Vulnerable Populations Health Effects, Special Needs

Transcription

1 Vulnerable Populations Health Effects, Special Needs Arthur Cooper, MD, MS Columbia University/Harlem Hospital

2 Vulnerable Populations The very young The very old The infirm and the disabled The impoverished and the dispossessed

3 Children In Disaster Planning What s The Big Deal?

4 Children In Disaster Planning As targets Primary targets Secondary casualties As family members Family emergency plans Community response plans As mitigation players Awareness and education Training and drills

5 Children Are Not Small Adults Pound-For-Pound Children breathe, drink, and eat more than adults

6 Differences During Pediatric Disasters May be unable to self identify Unable to provide reliable exposure history Impaired communication of symptoms Need constant adult supervision to avoid harm Afraid of staff in PPE and need constant reassurance Unable to walk through decontamination on their own Unable to legally consent for medical care

7 Children As Primary Targets (Partial Listing) 1995 Murrah Building Day Care, Oklahoma City 1998 Elementary school, Jonesboro, Arkansas 1999 Columbine High School, Colorado Intifada, Israel 2002 Al-Qaeda plans (seized) 2003 American School, Singapore (foiled) 2004 Beslan, Russia 2006 Platte Canyon High School, Colorado 2009 And the list goes on and on The gunman, a 54-year year-old homeless man, took 6 students hostage, sexually assaulted a female student, killed her and then himself.

8 Natural Disasters & Accidents Children Are Vulnerable Exposures & Doses Susceptibilities Developing Organs Latency Periods Advocacy Breast Milk CDC-ATSDR

9 Shock And Awe Physiological response Hypovolemia Hypothermia Airway & vascular access issues Emotional response Amputated Disembowled Dead Missing Beslan, Russia 2004

10 We had children lying everywhere Jonesboro, Arkansas USA March 1998

11 Psychological Aftermath My father died 100 times a day on TVs all across the country. Kathie Scobee Fulgham

12 In An Evacuation: No Parents Leave Without Their Children! Reuters

13 New York City Approach Pediatric Disaster Coalition Michael Frogel,, MD, George Foltin,, MD

14 Pediatric Chain of Survival

15 The Present The Current Public Health System Pre-Event 1 o Prevention Host Agent Environment Enforcement Engineering Education Event 2 o Prevention The Current EMS Trauma System Post-Event 3 o Prevention

16 The Future Host Agent Environment Enforcement Engineering Education Public Health Approach To A Comprehensive EMS Trauma Injury Control Emergency Preparedness System Pre-Event 1 o Prevention Event 2 o Prevention Post-Event 3 o Prevention

17 New York City Approach Prevention Risk Communication Access Triage Plan Life Support Surge Plan Specialized Care Pediatric Hospitals

18 Tier One Pediatric Hospitals Pediatric Hospitals + PICUs Surge in PICU capabilities Tier Two Pediatric Hospitals PICUs Surge in PACU capabilities

19 New York City Hospitals (n=63) "u Hospital with PICU (n=26) "u Hospital without PICU (n=37) Miles prepared by D. Meranus

20 Pediatric Disaster Receiving Hospitals New York City, 2009 prepared by D. Meranus

21 Pediatric Population per 100,000 Children New York City, 2008 prepared by D. Meranus

22 Density per Square Mile of New York City Public Elementary Schools, 2008 prepared by D. Meranus

23 Summary Most mass casualty events involve pediatric patients Children have special needs during mass casualty events Many 911 ambulance destinations have pediatric capabilities When possible and appropriate: pediatric patients should go there!

24 This Morning The very young Joseph Wright Children s s National Medical Center The very old Charlotte Yeh American Association of Retired Persons The infirm and the disabled Raymond Swienton University of Texas and Texas Department of Health The impoverished and the dispossessed Robert Ursano Uniformed Services University of the Health Sciences