Geographical Maldistribution of Pediatric Medical Resources in Seattle-King County

Abstract

Objective:Seattle-King County (SKC) Washington is at risk for regional disasters, especially earthquakes. Of 1.8 million residents, >400,000 (22%) are children, a proportion similar to that of the population of the State of Washington (24%) and of the United States (24%). The county's large area of 2,134 square miles (5,527 km2) is connected through major transportation routes that cross numerous waterways; sub-county zones may become isolated in the wake of a major earthquake. Therefore, each of SKC's three sub-county emergency response zones must have ample pediatric medical response capabilities. To date, total quantities and distribution of crucial hospital resources (available in SKC) to manage pediatric victims of a medical disaster are unknown. This study assessed whether geographical distribution of hospital pediatric resources corresponds to the pediatric population distribution in SKC.Methods:Surveys were delivered electronically to all eight acute care hospitals in SKC that admit pediatric patients. Quantities and categories of pediatric resources, including inpatient treatment space, staff, and equipment, were queried and verified via site visits.Results:Within the seven responding hospitals of eight queried, the following were identified: 477 formal pediatric bed spaces (pediatric intensive care unit, neo-natal intensive care unit, general wards, and emergency department), 43 informal pediatric bed spaces (operating room and post-anesthesia care unit), 1,217 pediatric nurses, 554 pediatric physicians, and 252 infant/pediatric-adaptable ventilators. The City of Seattle emergency response zone contains 82.1% of bed spaces, 83.5% of nurses, and 95.8% of physicians, yet only 22.8% of all SKC children live in that zone.Conclusions:The majority of hospital pediatric resources are located in the SKC sub-region with the fewest children. These resources are potentially inaccessible and unable to be redistributed by ground transportation in the event of a significant regional disaster. Future planning for pediatric care in the event of a medical disaster in SKC must address this vulnerability.

Assessment of community vulnerability and medical surge capacity in a foreseeable major disaster

“…A great deal of information about the relationships between the scale of damages in previous disasters and social factors at the community level has already been published [2][3][4][5]. Additionally, hospital surge capacity for critically ill and pediatric patients injured in disasters has been assessed on the basis of geographic information [6][7][8][9]. Several studies have reported associations among predicted casualties in a foreseeable disaster, area characteristics, and hospital surge capacities at the community level in a city [10][11][12].…”

System-Level Planning, Coordination, and Communication

“…5 , 10 Although dedicated resources for developing triggers for implementing and terminating crisis standards of care are available, the work of developing them is a responsibility of local health-care and government leadership. 11 , 12 Government leadership, in collaboration with health-care experts, is needed to defi ne specifi c criteria for activation of emergency response plans, including when "crisis standards of care" are invoked and when they are terminated, and provide guidance for providers and health-care systems 10 (see "Legal Preparedness" article by Courtney et al 13 in this consensus statement).…”

“…All HC/RHAs must be prepared to provide care for large numbers of pediatric patients across their region, and operational plans must account for unique local circumstances ( Fig 4 ). 10 Pediatric consultants should be available to all regional partners by phone or telemedicine for remote consultation. Potential benefi ts of telemedicine communications include improved situational awareness, assistance in field triage, and timely expert consultation.…”