Pediatric Disaster Life Support Pediatric Disaster Life Support (PDLS(PDLS©)©): Scene Assessment, Triage, : Scene Assessment, Triage, Resuscitation and Stabilization at the Resuscitation and Stabilization at the Scene of a DisasterScene of a Disaster

James Courtney, DO

Triage Assessment, Stabilization, Triage Assessment, Stabilization, ResuscitationResuscitation Learning ObjectiveLearning Objective At the end of this lecture, the students should be At the end of this lecture, the students should be

able to:able to:

- describe differences in triage decision making for children describe differences in triage decision making for children

- describe triage categoriesdescribe triage categories

- describe field triage assessmentdescribe field triage assessment

- describe principles of field triage, stabilization and describe principles of field triage, stabilization and resuscitationresuscitation

- describe initial field stabilization methods for childrendescribe initial field stabilization methods for children

- describe organization of field triage, treatment, staging, describe organization of field triage, treatment, staging, and clearing/transportation for childrenand clearing/transportation for children

General Principles of Disaster CareGeneral Principles of Disaster Care

Scene AssessmentScene Assessment

Triage AssessmentTriage Assessment

Initial StabilizationInitial Stabilization

ResuscitationResuscitation

Scene AssessmentScene Assessment

Ensure scene safetyEnsure scene safety

Establish that disaster existsEstablish that disaster exists

Estimate number of victims: adults/childrenEstimate number of victims: adults/children

Scene AssessmentScene Assessment Notification to medical control: regional Notification to medical control: regional

communications, local emergency management / communications, local emergency management / disaster authoritydisaster authority

- type of eventtype of event

- initial casualty estimateinitial casualty estimate

Make initial request for additional resourcesMake initial request for additional resources

Then Then begin triage assessment of individual patientsbegin triage assessment of individual patients

Triage AssessmentTriage Assessment

Derived from the French “trier” meaning to sort, it Derived from the French “trier” meaning to sort, it describes a medical decision making processdescribes a medical decision making process

Guides decisions about allocating scarce resources and limited time

““greatest good for greatest number”greatest good for greatest number”

Protocol helps makes decisions

Appropriate performance crucialAppropriate performance crucial

ICS separates triage from treatment immediately

-see everybody once briefly for overview

Dynamic process, re-triage / re-evaluate at Dynamic process, re-triage / re-evaluate at several stagesseveral stages

Triage in disaster setting may be very difficultTriage in disaster setting may be very difficult

Pediatric population unique challengePediatric population unique challenge

TriageTriage

Initial Brief AssessmentInitial Brief Assessment

Open airwayOpen airway

Control major hemorrhageControl major hemorrhage

CategorizeCategorize

Triage ClassificationsTriage Classifications

Simple Triage And Rapid TreatmentSimple Triage And Rapid Treatment

S.T.A.R.T.S.T.A.R.T.

JumpSTART JumpSTART

Tool for Rapid Pediatric Multicasualty Field Tool for Rapid Pediatric Multicasualty Field Triage (children from 1 - 8 years of age)Triage (children from 1 - 8 years of age)

Triage CategoriesTriage Categories

Red / Immediate / EmergentRed / Immediate / Emergent

Yellow / UrgentYellow / Urgent

Green / Non-Urgent / Walking WoundedGreen / Non-Urgent / Walking Wounded

Black / Deceased or soon to beBlack / Deceased or soon to be

Triage Classifications and ExamplesTriage Classifications and Examples

Red - tension pneumothorax, rib fractures, upper Red - tension pneumothorax, rib fractures, upper airway obstruction, hemorrhage, femur fracture, airway obstruction, hemorrhage, femur fracture, asthmaticasthmatic

Yellow - humerus fracture, scalp lacerations, Yellow - humerus fracture, scalp lacerations, shoulder dislocationshoulder dislocation

Green - ankle sprain, simple laceration, orphaned Green - ankle sprain, simple laceration, orphaned child, subluxed radial headchild, subluxed radial head

Black/Blue - cardiopulmonary arrest, severe open Black/Blue - cardiopulmonary arrest, severe open head injury head injury

STARTSTART

Most commonly used triage system Most commonly used triage system across countryacross country

Not applicable for under 8 years oldNot applicable for under 8 years old

Initial eval – not finalInitial eval – not final

Time limited (plan <1 min/patient)Time limited (plan <1 min/patient)

Categorize and move onCategorize and move on

STARTSTART

““If you can hear me and are able, walk If you can hear me and are able, walk over here” over here” GREENGREEN triage done – still need triage done – still need individual evaluation, but can await more individual evaluation, but can await more staff, allows initial rescuers to focus on staff, allows initial rescuers to focus on more severely injured people.more severely injured people.

