outpatient visits for ILI above their region-specific baseline levels.
  • Eleven influenza-associated pediatric deaths were reported to CDC during week 40 (Arizona, Colorado, Idaho, Kentucky, Louisiana [2], North Carolina, Ohio, South Carolina, and Tennessee [2]). Ten of these deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype is undetermined. These deaths occurred between August 30 and October 10, 2009. Since August 30, 2009, CDC has received 43 reports of influenza-associated pediatric deaths that occurred during the current influenza season (three deaths in children less than 2 years, five deaths in children 2-4 years, 16 deaths in children 5-11 years, and 19 deaths in individuals 12-17 years). Thirty-nine of the 43 deaths were due to 2009 influenza A (H1N1) virus infections. A total of 86 deaths in children associated with 2009 H1N1 virus have been reported to CDC. Among the 43 deaths in children, 28 children had specimens collected for bacterial culture from normally sterile sites and seven (25.0%) of the 28 were positive; Staphylococcus aureus was identified in five (71.4%) of the seven children. One S. aureus isolate was sensitive to methicillin, three were methicillin resistant, and one did not have sensitivity testing performed. All seven children with bacterial coinfections were five years of age or older and four (57.1%) of the seven children were 12 years of age or older.
  • November issue of PIR – Disaster Preparedness and Pediatrics: What’s Next
  • Exactly how prepared are US EDs to care for kids, in reference to the 2001 AAP/ACEP guidelines? A 2003 survey by Gausche-Hill and colleagues provides some interesting insight into the problem and offers some clues as to what factors may promote readiness As you can see, the vast majority – nearly 90% of pediatric patient visits occur in non-children’s hospitals. Half of these hospitals see less than 10 kids per day! Per my earlier comments, this frequency would not promote significant on-going exposure to sick kids. These investigators also found that only 6% of EDs had all of the recommended equipment in the AAP/ACEP guidelines. Hospitals most likely to be prepared were those that were larger in volume, and henceforth saw more kids. This was particularly true for EDs that had a defined clinical leader or advocate for pediatric emergency care. 30% response rate to survey
  • Pediatric Emergency Readiness and Pandemic Influenza

    1. 1. Pediatric Emergency Readiness and Pandemic Influenza Steven E. Krug, MD Head, Division of Emergency Medicine Children’s Memorial Hospital Chicago, IL AAP 2009 NCE Washington, DC
    2. 2. Disclosures <ul><li>I have no relevant financial relationships with the manufacturers of any commercial products and/or providers of commercial services discussed in this CME activity </li></ul><ul><li>I do not intend to discuss an unapproved or investigative use of a commercial product or device in my presentation </li></ul>
    3. 3. Objectives <ul><li>Describe the fundamental link between day-to-day emergency preparedness and disaster (aka pandemic) readiness for children </li></ul><ul><li>Define the role for pediatricians as advocates for pediatric emergency and disaster readiness and as participants in disaster mitigation, response and recovery </li></ul><ul><li>Discuss lessons learned from the Spring 2009 H1N1 patient surge and strategies for improved pediatric readiness for an influenza pandemic </li></ul>
    4. 4. Pediatric Disaster Preparedness: 101 <ul><li>Preparation for a pandemic, or any type of disaster, begins with basic preparation for pediatric emergencies </li></ul><ul><ul><li>This should occur at all levels of care </li></ul></ul><ul><ul><ul><li>Home/community </li></ul></ul></ul><ul><ul><ul><li>Office </li></ul></ul></ul><ul><ul><ul><li>Hospital </li></ul></ul></ul><ul><ul><li>This should anticipate children with special healthcare needs </li></ul></ul>
    5. 5. A ‘Blueprint’ for Disaster Readiness }- }- Day-to-day emergency readiness All-hazard mass casualty event readiness “ The Elevated Hurricane Zone Housing Solution”
    6. 6. So, How’s The Foundation of Our Nation’s Emergency Care System? <ul><li>Existing public safety systems (EMS, fire, etc) are frequently over-taxed by demand </li></ul><ul><li>EMS and trauma systems are woefully under-funded </li></ul><ul><li>Hospital-based emergency departments are increasingly and dangerously overcrowded </li></ul><ul><li>Pediatric capabilities of our emergency (and disaster) care systems is uncertain </li></ul>
    7. 7. Emergency Care: At the Breaking Point <ul><li>ED visits grew by 26% between 1993 and 2003 (90  114 million) </li></ul><ul><ul><li>Number of ED’s declined by 425 </li></ul></ul><ul><li>Critical shortages of healthcare providers (MDs, RNs, etc) </li></ul><ul><li>Substantial ED overcrowding </li></ul><ul><li>Ambulances are frequently diverted from overcrowded EDs </li></ul><ul><ul><li>~ 500,000 diversions in 2003 </li></ul></ul><ul><li>In addition to ED access concerns, overcrowding is associated with poor care quality & medical error </li></ul>Institute of Medicine. Future of Emergency Care in the US Healthcare System, 2006.
