Section 3 - Staffing Recommendations for Pediatrics during a Disaster

Purpose: The recommendations included in this section address the critical issue of hospital staffing for pediatric services during a disaster. Appropriate allocation of personnel and the delegation of responsibilities are critical to mitigate the confusion and chaos created by disaster situations. Staffing considerations for pediatric patients should be planned for prior to a disaster and is one of the important issues to be considered by the hospital's Emergency Preparedness Planning Committee and addressed in the hospital's CEMP. The following recommendations were created primarily to address needs of institutions that do not have significant pediatric services or pediatric staff. When applicable, Hospital Incident Command System (HICS) positions should also be utilized by hospitals.

Section Contents

General Guidelines:

  • Pre-identify hospital staff with specialty skills or experience in the treatment of pediatric patients.
  • Develop a plan to utilize the specific skills of the above personnel, including call-down and notification procedures.
  • Create key pediatric positions these persons will occupy in a disaster event.
  • If necessary, train additional staff who are willing to care for pediatric patients.
  • Integrate the pediatric staffing plan into your hospital's CEMP.

Planning: Survey Staff for Pediatric Experiences

One of the first steps in pediatric planning is identifying members of the hospital's staff with pediatric skills and/or training. These members will become the primary pediatric caregivers. Staff with pediatric training and skills will most likely list pediatric emergency medicine, emergency medicine, pediatrics, pediatric surgery or family medicine as their area of specialty.

Other staff may have some pediatric experience in their specialty training and should be considered as an additional source of staffing. These staff may include, but are not limited to, personnel trained in anesthesia, otolaryngology, trauma surgery, general surgery, orthopedics, urology, neurosurgery, and thoracic surgery. Staff with pediatric experience may also include family nurse practitioners.

Special attention must be paid to skills required for critical resuscitation procedures during the planning phase, especially for hospitals with limited pediatric specialty providers. Airway management, resuscitation, and critical care skills may be necessary during both pediatric and obstetric emergencies. Staff qualified to perform such procedures will be necessary during a disaster and should be identified in advance. For example, pediatric airway management may be performed by an anesthesiologist or otolaryngologist. Resuscitation and critical care medicine may be performed by anesthesiologists and general surgeons. Included in this cadre of staff are nurses, physician assistants, and nursing assistants who work in the hospital's emergency department (ED), operating rooms (ORs), post anesthesia care units (PACUs), intensive care units (ICUs), inpatient units and outpatient clinics.

If qualified staff members are not available to perform such procedures, consideration should be given to training staff that are willing to provide these services. (See Section 4 - Training.)

Once these primary pediatric caregivers are identified, their names and contact information should be maintained as a special call-down sheet for pediatric disasters. Regular survey updates are needed to maintain a current roster of experienced staff. The Emergency Preparedness Planning Committee should determine how that information is maintained and how that information is communicated to the Incident Command Center during a pediatric disaster.

It may also be useful to know if there are pharmacists, respiratory therapists, dieticians and social workers with pediatric experience, as well.

Mitigation: Create Pediatric Leadership Positions for Key Personnel and Qualified Staff

The following designated staff members should serve as key personnel to coordinate the various elements of pediatric care and planning and serve as regular members of the Emergency Preparedness Planning Committee. Following are two key positions suggested for assignment to qualified clinical personnel:

Physician Coordinator for Pediatric Emergency Care in a Disaster

  • A qualified member of the medical staff nominated by the ED Medical Director and approved by the Emergency Preparedness Planning Committee to assume the following responsibilities:
    1. Ensure adequate skill and knowledge of hospital's medical staff and staff physicians in emergency care and resuscitation of infants and children.
    2. Assist with development and periodic review of ED medications, equipment, supplies, policies, and procedures.
    3. Lead and assist with the development and updating of the hospital's CEMP, granting special attention to the needs of pediatric patients.
    4. Serve as a liaison to appropriate in-hospital and out-of-hospital pediatric care committees in the community (if they exist).
    5. Serve as a liaison to a definitive care hospital and trauma center, needed to integrate services or facilitate transfer for the continuum of care of the patient.
    6. Facilitate pediatric emergency education for ED health care providers.
    7. Identify, in advance, appropriately qualified staff that can/will accept responsibility for the immediate or extended care of pediatric patients during a disaster.