Gen 80% of victims will be green, self Gen 80% of victims will be green, self extricate (may self transport – eases extricate (may self transport – eases burden on field but hard on hospitals)burden on field but hard on hospitals)

STARTSTART

EVAL (and tag) those unable to walk for EVAL (and tag) those unable to walk for transport: RPMtransport: RPM

Resp: no => open airway= still no then Resp: no => open airway= still no then reposition airway = still no =>reposition airway = still no =>BLACKBLACK if yes => if yes => REDRED (immediate). (immediate).

Spont resp >30 => Spont resp >30 => REDRED/ under 30 => next / under 30 => next item of assessmentitem of assessment

STARTSTART

Perfusion: cap refill > 2 sec => control Perfusion: cap refill > 2 sec => control bleeding, label bleeding, label REDRED; <2 sec, next item; <2 sec, next item

Perfusion: Radial Pulse => if no label Perfusion: Radial Pulse => if no label REDRED; ; if yes then next itemif yes then next item

Mental status: Cannot follow simple Mental status: Cannot follow simple commands => commands => REDRED; CAN follow simple ; CAN follow simple commands (and has cap refill < 2 sec and commands (and has cap refill < 2 sec and spont resp < 30) => spont resp < 30) => YELLOWYELLOW (delayed) (delayed)

STARTSTART

As soon as one can categorize a patient, As soon as one can categorize a patient, STOP evaluating (if they are STOP evaluating (if they are REDRED for for breathing, they won’t be seen any faster breathing, they won’t be seen any faster for additional problems) and move on.for additional problems) and move on.

Minimal treatment during triage: airway Minimal treatment during triage: airway maneuver (chin tilt, jaw thrust) and dress maneuver (chin tilt, jaw thrust) and dress active blood loss (not scrapes).active blood loss (not scrapes).

Pediatric TriagePediatric Triage

Pediatric TriagePediatric Triage

Triage of children and adults is typically Triage of children and adults is typically done simultaneously during a disasterdone simultaneously during a disaster

It is important to remember that although It is important to remember that although the injury process may be the same, a the injury process may be the same, a child’s child’s vulnerabilityvulnerability to that injury may be to that injury may be very differentvery different- Specifically, their response to airway obstructionSpecifically, their response to airway obstruction

Pediatric TriagePediatric Triage

The standard adult triage tools do not take The standard adult triage tools do not take into account the specific vulnerability that into account the specific vulnerability that children have to dying from airway children have to dying from airway obstructionobstruction

Children may have a Children may have a reversiblereversible period of period of respiratory arrest from which they may respiratory arrest from which they may recover if treated promptlyrecover if treated promptly

Pediatric TriagePediatric Triage

Due to this, a specific Due to this, a specific pediatricpediatric triage tool triage tool was developed and testedwas developed and tested

-JumpSTARTJumpSTART

Builds from the concepts of triage taught Builds from the concepts of triage taught in in STARTSTART triage, which is commonly triage, which is commonly utilizedutilized

Confused?Confused?

If you remember the specific vulnerability If you remember the specific vulnerability children have to airway compromise, this children have to airway compromise, this makes sensemakes sense

The “Jumpstart” term refers to the extra The “Jumpstart” term refers to the extra chance we give a child to breathe before chance we give a child to breathe before we declare them a we declare them a BLACKBLACK TAG TAG

JumpSTART (under 8)JumpSTART (under 8)

Kids more airway dependent – rescue Kids more airway dependent – rescue breaths attempted if pulse present (unlike breaths attempted if pulse present (unlike adults) Resp 15-45 instead of <30adults) Resp 15-45 instead of <30

Vascular system clamps down sooner, so Vascular system clamps down sooner, so cap refill less reliable. Use peripheral pulse cap refill less reliable. Use peripheral pulse instead.instead.

