Children and disasters A Boots On THE GROUND PERSPECTIVE

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Children and disastersA Boots On THE GROUND
PERSPECTIVE

• David Lipin
• 20 Nov 2008

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Overview

• Aeromedical Evacuation
• Providing Food Care
• Support Services
• Other Basic Shortfalls
• Recommendations

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Children Families

• Caring for children in disasters means caring for
  the family as a unit
• Patient co-habitation w/ non-patient family
• Single person caring for multiple individuals
• Extended families
• Household pets

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Aeromedical Evacuation

• Children are regularly separated from parents
  during evacuation

• Limited aircraft and total airlift capacity
• Patients are prioritized over healthy individuals

• Ill/injured parent unable to care for child
  during transit
• Accurate destination location for re-unification
  sometimes not available

• Generally fewer pediatric beds increases
  likelihood of medical evac and farther evac
  distance

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Aeromedical Evacuation

• Burdensome military medical transport rqmts
• Must have designated destination bed prior to
  departure scheduling
• Flights delayed until sufficiently full
• Only military medical personnel on military
  aircraft
• Limitations on and type of accompanying
  caregivers and family
• Civilians perceive military is military
• Differing capabilities and procedures between
  Active and National Guard components lead to
  frustration
• Active military under Federal response does not
  provide same services as National Guard under
  State response

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Providing Food Care

• Pediatric-specific necessities
• Infant formula, bottles, diapers, other supplies
• Child-friendly food
• Food/formula refrigeration and heating

• Often requires professional consultation
• Substituting different foods
• Modifying care/feeding techniques
• Compensating for altered environment

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Support Services(in Medical/Special Needs
Shelters)

• Environment
• Lack of supervision when parents are patients or
  caring for patients
• Lack of appropriate activities for children

• Exposed to suffering other traumatic situations
• No accommodation for pets in medical special
  needs shelters

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Support Services(in Medical/Special Needs
Shelters)

• Legal Issues
• Difficult to obtain reporting requirements and
  procedures (e.g., suspected abuse)
• Difficult to report abuse (lack of
  communications, lack of child support services)
• Delayed ability to manage children separated from
  parents
• Registered sex offenders in shelters (inability
  to determine status)

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Children are Impacted by Basic Shortcomings

• Insufficient disaster preparedness at home
• Inability to communicate between evacuation
  origins and destinations
• Prolonged/complex evacuation processes
• Inability to track patient/evacuee movement
• Especially inter-state
• Lack of preventative/prophylactic mental health
  and social services intervention at point of care
  (shelters, medical facilities)
• Lack of security at shelters

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Recommendations

• Problem As the number of physicians who accept
  Medicaid diminishes, displaced evacuees have
  increased difficulty accessing healthcare at a
  time when their displacement generally increases
  their healthcare needs.
• Solution CMS should create a national emergency
  healthcare program (e.g., emergency Medicaid) for
  out-patient services that is aligned with its
  in-patient (NDMS) program, increasing
  reimbursement rates, decreasing out-of-pocket and
  reimbursable patient expenses, etc.

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Recommendations

• Problem health insurance programs generally do
  not allow or facilitate disaster preparedness by
  permitting patients to maintain a prescription
  medication buffer.
• Solution CMS should permit patients to maintain
  a 30-day supply of critical medications.

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Recommendations

• Problem available healthcare professionals are
  unable or unwilling to assist during disasters
  due to out-of-area licenses, lack of liability
  coverage, and pre-registration requirements for
  existing medical response entities.
• Solution HHS should create a web-based system
  for designated healthcare entities to perform
  instant, basic credentialing of out-of-area
  medical professionals.
• Solution HHS should offer Federal liability
  protection for licensed healthcare professionals
  working for a healthcare entity during a disaster.

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Recommendations

• Problem during disasters, health problems tend
  to co-exist with and exacerbate other basic
  family and individual needs yet our National
  disaster medical model is largely focused on
  physical health services, allowing these other
  needs to create bottlenecks that impact service
  delivery, and thus impact children and other
  individuals with special needs.
• Solution NDMS should expand to provide a more
  complete (yet still basic) disaster health
  services solution, including mental health,
  social services and domestic animal services
  co-habitant with or proximal to physical health
  sites.

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Recommendations

• Problem short-notice evacuation of a significant
  population from a disaster area is inherently
  chaotic, and will inevitably create subsequent
  re-location and re-unification problems.
• Solution FEMA should create a national evacuee
  tracking system that is accessible by all public
  and private entities involved with evacuation,
  with results viewable by evacuees and their
  families.

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Recommendations

• Problem disaster medical treatment and transport
  services are provided by disparate entities
  (e.g., out-of-area hospitals and ambulance
  services, DoD, VA, HHS) that have no mechanism of
  coordinating their activity and services.
• Solution NDMS should enhance their electronic
  medical record system to create a National
  disaster healthcare record system used by all
  healthcare entities that treat or transport
  patients during a disaster.

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Recommendations

• Problem Evacuating large numbers of civilian
  patients during disasters creates rapidly
  evolving patient numbers and conditions. Civilian
  healthcare systems are designed to manage this
  ambiguity, but the military is not. Applying
  current military protocols for moving patients in
  a disaster is an attempt to apply a static
  solution to an inherently dynamic problem,
  producing inefficiency at the time-sensitive
  embarkation-side rather than the more stable
  reception-side of the problem.
• Solution DoD should develop a casualty
  evacuation model, common across Active military
  (Federal) and National Guard (States), that
  provides rapid patient movement while relying on
  external entities to manage patient reception and
  disposition.

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In Conclusion

• Traditional disaster planning is done in silos,
  with each component planning its own preparedness
  and response program. This approach leaves gaps
  when citizens require more than one solution at a
  time. Families, and therefore children, are
  impacted most by our failure to provide
  comprehensive, integrated disaster services to
  our citizens.

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• David Lipin
• dlipin_at_gmail.com