Nursing Coordinator for Pediatric Emergency Care in a Disaster

  • A qualified member of the nursing staff nominated by the Director of Nursing and approved by the Emergency Preparedness Planning Committee to assume the following responsibilities:
    1. Ensure adequate skill and knowledge of hospital's nursing staff in emergency care and resuscitation of infants and children and routine care of pediatric patients.
    2. Identify, in advance, appropriately qualified staff that can/will accept responsibility for the immediate or extended care of pediatric patients during a disaster.
    3. Facilitate nursing continuing education in pediatrics.
    4. Lead the development and updating of the hospital's policies and procedures for pediatric care.
    5. Serve as a liaison to appropriate in-hospital pediatric care committees.
    6. Serve as a liaison to inpatient nursing as well as to facilitate transfer for the continuum of care of the patient.
    7. Assist with development and periodic review of pediatric medications, equipment and supplies as a member of the Emergency Preparedness Planning Committee.

Response: Staffing for a Coordinated and Comprehensive Emergency Management Plan

Since many levels of staffing are required to respond adequately to a disaster involving pediatric patients, it is important that the designated team that will look after the welfare of the pediatric patients be as all encompassing as possible. A Medical/Technical Specialist - Pediatric Care should be identified for pediatric medical and nursing care. (See the Sample Job Action Sheets at the end of this chapter.)

While the team will include such clinical staff as physicians, nurses and ancillary ED and inpatient personnel to provide emergency evaluation and treatment to children of all ages, additional staff may be called upon to respond to non-clinical pediatric patient needs. Also included at the end of this chapter are Sample Job Action Sheets that may be used to distribute tasks to staff designated to ancillary leadership positions. Along with the Physician and Nursing Coordinators who will act as the point persons for clinical care, a general Pediatric Logistics Unit Leader and a Pediatric Services Unit Leader should also be assigned to monitor non-clinical areas. These Unit Leaders will facilitate accurate communication between non-clinical areas and oversee disaster response in areas such as Procurement, Transportation, Materials/Supplies and Nutrition.

In planning to meet the immediate physical needs of the pediatric patient population during a disaster, hospitals may further prepare for child victims by considering psychological treatment that addresses their possible reactions to disaster including acute stress disorder, grief and anger. With this in mind, it is recommended that hospitals prepare for the mental health needs of pediatric patients and coordinate a response plan that incorporates the skills of psychiatrists, psychiatric nurses, social workers and a hospital chaplain. (See Section 14. Psychosocial Needs of Children during a Disaster for additional information).

Sample HICS Job Action Sheet – Pediatric Services Unit Leader

You report to: ____________________________________________________(Operations Chief)

Command Center: ________________________________________________________________

Mission: To ensure that the pediatric treatment and holding areas are properly assigned, equipped, and staffed during an emergency

Immediate (Operational Period 0-2 Hours):

  • _____Receive appointment from Unit Leader
  • _____Read this entire job action sheet
  • _____Obtain briefing from Unit Leader
  • _____Gather external information from Treatment Area Supervisor/ED Charge Nurse regarding:
    • _____Number of expected pediatric patients and their conditions
    • _____Current total number of ED patients
    • _____Expected time of patient arrival
  • _____Determine number of available pediatric/crib beds [inpatient] and report to Operations Chief for planning purposes
  • _____Determine qualified, on-site pediatric staff members
  • _____Determine additional staff needed based on expected patient volume
  • _____Alert Discharge Unit Leader to institute early discharge/transfer of patients
  • _____Initiate Pediatric Response Team as per plan
  • _____Predetermined Physicians for Pediatric Response (Pediatric/Family/Practice/Staff/Community)
  • _____Predetermined Nurses (with pediatric experience and/or PALS/ENPC certification)
  • _____Predetermined ancillary technicians with pediatric experience
  • _____Others as predetermined
  • _____Determine need for opening of a Pediatric Safe Area (dependent on expected number of unaccompanied children during the disaster)
  • _____Assign Pediatric Safe Area Coordinator
  • _____Communicate with Operations Chief to assure coordination of non-pediatric ancillary/support personnel are assigned to each area
  • _____Assure preparation of a pre-designated Pediatric Disaster Care Areas
  • _____Clear area
  • _____Designate each specific area per plan and based on expected casualties
  • _____Assure support personnel are assigned to each area
  • _____Assure delivery of medical and non-medical pediatric equipment
  • _____Assure set-up of pediatric equipment by clinical staff
  • _____Receive pediatric patients
  • _____Communicate findings to Treatment Area Supervisor for dissemination as per disaster plan
  • _____Following triage of all children, move uninjured/unaffected children to pre-designated Pediatric Safe Area