Mental status AVPU instead of following Mental status AVPU instead of following simple commandssimple commands

JumpSTARTJumpSTART

““If you can hear me and you are able, walk If you can hear me and you are able, walk over here for help.” over here for help.”

Probably won’t work for childrenProbably won’t work for children

If they are ambulatory, then they are If they are ambulatory, then they are GREENGREEN

Use adults on scene to help corral the Use adults on scene to help corral the GREENGREEN children children

JumpSTARTJumpSTART

Respirations: NO Respirations: NO open airway => yes open airway => yes REDRED; no -> check peripheral pulse.; no -> check peripheral pulse.

NO pulse = NO pulse = BLACKBLACK

Pulse Pulse 15 sec mask to mouth ventilation 15 sec mask to mouth ventilation

Spont resp: NO Spont resp: NO BLACKBLACK; YES ; YES REDRED

JumpSTARTJumpSTART

Breathing: RR <15, >40 or irregular =Breathing: RR <15, >40 or irregular =REDRED

RR 15-40, regular – check pulseRR 15-40, regular – check pulse

No peripheral pulse: No peripheral pulse: REDRED

Peripheral pulse: check mental statusPeripheral pulse: check mental status

AV (appropriate) AV (appropriate) YELLOWYELLOW

PU (inappropriate) PU (inappropriate) REDRED

Kids in triageKids in triage

Don’t follow commands.Don’t follow commands.

May actually hide from rescuersMay actually hide from rescuers

May be extricated by May be extricated by GREENGREEN parents/ parents/ adults with delay in triage and treatment.adults with delay in triage and treatment.

Need distraction and dedicated supervisor Need distraction and dedicated supervisor able to run after wandering toddlersable to run after wandering toddlers

ExamplesExamples

Awake 8 yr old child Awake 8 yr old child brought in 3 days brought in 3 days after earthquake with after earthquake with 20 others20 others

Can not walkCan not walk

Responds to voiceResponds to voice

Respiratory Rate 50Respiratory Rate 50

No obvious injuriesNo obvious injuriesIMMEDIATE

ExamplesExamples

Unconscious 4 year old Unconscious 4 year old hit in head by debris hit in head by debris moments agomoments ago

In a room full of injured In a room full of injured childrenchildren

Not breathingNot breathing

Obvious head injuryObvious head injury

What do you do?What do you do?

How do you classify How do you classify this child if he this child if he breathes?breathes?

ExamplesExamples

IMMEDIATE

DECEASED

How do you classify How do you classify this child if he does this child if he does not breathe after 5 not breathe after 5 rescue breaths?rescue breaths?

You are receiving You are receiving multiple casualties on multiple casualties on a hospital shipa hospital ship

Young child found Young child found breathing but sleepybreathing but sleepy

Brought in by military Brought in by military helicopter with IV helicopter with IV runningrunning

ExamplesExamples

What do you want to What do you want to assess?assess?

Respiratory Rate 30Respiratory Rate 30

Has a palpable pulseHas a palpable pulse

Arouses to touch and Arouses to touch and loud voiceloud voice

ExamplesExamples

DELAYED

Categorize the FollowingCategorize the Following

1.1. 7 y.o. female, crying, unwilling to move right arm, 1° 7 y.o. female, crying, unwilling to move right arm, 1° burn to anterior thighburn to anterior thigh

2.2. 10 y.o. male, deformed thigh, pale, pulse 120, BP 10 y.o. male, deformed thigh, pale, pulse 120, BP 30/40, RR 3030/40, RR 30

3.3. 20 y.o. female, apneic, severe head injury with visible 20 y.o. female, apneic, severe head injury with visible grey mattergrey matter

4.4. 2 y.o. male, 2-3° burns to face, neck and chest2 y.o. male, 2-3° burns to face, neck and chest

5.5. 5 day old infant, found on ground, appears unharmed5 day old infant, found on ground, appears unharmed

GREENGREEN

REDRED

BLACKBLACK

REDRED

YELLOWYELLOW

Pediatric TriagePediatric Triage

Focus on Focus on integrationintegration of children in to the of children in to the triage systemtriage system

Once a child is classified as a color, Once a child is classified as a color, quickly move them to a treatment area in quickly move them to a treatment area in order of severityorder of severity- REDRED first, then first, then YELLOWYELLOW, then , then GREENGREEN