    8. 8. Pediatric Readiness: “Growing Pains” <ul><li>Although children make up at least 1/4 of all ED visits nationwide </li></ul><ul><ul><li>Most general EDs and EMS agencies do not require specialized pediatric training for their clinical staff </li></ul></ul><ul><ul><li>Only 6% of all EDs have the full scope of pediatric equipment, medications, supplies </li></ul></ul><ul><ul><li>Paucity of research on best practices, clinical outcomes, & patient safety in pediatric emergency care </li></ul></ul>“ If there is one word to describe the current state of pediatric emergency care in 2006, it is UNEVEN ” --- IOM Panel, 2006
    9. 9. Pediatric Emergency Care: The Experience Gap <ul><li>Children account for 5 to 10% of all EMS patients </li></ul><ul><ul><li>Only 0.5 -1% are critically ill/injured </li></ul></ul><ul><ul><li>Limited experience for paramedics with sick kids </li></ul></ul><ul><li>Children make 25-30 million ED visits per year </li></ul><ul><ul><li>Less than 5% of require 3 0 care </li></ul></ul><ul><ul><li>Nearly 90% of children are cared for in general hospital ED’s </li></ul></ul><ul><ul><li>Many of these EDs see few children </li></ul></ul><ul><ul><ul><li>50% of EDs care for < 10 kids/day </li></ul></ul></ul><ul><ul><ul><li>Limited experience with sick kids </li></ul></ul></ul>
    10. 10. POLICY STATEMENT Pediatrics 2007; 120(1): 200-12 Preparation for Emergencies in the Offices of Pediatricians and Pediatric Primary Care Providers Frush K, and the Committee on Pediatric Emergency Medicine <ul><li>Perform a self-assessment of office readiness for emergencies </li></ul><ul><li>Develop an organizational plan for emergency response in the office </li></ul><ul><li>Maintain recommended office equipment, medications, supplies and tools to guide resuscitation interventions (e.g. protocols, pre-calculated drug doses) </li></ul><ul><li>Develop a plan to provide education and training for all office staff </li></ul><ul><li>Practice mock codes in the office on a regular basis </li></ul><ul><li>Educate families about what to do in an emergency </li></ul><ul><li>Partner with EMS and hospital-based emergency care providers to ensure optimal emergency care and disaster readiness for children </li></ul>– or a pandemic!
    11. 11. Pediatrics - October 2009; 124(4):1233-43. Guidelines for Care of Children in the ED Gausche-Hill M, Krug S, and the American Academy of Pediatrics, American College of Emergency Physicians, Emergency Nurses Association <ul><li>Recommendations regarding personnel, training, equipment, supplies, medications, support services, quality and process improvement, policies, protocols, and other resources necessary for optimal pediatric emergency care </li></ul><ul><ul><li>Updated version of 2001 AAP/ACEP joint policy statement </li></ul></ul><ul><li>The presence of MD & RN pediatric coordinators may be the most important factor associated with readiness* </li></ul><ul><ul><li>This ADVOCATE could be a community or hospital based pediatrician </li></ul></ul><ul><li>Offers recommendations for patient safety & disaster readiness </li></ul>*Gausche-Hill M, et al. Pediatrics 2007; 120(6): 1229-37
    12. 12. POLICY STATEMENT Pediatrics 2006; 117(2): 560-65 The Pediatrician and Disaster Preparedness Committee on Pediatric Emergency Medicine and the Task Force on Terrorism <ul><li>Advocate for children and families in disaster planning at all levels </li></ul><ul><li>Become knowledgeable about issues related to pediatric disaster mgmt </li></ul><ul><li>Participate in disaster planning: </li></ul><ul><ul><li>Office emergency readiness and an office disaster plan – develop & practice </li></ul></ul><ul><ul><li>Take part in local community and hospital disaster planning, exercises, drills </li></ul></ul><ul><ul><li>Work with local schools and child care facilities in developing their plans </li></ul></ul><ul><ul><li>Provide anticipatory guidance to families on preparedness – esp. CSHCN </li></ul></ul><ul><ul><li>Participate in disease surveillance and reporting activities </li></ul></ul><ul><ul><li>Participate/provide guidance to local volunteer disaster response groups </li></ul></ul>
    13. 13. School Readiness Concerns
    14. 15. Children’s Memorial Hospital, Chicago, IL
    15. 16. Children’s Memorial Hospital ED Visits
