Do Pandemic Preparedness Planning Systems Ignore Critical Community and Local-Level Operational Challenges?

Harvard Humanitarian Initiative, Harvard University, USA.
Disaster Medicine and Public Health Preparedness (Impact Factor: 0.7). 03/2010; 4(1):24-9. DOI: 10.1097/DMP.0b013e3181cb4193
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Available from: Frederick M Burkle, Nov 01, 2014
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    ABSTRACT: Previous simulation studies suggest that temporary pediatric mass critical care approaches would accommodate plausible hypothetical sudden-impact public health emergencies. However, the utility of sustained pediatric mass critical care responses in prolonged pandemics has not been evaluated. The objective of this study was to compare the ability of a typical region to serve pediatric intensive care unit needs in hypothetical pandemics, with and without mass critical care responses sufficient to triple usual pediatric intensive care unit capacity. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: The Monte Carlo simulation method was used to model responses to hypothetical pandemics on the basis of national historical evidence regarding pediatric intensive care unit admission and length of stay in pandemic and nonpandemic circumstances. Assuming all ages are affected equally, federal guidelines call for plans to serve moderate and severe pandemics requiring pediatric intensive care unit care for 457 and 5,277 infants and children per million of the population, respectively. A moderate pandemic would exceed ordinary surge capacity on 13% of pandemic season days but would always be accommodated by mass critical care approaches. In a severe pandemic, ordinary surge methods would accommodate all the patients on only 32% of pandemic season days and would accommodate 39% of needed patient days. Mass critical care approaches would accommodate all the patients on 82% of the days and would accommodate 64% of all patient days. Mass critical care approaches would be essential to extend care to the majority of infants and children in a severe pandemic. However, some patients needing critical care still could not be accommodated, requiring consideration of rationing.
    Pediatric Critical Care Medicine 10/2010; 13(1):e1-4. DOI:10.1097/PCC.0b013e3181fe390a · 2.34 Impact Factor
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    Disaster Medicine and Public Health Preparedness 09/2011; 5 Suppl 2(S2):S176-81. DOI:10.1001/dmp.2011.52 · 0.70 Impact Factor
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    ABSTRACT: Public health emergencies require resources at state, regional, federal, and often international levels; however, community preparedness is the crucial first step in managing these events and mitigating their consequences, particularly for children. Community preparedness can be optimized through system-wide planning that includes integrating multiple points of contact, such as the community, prehospital care, health facilities, and regional level of care assets.Citizen readiness, call centers, alternate care facilities, emergency medical services, and health emergency operations centers linked to community incident command systems should be considered as important options for delivery of population-based care. Early collaboration between pediatric clinicians and public health authorities is essential to ensure that pediatric needs are addressed in community preparedness for mass critical care events. In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations.Steering Committee members established subcommittees by topic area and performed literature reviews of MEDLINE and Ovid databases. The Steering Committee produced draft outlines and convened October 6-7, 2009, in New York, NY, to review and revise each outline. Eight draft documents were subsequently developed from the revised outlines as well as through searches of MEDLINE updated through March 2010.The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. Feedback on each manuscript was compiled and the Steering Committee revised each document to reflect expert input in addition to the most current medical literature. The Pediatric Emergency Mass Critical Care Task Force recommends active promotion of programs to ensure an informed citizenry; education of children and families in Centers for Disease Control and Prevention community mitigation strategies; emphasis on community-level preparedness empowering the public to provide self care; use of 9-1-1 telephone triage with pre-established protocols and in coordination with emergency medical services; and advocacy for healthcare coalitions and other creative operational concepts that provide guidance and protocols for care of the pediatric population.
    Pediatric Critical Care Medicine 11/2011; 12(6 Suppl):S141-51. DOI:10.1097/PCC.0b013e318234a786 · 2.34 Impact Factor
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