PreplanningPreplanning

Needs assessment of communityNeeds assessment of community

Commitment on part of institutions and key Commitment on part of institutions and key personnel to treating injured childrenpersonnel to treating injured children

Consider children with special needsConsider children with special needs

Consider evacuation process for NICU/PICU/SCU Consider evacuation process for NICU/PICU/SCU for newbornsfor newborns

Lack of supervisionLack of supervision

DecontaminationDecontamination

Decontamination of ChildrenDecontamination of Children

Special issues must be accounted for Special issues must be accounted for before undertaking decontamination of before undertaking decontamination of childrenchildren

Advance planning will make the differenceAdvance planning will make the difference

Goal is to integrate care of children with Goal is to integrate care of children with that of the general populationthat of the general population

Decontamination of ChildrenDecontamination of Children

ParentsParents- After a disaster or major emergency, most parents After a disaster or major emergency, most parents

will not separate from their childrenwill not separate from their children

- Decontamination patient flow must account for thisDecontamination patient flow must account for this

- Takes longer than expected to decontaminate Takes longer than expected to decontaminate parent and childparent and child

Decontamination of ChildrenDecontamination of Children

Temperature ExtremesTemperature Extremes- Decontamination water must not be ice cold for Decontamination water must not be ice cold for

young childrenyoung childrenRisk of hypothermia, especially in winterRisk of hypothermia, especially in winter

Children must be covered immediatelyChildren must be covered immediately

- Risk of injury if too hot or chemicals usedRisk of injury if too hot or chemicals usedDo not use bleach in decon waterDo not use bleach in decon water

Do not use rough scrubbing devicesDo not use rough scrubbing devices

Decontamination of ChildrenDecontamination of Children

Special EquipmentSpecial Equipment- Have a plan for special equipment on children or Have a plan for special equipment on children or

adultsadultsWheelchairsWheelchairs

Electronic equipmentElectronic equipmentFirearmsFirearms

Decontamination of ChildrenDecontamination of Children

Special IssuesSpecial Issues- How long does it take a child to take a shower or How long does it take a child to take a shower or

bath normally?bath normally?

- Children may not be cooperativeChildren may not be cooperative

- Children will likely be frightened with protective Children will likely be frightened with protective suitssuits

- How do you track a How do you track a non-verbalnon-verbal, naked child after , naked child after decontamination?decontamination?

Child Likely To Need Specialized CareChild Likely To Need Specialized Care Shock SBP <80, HR>130<50Shock SBP <80, HR>130<50

Resp distress RR>30<10, stridorResp distress RR>30<10, stridor

GCS<9GCS<9

MechanismMechanism

- MVAMVA

- Pedestrian/bicyclist thrown >15 feetPedestrian/bicyclist thrown >15 feet

- Penetrating injury to head, neck, trunkPenetrating injury to head, neck, trunk

Child Likely To Need Specialized CareChild Likely To Need Specialized CareSpecific injuriesSpecific injuries

skull fractureskull fracture pneumothorax, flail chestpneumothorax, flail chest abd trauma with peritoneal signsabd trauma with peritoneal signs amputation / deglovingamputation / degloving vascular injuryvascular injury burn with inhalationburn with inhalation FB aspiration / ingestionFB aspiration / ingestion

Progression of Pediatric ShockProgression of Pediatric Shock

Response to ShockResponse to Shock

Vascular resistance

Blood pressure

Cardiac

output

Compensatedshock

Decompensatedshock

140

100

60

20

Per

cent

of

cont

rol

Pediatric Assessment TrianglePediatric Assessment Triangle

Pediatric ResuscitationPediatric ResuscitationRussian Field Hospital

Nias, Indonesia

4/05

Russian Field Hospital

Nias, Indonesia

4/05

Treatment Treatment Patients frequently may outnumber transport, Patients frequently may outnumber transport,

leading to time in field where treatment can be leading to time in field where treatment can be started started

Sort patients by category (Sort patients by category (GREENGREEN, , YELLOWYELLOW, , REDRED and and BLACKBLACK) and treat within areas. ) and treat within areas.

If If GREENGREEN patients self triaged, they need evaluation. patients self triaged, they need evaluation.