    16. 17. Spring 2009 – Lessons Learned <ul><li>Disconnect between federal and local pandemic planning and management recommendations </li></ul><ul><li>Variable screening and treatment practices across facilities/practices within local communities </li></ul><ul><li>Demand for clinical services by ill and ‘worried well’ patients exceeded capacity </li></ul><ul><li>Availability of key medications and supplies limited service delivery and placed patients & staff at risk </li></ul><ul><li>Impact of the pandemic on healthcare staff further reduced service capacity at all levels of care </li></ul><ul><li>Impact on key safety net services threatened patient care quality and safety </li></ul>
    17. 18. H1N1 Preparedness: 10 Steps You Can Take <ul><li>1. Develop a business/practice continuity plan </li></ul><ul><ul><li>Cross-training of staff to support key functions </li></ul></ul><ul><ul><li>Develop alternate plans for critical supplies </li></ul></ul><ul><ul><li>Plan to support core business functions for several weeks </li></ul></ul><ul><li>2. Inform staff about pandemic surge coping plan </li></ul><ul><ul><li>Clear and frequent communication – assure understanding </li></ul></ul><ul><ul><li>Promote resiliency through personal/family plan development </li></ul></ul><ul><li>3. Plan to operate in the face of absenteeism </li></ul><ul><ul><li>Anticipate 20 to 50% </li></ul></ul><ul><li>4. Protect the workplace, ill personnel remain home </li></ul><ul><ul><li>Staff should engage in self monitoring behaviors </li></ul></ul><ul><ul><li>Align FMLA policies with infection control expectations </li></ul></ul>Source: CDC – “Ten Steps” Available at: http://cdc.gov/h1n1flu/10steps.htm
    18. 19. H1N1 Preparedness: 10 Steps You Can Take <ul><li>5. Plan for a patient surge and an increased demand for services </li></ul><ul><ul><li>Consider telephone as a tool to deliver messaging on when & where to seek care, or where to seek additional information </li></ul></ul><ul><ul><li>Consider extending hours of operation </li></ul></ul><ul><ul><ul><li>Telephone triage </li></ul></ul></ul><ul><ul><ul><li>Office hours </li></ul></ul></ul><ul><ul><li>Develop a plan to manage patients who do not require emergency care </li></ul></ul><ul><li>6. Plan to care for H1N1 patients in your facility </li></ul><ul><ul><li>Plan to screen patients at entry for signs of ILI </li></ul></ul><ul><ul><li>If feasible, employ a separate waiting and exam rooms </li></ul></ul><ul><ul><li>Provide face masks where appropriate </li></ul></ul><ul><ul><li>Support use of hand hygiene products </li></ul></ul>
    19. 20. H1N1 Preparedness: 10 Steps You Can Take <ul><li>7. Take steps to protect your workforce </li></ul><ul><ul><li>Promote use of PPE, and hand hygiene by staff </li></ul></ul><ul><ul><li>Stockpile necessary equipment and supplies </li></ul></ul><ul><li>8. Provide seasonal flu immunization for staff </li></ul><ul><li>9. Be aware of the pandemic planning and response activities within your community </li></ul><ul><ul><li>State/local health department; hospitals and clinics; schools </li></ul></ul><ul><li>10. Keep abreast of reliable & updated information on epidemiology, planning and treatment </li></ul><ul><ul><li>CDC and AAP websites, Dept of Health, local hospitals </li></ul></ul>CDC: Medical Offices And Clinics Pandemic Influenza Planning Checklist Available at: http://pandemicflu.gov/professional/pdf/medofficesclinics.pdf
    20. 21. Being Aware  Being Prepared <ul><li>Local epidemiology/prevalence of H1N1 </li></ul><ul><li>Viral screening/testing </li></ul><ul><li>Anti-viral therapy </li></ul><ul><ul><li>Treatment and prophylaxis </li></ul></ul><ul><ul><ul><ul><li>At-risk populations </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Dosing & medication safety concerns </li></ul></ul></ul></ul><ul><li>Vaccination </li></ul><ul><li>Infection control </li></ul><ul><ul><li>N95/PPE use, isolation, furloughs </li></ul></ul>http://aap.org/new/swineflu.htm http://www.cdc.gov/h1n1flu/
    21. 22. http://www.cdc.gov/h1n1flu/update.htm
    22. 26. Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season September 22, 2009 2:00 PM ET Updated to include complications and treatment considerations for infants and young children, clarity on underlying conditions that contribute to increased risk for influenza-related complications, and information on anti-viral medication dosing and safety concerns with oral suspensions