Intermediate (Operational Period 2-12 Hours):

  • _____Assess ongoing staffing needs based on patient status report form:
    • _____Pediatric healthcare personnel (emergency department, inpatient, and OR)
    • _____Non-pediatric ancillary/support personnel
    • _____Pediatric Safe Area Coordinator
  • _____Assess additional medical and non-medical equipment/supply needs
  • _____Communicate with Pediatric Logistics Unit Leader via Operations Chief to Logistics Chief
  • _____Assure delivery of needed supplies to pediatric designated areas
  • _____Assess Pediatric Response Team basic needs:
    • _____Food
    • _____Rest
    • _____Psychological support
  • _____Obtain status of pediatric casualties (discharges, admissions, transfers, and Pediatric Safe Area) and report of Operations Chief
  • _____Hold information sessions with Public Information Officer as needed
  • _____Obtain Child Survey Forms (See Section 5. Security) from all pediatric patient areas
  • _____Report any unidentified or unaccompanied pediatric patients to Operations Chief

Extended (Operational Period Beyond 12 Hours):

  • _____Debrief Pediatric Response Team and Pediatric Safe Area Coordinator regarding:
    • _____Summary of Incident
    • _____Review of areas of success
    • _____Identify opportunities of success
    • _____Thank and congratulate team

Sample HICS Job Action Sheet - Medical/Technical Specialist - Pediatric Care

Mission: Advise the Incident Commander or Operations Section Chief, as assigned, on issues related to pediatric emergency response.

Date:__________ Start:______ End:______ Position Assigned to:___________ Initial:______________

Position Reports to:______________________ Signature:_______________________________________

Hospital Command Center (HCC) Location:______________________ Telephone:________________

Fax:_________________ Other Contact Info:_________________ Radio Title:__________________


Immediate (Operational Period 0-2 Hours) Time  Initial 
Receive appointment and briefing from the Incident Commander or Operations Section Chief, as assigned.    
Read this entire Job Action Sheet and review incident management team chart (HICS Form 207). Put on position identification.    
Notify your usual supervisor of your HICS assignment.    
Document all key activities, actions, and decisions in an Operational Log (HICS Form 214) on a continual basis.    
Meet with the Command staff, Operations and Logistics Section Chiefs and the Medical Care Branch Director to plan for and project pediatric patient care needs.    
Communicate with the Operations Section Chief to obtain:
  • Type and location of incident
  • Number and condition of expected pediatric patients
  • Estimated arrival time to facility
  • Unusual or hazardous environmental exposure
    
Request staffing assistance from the Labor Pool and Credentialing Unit Leader, as needed, to assist with rapid research as needed to determine hazard and safety information critical to treatment and decontamination concerns for the pediatric victims.    
Provide pediatric care guidance to Operation Section Chief and Medical Care Branch Director based on incident scenario and response needs.    
Ensure pediatric patient identification and tracking practices are being followed.    
Communicate and coordinate with Logistics Section Chief to determine pediatric:
  • Medical care equipment and supply needs
  • Medications with pediatric dosing
  • Transportation availability and needs (carts, cribs, wheel chairs, etc.)
    