Limited initial treatment – don’t delay evacuation if Limited initial treatment – don’t delay evacuation if vehicle availablevehicle available

TreatmentTreatment

Kids will be mixed in – do you have enough Kids will be mixed in – do you have enough supplies in kid size (oxygen, IVs, splints)?supplies in kid size (oxygen, IVs, splints)?

Does your locality stock a “disaster truck”?Does your locality stock a “disaster truck”?

Does it have kid size equipment and kid sized Does it have kid size equipment and kid sized doses of Hazmat antidotes?doses of Hazmat antidotes?

Do you have Broselow tapes to guide Do you have Broselow tapes to guide dosing?dosing?

Field StabilizationField Stabilization

Airway - chin lift, jaw thrust, oro- or nasopharyngeal Airway - chin lift, jaw thrust, oro- or nasopharyngeal airwayairway

Breathing - supplemental O2 as availableBreathing - supplemental O2 as available

- limited resources for mechanical/manual ventilationlimited resources for mechanical/manual ventilation

Circulation - hemorrhage control - direct pressure, Circulation - hemorrhage control - direct pressure, dressings (rotating tourniquets)dressings (rotating tourniquets)

- limited resources for IVFlimited resources for IVF

Fracture Stabilization - using resources availableFracture Stabilization - using resources available

Field StabilizationField Stabilization

There is little role for initiation of CPR in disaster There is little role for initiation of CPR in disaster situationssituations

Consider on site organization of arriving personnel and Consider on site organization of arriving personnel and arriving resourcesarriving resources

Consider establishment of clearing/staging until:Consider establishment of clearing/staging until:

- triage patients for treatment on site or transport to triage patients for treatment on site or transport to hospital/health care facilityhospital/health care facility

- efficient utilization of resources, personnel, and efficient utilization of resources, personnel, and suppliessupplies

Resuscitation/StabilizationResuscitation/Stabilization Simple measures that do not require Simple measures that do not require

sophisticated equipment are most appropriate.sophisticated equipment are most appropriate.

Needs must be evaluated and balanced against Needs must be evaluated and balanced against available resources.available resources.

The principle of “doing the greatest good for the The principle of “doing the greatest good for the greatest number”.greatest number”.

Consider IV Access in the Following:Consider IV Access in the Following:

Time to definitive care 30-60 minutesTime to definitive care 30-60 minutes

Prolonged extrication / entrapmentProlonged extrication / entrapment

Dehydration > 15%Dehydration > 15%

Multiple fracturesMultiple fractures

Scalp lacerations with significant blood lossScalp lacerations with significant blood loss

IV AccessIV Access Attempt peripheral access if unsuccessful in <90 sec. Attempt peripheral access if unsuccessful in <90 sec.

consider IO.consider IO. Estimated body weight in kg: (age in yrs x 2) + 10Estimated body weight in kg: (age in yrs x 2) + 10 Blood volume = 80 mls/kg x body weightBlood volume = 80 mls/kg x body weight Estimate blood loss: # pelvic ring = 10% total blood volume, Estimate blood loss: # pelvic ring = 10% total blood volume,

# femur up to 20%.# femur up to 20%. IO access sitesIO access sites

- distal femur distal femur - proximal tibiaproximal tibia- med/lat malleolusmed/lat malleolus- iliac crestsiliac crests

High success rate, up to 80% in less than one minuteHigh success rate, up to 80% in less than one minute

Treatment:Treatment: Dressings – rinse gross dirt with sterile Dressings – rinse gross dirt with sterile

fluids or tap water if available, sterile fluids or tap water if available, sterile cover to prevent further contaminationcover to prevent further contamination

Pressure dressing for active bleedingPressure dressing for active bleeding- Recruit neighbor to help hold pressure during Recruit neighbor to help hold pressure during

triage while awaiting transport/evacuationtriage while awaiting transport/evacuation

Splint – extremity injuriesSplint – extremity injuries

TreatmentTreatment

Medications: pain control, specific Medications: pain control, specific antidotes with Hazmat event/teamantidotes with Hazmat event/team

Monitoring: repeat assessment after Monitoring: repeat assessment after triage, re-categorize if necessary (to triage, re-categorize if necessary (to worse, never better – they still have the worse, never better – they still have the same underlying injury)same underlying injury)

Further field careFurther field care

Depends on local plansDepends on local plans

Send personnel and supplies to site, or Send personnel and supplies to site, or bring patients to hospital (personnel and bring patients to hospital (personnel and supplies)supplies)- EMS –patient to hospitalEMS –patient to hospital

- NDMS – personnel and supplies to siteNDMS – personnel and supplies to site

TransportTransport

Decides which patients leave scene first and Decides which patients leave scene first and where they’re going where they’re going

Helpful bystanders and self transporters will Helpful bystanders and self transporters will fill the nearest hospitals first. fill the nearest hospitals first.

