When disasters strike, resources are stretched beyond capacity, says George Foltin, MD, FAAP, FACEP, co-chair of the New York City Department of Health and Mental Hygiene Centers for Bioterrorism Preparedness Planning Pediatric Task force. In these situations, hospitals unaccustomed to caring for seriously injured children could be called upon to take on pediatric patients.
Recognizing this is a specialized and complex healthcare field, the task force has published the Pediatric Disaster Toolkit: Hospital Guidelines for Pediatrics in Disasters.
This document contains suggestions to weave into each institutions existing disaster plan, forming a structured approach to helping families cope. The toolkit includes information about dietary needs, patient tracking related to accompanied and unaccompanied children, setting up a pediatric safe area, facilitating family communication and recommendations for hospital supplies and equipment.
Foltin notes that family reunification was a monumental problem after Hurricane Katrina. Nurses should reach out to the community to inform parents about ways to speed up identification. Sometimes something as simple as having a Sharpie in the house so that the parent can write the childs name and phone number on an arm can make a tremendous difference in family reunification, he says. This is especially useful for children who are too young to speak.
Disaster planning is part of what hospitals do on a regular basis, says Eva Williamson, RN, MSN, MPH, NE-BC, clinical director of nursing and medicine of the Moses Division at Montefiore Medical Center in the Bronx, N.Y. She says most hospitals have regular disaster drills. These drills help identify weaknesses in the disaster plan that the hospital has devised, and help identify the best way to use precious resources. Good communication among the caregivers leads to good communication between staff and families, creating a win-win for everyone, she says. Montefiore has walkie-talkies on hand to be sure communication is continuous during an emergency.
Coping With the WorstMary Caputo, RN
At Jersey Shore University Medical Center in Neptune, N.J., the staff sees seriously injured patients on a daily basis, says Denise Swan, RN, BSN, nurse manager of the trauma surgical intensive care and trauma admitting area. We are a Level II Trauma Center, and we see these individuals at a time when they are the most frightened. Many have life-changing injuries, Swan says. We have an outstanding patient representative department, and they are a big help to the families at these times. They help establish communication among family members, and some are trained in critical incident stress debriefing.
Patients who are not readily identified are given a bracelet with an alpha-numeric code. They will keep this identifier throughout their stay, even when their actual identity is ascertained. By keeping the code, any tests entered before the patients ID is ascertained will be kept in the correct patient file.
Learning to CopeDenise Swan, RN
School nurses are the linchpin of coping with disasters in the community. The New Jersey State School Nurses Association supports the position paper of the National Association of School Nurses, encouraging a national approach to planning for disaster management and recovery. In Somerset County, there are nurses who are putting a concrete plan into place.
Mary Caputo, RN, MSN, NCSN, member of the NJSSNA Executive Committee, and Ruth Standley, RN, MSN, president of the Somerset County School Nurses Association, are working with the Greater Somerset County Chapter of the Red Cross to prepare school nurses for the leadership role they would have to assume in the event of a disaster. Noting the Red Cross is the primary organizer of shelters when disaster strikes, and local schools often are the first sites selected, Caputo and Standley are working on recruiting and arranging training for local school nurses to staff the shelters on a volunteer basis.
Its a natural fit, Caputo says. The nurses are often part of the community, and they know the children and the area. They can offer support and are able to manage a health office similar to the regular school health office. The Red Cross is expert at caring for folks in shelters during emergencies, and can offer the nurses the support they need.
Caputo says schools should be prepared to shelter in place, which means in an emergency the school nurse should have enough critical medication onsite to last 72 hours for students. Insulin, asthma inhalers and other preventive medications are examples. Emergency cards must be completed, she says, so the nurse would know if the working parent is 10 minutes or two hours away.
The most important disaster plan is the plan each family makes for themselves, Caputo says. Knowing where to meet, having enough food and water in the house at all times to be able to survive isolation and having a properly stocked Go Kit with everyones medications, identification papers and important documents is as important as any national planning. Families empowered by preparation are powerfully advantaged at crunch time.
The Pediatric Disaster Tool Kit; Hospital Guidelines for Pediatrics During Disasters can be found online at www.nyc.gov/html/doh/html/bhpp/bhpp-focus-ped-toolkit.shtml.