A mass casualty event can result in an overwhelming number of critically injured pediatric victims that exceeds the available capacity of pediatric critical care (PCC) units, both locally and regionally. To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) was established. The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from 18 of 25 major NYC PCC-capable hospitals. A PCC surge committee created recommendations for making additional PCC beds available with an emphasis on space, staff, stuff (equipment), and systems. The PDC assisted 15 hospitals in creating PCC surge plans by utilizing template plans and site visits. These plans created an additional 153 potential PCC surge beds. Seven hospitals tested their plans through drills. The purpose of this article was to demonstrate the need for planning for disasters involving children and to provide a stepwise, replicable model for establishing a PDC, with one of its primary goals focused on facilitating PCC surge planning. The process we describe for developing a PDC can be replicated to communities of any size, setting, or location. We offer our model as an example for other cities. (Disaster Med Public Health Preparedness. 2017;11:473-478).
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road collisions to terrorism-related shootings and bombings. The aim of this study was to characterize childhood injuries resulting from different types of MCEs in Israel. Methods: A retrospective study of MCE-related injuries among hospitalized children (0-17 years) between the years 1998-2007 and recorded in the Israel Trauma Registry (ITR) was conducted. For this study, a MCE included any event in which >10 persons were injured. Study parameters included demographic characteristics, injury type and mechanism, hospital utilization, and injury outcome. Findings were compared with non-MCE pediatric hospitalizations during the same period. Results: During the study period, 158 MCEs were recorded in Israel, of which, 75 (47%) involved children (mean age 11.3 years, 52% girls). The majority of MCEs were terrorism-related (63.4%); followed by motor vehicle collisions (buses or trains) (32%); a collapsed building (2.6%); and other mechanisms (2%). Teenagers (ages 10-17 years) were injured twice that of younger children (ages 0-9 years), (67% and 33%, respectively; p = 0.05). Head and neck were the most common body regions to be injured (67%). Most children sustained mild injuries (55%; Injury Severity Scale Score (ISS) 1-8), however, a significant percentage had severe to fatal injuries (29%; ISS >16). In comparison to non-MCE injuries, MCE-related injuries were more severe: ISS >16 (8% vs. 29%, respectively;/-<0.0001); in-hospital mortality (0.4% vs. 3.4%, respectively;/" <0.0001); underwent surgical procedures (20% vs. 50%, respectively, /> <0.05); and intensive care unit admission rate (6% vs 31%, /> <0.0001), and longer hospital stay (median length of stay 3.5 vs. 8.9 days, respectively;/) <0.0001). Conclusions: Morbidity and mortality are significantly higher among children injured in MCEs than by other mechanisms. In an effort to improve future pediatric MCE-related injuries, medical staff should be better prepared and resources should be improved for dealing with pediatric pre-hospital and hospital care following a MCE.
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