Includes decisions about longer transport Includes decisions about longer transport times for specialty caretimes for specialty care

Use helicopters for long distance transportsUse helicopters for long distance transports

Children with Special Health Care Children with Special Health Care NeedsNeeds

Children with Special Health Care Children with Special Health Care Needs (CSHCN)Needs (CSHCN)

Children with special medical or physical Children with special medical or physical needsneeds- Wheelchair or crutchesWheelchair or crutches

- Learning disabilityLearning disability

- Vision, hearing, or language impairedVision, hearing, or language impaired

- Technology dependentTechnology dependent

VentilatorVentilator

DialysisDialysis

Children with Special Health Care Children with Special Health Care Needs (CSHCN)Needs (CSHCN)

Children with Special Health Care Children with Special Health Care Needs (CSHCN)Needs (CSHCN)

Prevalence of CSHCNPrevalence of CSHCN

Based on a national surveyBased on a national survey- 1 in 5 households self identify as having a CSHCN1 in 5 households self identify as having a CSHCN

- Approximately 1 in 8 children are identified by Approximately 1 in 8 children are identified by parents as being CSHCNparents as being CSHCN

Care of these children must be integrated Care of these children must be integrated in to the care of all children during a in to the care of all children during a disasterdisaster

Special Challenges for CSHCNSpecial Challenges for CSHCN

ShelteringSheltering- Controversy: Controversy: Together or separately?Together or separately?

- Controversy: Controversy: Should CSHCN be considered medical Should CSHCN be considered medical patients if they are not injured or ill?patients if they are not injured or ill?

DecontaminationDecontamination- What is the best way to decontaminate medical hardware What is the best way to decontaminate medical hardware

such as a wheelchair?such as a wheelchair?

- How do we decontaminate technology, such as a How do we decontaminate technology, such as a ventilator?ventilator?

Special Challenges for CSHCNSpecial Challenges for CSHCN

TransportationTransportation- Take equipment with or leave behind during evacuation?Take equipment with or leave behind during evacuation?

For all of these topics, special For all of these topics, special advance advance planningplanning is required to be successful in taking is required to be successful in taking care of care of allall children children

Sheltering for ChildrenSheltering for Children

Hurricane Katrina taught us many harsh Hurricane Katrina taught us many harsh lessons about how important shelter lessons about how important shelter planning isplanning is

Sheltering IssuesSheltering Issues

HygieneHygiene- Children pose a special risk to maintaining Children pose a special risk to maintaining

hygiene in a shelter operationhygiene in a shelter operation

- Basic supplies such as wipes and diapers Basic supplies such as wipes and diapers frequently overlookedfrequently overlooked

- Children are at a special risk of Children are at a special risk of acquiringacquiring gastrointestinal and respiratory diseasesgastrointestinal and respiratory diseases

- Children are exceptionally good at Children are exceptionally good at spreadingspreading these diseasesthese diseases

- Must plan for handwashing/sanitizingMust plan for handwashing/sanitizing

Sheltering IssuesSheltering Issues

Safety and SupervisionSafety and Supervision- Shelters are dangerous environmentsShelters are dangerous environments

- Rarely childproofedRarely childproofed

- Children move quickly throughout environmentChildren move quickly throughout environment

- Easy to get lostEasy to get lost

- Possible criminal elementPossible criminal element

Sheltering IssuesSheltering Issues

Health MaintenanceHealth Maintenance- Clean water and healthy food a challengeClean water and healthy food a challenge

- Children require something to doChildren require something to doConsider a recreational therapy groupConsider a recreational therapy group

- Children require more sleepChildren require more sleepShelters are frequently loudShelters are frequently loud

- Pediatric Health Screening importantPediatric Health Screening importantPrevention of diseasePrevention of disease