Communicate with Planning Section Chief to determine pediatric:
  • Bed availability
  • Ventilators
  • Trained medical staff (MD, RN, PA, NP, etc.)
  • Additional short and long range pediatric response needs
    
Ensure that appropriate pediatric standards of care are being followed in all clinical areas.    
 
Immediate (Operational Period 0-2 Hours) Time Initial
Collaborate with the PIO to develop media and public information messages specific to pediatric care recommendations and treatment.    
Participate in briefings and meetings and contribute to the Incident Action Plan, as requested.    
Document all communications (internal and external) on an Incident Message Form (HICS Form 213).
Provide a copy of the Incident Message Form to the Documentation Unit.		    
 
Immediate (Operational Period 2-12 Hours) Time Initial
Continue to communicate and coordinate with Logistics Section Chief the availability of pediatric equipment and supplies.    
Coordinate with Logistics and Planning Section Chiefs to expand/create a Pediatric Patient Care area, if needed.    
Continue to monitor pediatric care activities to ensure needs are being met.    
Meet regularly with the Operations Section Chief and Medical Care Branch Director for updates on the situation regarding hospital operations and pediatric needs.    
 
Extended (Operational Period Beyond 12 Hours) Time Initial
Ensure the provision of resources for pediatric mental health and appropriate event education for children and families.    
Continue to ensure pediatric related response issues are identified and effectively managed.    
Continue to meet regularly with the Operations Section Chief or Incident Commander, as appropriate, for situation status updates and to communicate critical pediatric care issues.    
Ensure your physical readiness through proper nutrition, water intake, rest and stress management techniques.    
Observe all staff and volunteers for signs of stress and inappropriate behavior. Report concerns to the Mental Health Unit Leader. Provide for staff rest periods and relief.    
Upon shift change, brief your replacement on the status of all ongoing operations, issues and other relevant incident information.    
 
Demobilization/System Recovery Time Initial
Ensure return/retrieval of equipment and supplies and return all assigned incident command equipment.    
Upon deactivation of your position, ensure all documentation and Operational Logs (HICS Form 214) are submitted to the Operations Section Chief or Incident Commander, as appropriate.    
Upon deactivation of your position, brief the Operations Section Chief or Incident Commander, as appropriate, on current problems, outstanding issues and follow-up requirements.    
Submit comments to the Operations Section Chief or Incident Commander, as appropriate, for discussion and possible inclusion in the after-action report; topics include:
  • Review of pertinent position descriptions and operational checklists
  • Recommendations for procedure changes
  • Section accomplishments and issues
    
Participate in stress management and after-action debriefings. Participate in other briefings and meetings as required.    


Documents/Tools
Incident Action Plan
HICS Form 207 - Incident Management Team Chart
HICS Form 213 - Incident Message Form
HICS Form 214 - Operational Log
Hospital emergency operations plan
Hospital organization chart
Hospital telephone directory
Radio/satellite phone
Local public health reporting forms

Sample HICS Job Action Sheet - Pediatric Logistics Unit Leader

You report to:_____________________________________________________(Logistics Chief)

Command Center:________________________________________________________________

MISSION: To ensure that the pediatric needs are addressed by Procurement, Transportation, Materials Supply, and Nutritional Supply during an emergency.

IMMEDIATE:

  • _____Receive appointment from Logistics Chief
  • _____Read this entire job action sheet
  • _____Obtain briefing from Logistics Chief
  • _____Number of expected pediatric patients and their conditions
  • _____Timeline for supply needs
  • _____Depending on the extent of HEICS activation, meet with Logistics Chief and
  • _____Distribute tasks to the following Unit Leaders:

  • _____Procurement Unit Leader:
    • _____Receive briefing from Logistics Chief and Pediatric Logistics Unit Leader
    • _____Initiate Procurement Disaster Call list if warranted
    • _____Work with vendors for pediatric supplies including hospital vendors and community resources (local pharmacies and grocery stores) for back-up resources


