IOM forum promotes disaster preparedness specifically for children and their families

With so many disasters in the last few months, from tornadoes to the Boston terrorist attack, it’s time to seize the moment to advocate for preparedness for children and families, argued a number of speakers at a June Institute of Medicine (IOM) workshop on the issue.

“I have never seen so much government buy-in to the concept that children need to be protected as we currently have today,” said Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University and key expert on children and disasters.

Redlener said that after Hurricane Katrina hospitals should have learned to protect generators, not only moving them to a higher floor, but also protecting the fuel supply and the electrical systems. Instead, he said, after Hurricane Sandy, the nation saw pictures of people carrying premature infants down a dark hospital stairwell, a situation that could have been catastrophic.

Additionally, hundreds of Oklahoma schools are without adequate tornado protection, he said. He further questioned the adequacy of evacuation protocols, following the incident in which Oklahoma residents were killed in a traffic jam as they tried to outrun a tornado on the advice of a television weatherman.

Redlener warned that it takes a long time to recover from a disaster. People take far longer to recover than the infrastructure does, and protecting kids from the psychological trauma of big events requires an adult to buffer them. The nation needs to learn to cope with the “resilience erosion,” he cautioned, as Mom or Dad may become degraded in their ability to be a safety net after months or years of waiting for things to get better.

Even after all the disasters the nation has had, he said, there still is no central coordinator to manage state, federal, and nonprofit assets and to deal with sometimes uncooperative banks and insurance companies during recovery. Such a coordinator is exactly what families need, he said.

Redlener also warned that although he is a “big believer” in community-based models for pediatric preparedness, those programs are hardly ever scaled up and are not an alternative to what the federal government needs to do with the “largesse of our tax dollars.”

Scott Needle, MD, a community pediatrician with the Healthcare Network of Southwest Florida, argued that office-based providers, including pediatricians, have been neglected in organizing for disaster. He told the workshop attendees that there are major disincentives for pediatricians to prepare before a disaster or to get out of their offices and help during a disaster. Medicaid in general, he said, is a low payer and getting enhanced payments requires getting agreement from host authorities on the state and federal levels.

Esther Chernak, MD, MPH, of the Drexel University School of Public Health, cited a study that she worked on for the Pennsylvania Department of Health that found that most pediatricians in the state have little understanding of the public health systems, how they are organized, or their capacity. The study found that many pediatricians do not have the time to think about preparedness planning. They do, however, care about continuity of operations.

According to Chernak, the study showed that most pediatricians wanted information rather than financial aid: real-time situational awareness and pediatric-specific information. They want to get information at least 5 or 10 minutes before the public does so that when people call they can speak knowledgeably about the issues, she said.

On the other hand, Chernak said, health departments often fail to recognize pediatricians’ potential to assist in disaster communications to the public, but the departments often overestimate outpatient practices’ surge capacity, even for something such as taking phone calls.

Audio and slides of the conference are available at http://iom.edu/Activities/PublicHealth/MedPrep/2013-JUN-10.aspx.

Subscribe to Contemporary Pediatrics to get monthly clinical advice for today's pediatrician.