Maintaining primary care for extended staysMaintaining primary care for extended stays

ResourcesResources

PDLS is a startPDLS is a start

Much information exists to guide the Much information exists to guide the preparation and care for children in preparation and care for children in disastersdisasters

ResourcesResources

U.S. Center for Disease ControlU.S. Center for Disease Control- www.cdc.govwww.cdc.gov

National Center for Disaster PreparednessNational Center for Disaster Preparedness- http://www.ncdp.mailman.columbia.edu/http://www.ncdp.mailman.columbia.edu/

American Psychological AssociationAmerican Psychological Association- www.apa.orgwww.apa.org

ResourcesResources

JumpSTART Triage ToolJumpSTART Triage Tool- www.jumpstarttriage.orgwww.jumpstarttriage.org

American Academy of PediatricsAmerican Academy of Pediatrics- http://www.aap.org/terrorism/topics/disaster_planning.htmlhttp://www.aap.org/terrorism/topics/disaster_planning.html

Pediatric Disaster Preparedness Pediatric Disaster Preparedness Consensus Conference SummaryConsensus Conference Summary- http://www.bt.cdc.gov/children/pdf/working/execsumm03.pdfhttp://www.bt.cdc.gov/children/pdf/working/execsumm03.pdf

U.S. Department of Homeland SecurityU.S. Department of Homeland Security- www.dhs.govwww.dhs.gov

DisclaimerDisclaimer

The information herein should NOT be used as a substitute of The information herein should NOT be used as a substitute of an appropriately certified and licensed physician or health care an appropriately certified and licensed physician or health care provider. The information herein is provided for educational provider. The information herein is provided for educational and informational purposes only and in no way should be and informational purposes only and in no way should be considered as an offering of medical advice. The authors, considered as an offering of medical advice. The authors, editors, and publisher of this site have used reasonable efforts editors, and publisher of this site have used reasonable efforts to provide up-to-date, accurate information that is within to provide up-to-date, accurate information that is within generally accepted medical standards at the time of generally accepted medical standards at the time of production. However, as medical science is ever evolving, and production. However, as medical science is ever evolving, and human error is always possible, PDLS does not guarantee total human error is always possible, PDLS does not guarantee total accuracy or comprehensiveness of the information on this site, accuracy or comprehensiveness of the information on this site, nor are they responsible for omissions, errors, or the results of nor are they responsible for omissions, errors, or the results of using this information. The reader should confirm the accuracy using this information. The reader should confirm the accuracy of the information in this article from other sources. In of the information in this article from other sources. In particular, all drug doses, indications, and contraindications particular, all drug doses, indications, and contraindications should be confirmed in package inserts.should be confirmed in package inserts.

Course DirectorsCourse Directors

PDLS 2.0 content revision- March 2006PDLS 2.0 content revision- March 2006- Andrew L. Garrett MD, FAAPAndrew L. Garrett MD, FAAP

- Richard V. Aghababian, MD, FACEPRichard V. Aghababian, MD, FACEP

University of Massachusetts Medical SchoolUniversity of Massachusetts Medical School

PDLS course- 1999PDLS course- 1999- Richard V. Aghababian MD, FACEPRichard V. Aghababian MD, FACEP

Original ContributorsOriginal Contributors Gregory Ciottone, MDGregory Ciottone, MD

Lucille Gans, MDLucille Gans, MD

Patricia Hughes, RNPatricia Hughes, RN

Frank Jehle, MDFrank Jehle, MD

Taryn Kennedy, MDTaryn Kennedy, MD

Gretchen Lipke, MDGretchen Lipke, MD

Mariann Manno, MDMariann Manno, MD

Gina Smith, RNGina Smith, RN

Fred Henretig, MDFred Henretig, MD

Theodore Cieslak, MDTheodore Cieslak, MD

Robert McGrath, M.Ed.Robert McGrath, M.Ed.

W. Peter Metz, MDW. Peter Metz, MD

John A. Paraskos, MDJohn A. Paraskos, MD

Carol Shustak, RNCarol Shustak, RN

Elizabeth Shilale, RNElizabeth Shilale, RN

A. Richard StarzykA. Richard Starzyk

Michael Weinstock, MDMichael Weinstock, MD

Sharon Welsh, RNSharon Welsh, RN

Lou Romig, MDLou Romig, MD