    23. 27. Antiviral Therapy Recommendations <ul><li>Patients at risk for H1N1 related complications </li></ul><ul><ul><li>People with more severe illness, such as those hospitalized with suspected or confirmed influenza </li></ul></ul><ul><ul><li>Children younger than 2 years old </li></ul></ul><ul><ul><ul><li>Children less than 5 years ? </li></ul></ul></ul><ul><ul><li>Adults 65 years and older </li></ul></ul><ul><ul><li>Pregnant women </li></ul></ul><ul><ul><li>People with certain chronic medical or immunosuppressive conditions </li></ul></ul><ul><ul><li>People younger than 19 years of age who are receiving long-term aspirin therapy </li></ul></ul>
    24. 28. Which Children Are at High Risk? <ul><li>Neurological disorders </li></ul><ul><ul><li>Epilepsy or cerebral palsy especially accompanied by neuro-developmental disabilities </li></ul></ul><ul><ul><li>Neuromuscular disorders (muscular dystrophy) </li></ul></ul><ul><li>Chronic respiratory diseases associated with impair pulmonary function and difficulty with secretions </li></ul><ul><ul><li>Moderate to severe asthma </li></ul></ul><ul><ul><li>Technology dependent children (e.g. tracheostomy) </li></ul></ul>
    25. 29. Which Children Are at High Risk? <ul><li>Moderate to profound intellectual disability or developmental delay when associated with specific neurological and respiratory condition </li></ul><ul><li>Immune deficiencies (congenital or acquired) </li></ul><ul><li>Congenital heart disease, significant metabolic (mitochondrial), or endocrine disorders </li></ul>
    26. 30. Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel October 14, 2009, 2:00 PM ET Updated interim guidance on infection control measures to prevent transmission in healthcare facilities. Emphasizes the ‘hierarchy of controls’ (Elimination of potential exposures, Engineering controls, Administrative controls, Personal protective equipment) as a strategy to protect both staff and patients.
    27. 31. http://www.cdc.gov/h1n1flu/clinicians/pdf/childalgorithm.pdf October 16, 2009
    28. 32. <ul><li>Disaster Planning Resources for Pediatricians </li></ul><ul><ul><li>Needle: A Disaster Preparedness Plan for Pediatricians </li></ul></ul><ul><li>Information on Biological, Chemical, Nuclear & Thermo/Mechanical Agents </li></ul><ul><ul><li>Psychosocial and mental health considerations </li></ul></ul><ul><li>Influenza </li></ul><ul><ul><li>Resources for clinicians </li></ul></ul><ul><ul><ul><li>Practice guidance, patient resources, management recommendations </li></ul></ul></ul><ul><ul><li>Resources for patient and families </li></ul></ul><ul><ul><li>Numerous links </li></ul></ul><ul><ul><ul><li>CDC, HHS, NCCD, others </li></ul></ul></ul>http://www.aap.org/disasters
    29. 33. http://www.aap.org/disasters/pdf/DisasterPrepPlanforPeds.pdf
    30. 34. Pediatrics - October 2009; 124(4):1216-26. Policy Statement—Recommendations for the Prevention and Treatment of Influenza in Children, 2009–2010 Committee on Infectious Diseases <ul><li>Updated recommendations for the routine use of trivalent seasonal influenza vaccine and anti-viral medications for the prevention and treatment of seasonal influenza in children </li></ul>
    31. 35. AAP DPAC Disaster Preparedness Advisory Council <ul><li>Steven Krug, MD, FAAP - Chairperson </li></ul><ul><li>Sarita Chung, MD, FAAP </li></ul><ul><li>Daniel Fagbuyi, MD, FAAP </li></ul><ul><li>Margaret Fisher, MD, FAAP </li></ul><ul><li>Scott Needle, MD, FAAP </li></ul><ul><li>David Schonfeld, MD, FAAP </li></ul><ul><li>Liaison Members: </li></ul><ul><ul><li>DHS/OHA, HHS/ASPR, CDC, NICHD </li></ul></ul><ul><li>Laura Aird – AAP Staff </li></ul>
    32. 36. New doll available at the American Girl Store: ‘Suzy Swine Flu’….
    33. 39. Pediatrics 2007; 120(6): 1229-37 Pediatric Preparedness of US Emergency Departments: A 2003 Survey Marianne Gausche-Hill, Charles Schmitz, and Roger J. Lewis <ul><li>Closed response survey of 5100 US emergency departments assessing their awareness & compliance with published AAP/ACEP pediatric readiness guidelines </li></ul><ul><li>Nearly 90% of pediatric ED visits occur in a non-children’s hospital ED </li></ul><ul><ul><li>26% of these visits occur in remote or rural facilities < 1000 kids/yr </li></ul></ul><ul><ul><li>50% of emergency departments see less than 10 kids per day </li></ul></ul><ul><li>Only 6% had all recommended equipment per AAP/ACEP 2001 guidelines </li></ul><ul><ul><li>Common shortfalls were neonatal & infant sized equipment (e.g. airways) </li></ul></ul><ul><li>Readiness scores were higher in larger volume EDs, and particularly in those with a physician and/or nurse leader for pediatric care </li></ul><ul><ul><li>This ADVOCATE could be a hospital or community-based pediatrician </li></ul></ul>

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