  • _____Transportation Unit Leader:
    • _____Receive briefing from Logistics Chief and Pediatric Logistics Unit Leader
    • _____Initiate Transportation Disaster Call list if warranted
    • _____Count open stretchers, carts, cribs, and wheelchairs for pediatric transportation
    • _____If adult transport equipment options are used, ensure all are appropriately modified and safe for pediatric transport
    • _____Report transportation options to Logistics Chief
    • _____Coordinate delivery of transportation options to designated pediatric area or ED depending on scenario
    • _____Designate transporters as needed from CS staff or Labor pool
    • _____Ensure that all transporters are aware of pediatric safety issues and are not to leave pediatric patients unattended (see Section 9 - Transportation for more information)


  • _____Materials/Supplies Unit Leader:
    • _____Receive briefing from Logistics Chief and Pediatric Logistics Unit Leader
    • _____Initiate Materials/Supplies Disaster Call list if warranted
    • _____Collect and coordinate essential pediatric medical equipment and supplies
    • _____Assist in preparation of pre-designated Pediatric Disaster Care Areas with Pediatric Services Unit Leader (See Section 4 - Equipment Recommendations for more information)
    • _____Assist in preparation of pre-designated Pediatric Safe Area with Pediatric Services Unit Leader (See Section 5 - Security for more information)


  • _____Nutritional Supply Unit Leader: (See Section 12 - Pediatric Dietary Needs for additional information)
    • _____Receive briefing from Logistics Chief and Pediatric Logistics Unit Leader
    • _____Initiate Nutritional Call list if warranted
    • _____Estimate number of pediatric meals needed for 48 hours (See Section 12 - Pediatric Dietary Needs for more information)
    • _____Estimate pediatric food/snacks/hydration needs for Pediatric Safe Area

INTERMEDIATE:

  • _____Obtain regular updates from Logistics Chief
  • _____Assess additional equipment/supply needs for pediatrics
  • _____Address pediatric concerns, questions and issues as needed

EXTENDED:

  • _____Document actions and decisions, submit reports to Logistics Chief
  • _____Participate in debriefing
  • _____Review areas of success
  • _____Identify opportunities for improvement
  • _____Thank and congratulate team

Staffing Recommendations for Obstetrics during a Disaster

Purpose: The recommendations included in this section address the critical issue of hospital staffing for obstetrics services during a disaster. Appropriate allocation of personnel and the delegation of responsibilities are critical to mitigating the confusion and chaos created by disaster situations. Staffing considerations for obstetric patients should be planned prior to a disaster and are important issues to be considered by the hospital's Emergency Preparedness Planning Committee and addressed in the hospital's CEMP. The following recommendations were created primarily to address needs of institutions that do not have significant obstetric services or staff. When applicable, hospital ICS positions should also be utilized or adapted by hospitals.

General Guidelines

The volume of pregnant and laboring patients that present at a non-birthing hospital is not likely to match the demand for pediatric services. Consequently, the facility may not need to plan for as many staff dedicated to obstetrics as to pediatrics. However, it is necessary for facilities to consider carefully how the needs of prenatal, laboring, birthing and fresh postpartum cases will be handled should the situation arise where women cannot access their usual provider or planned birthing hospital during an emergency.

Planning steps are similar to those taken in planning for the needs of pediatric patients:

  • Pre-identify hospital staff with specialty skills or experience in the treatment of obstetric patients.
  • Survey staff for obstetric and newborn care expertise.
  • Develop a plan to utilize the specific skills of the above personnel, including call-down and notification procedures.
  • Establish leadership roles for obstetrical services in disasters.
  • Determine how obstetric medical and nursing service coordinators will interact with pediatric medical and nursing service coordinators.
  • If necessary, train additional staff who are willing to care for obstetric patients and neonates.
  • Integrate an obstetric staffing plan into your hospital's CEMP.
  • Appoint medical and nursing staff coordinators for emergency obstetric care.
  • Review current policies and procedures for emergency childbirth and identify staffing needs.
  • Identify gaps in knowledge and trained staff, then provide training with opportunities for annual refreshers.
  • Drill as necessary to keep knowledge and skills refreshed.