Section 4 - Training
Purpose: The recommendations included in this section suggest training to ensure that pediatric patients receive appropriate care at all hospital facilities during a mass casualty, disaster, or terrorism-related event. General medical and disaster training as well as pediatric-specific education options are included, all of which are recommended to enhance hospital response.
- General Guidelines
- Training Recommendations
- Primary Disaster and Emergency Courses
- Training Resources
- American Heart Association Sponsored Courses
- Emergency Nurses Association Sponsored Courses
- American College of Surgeons Sponsored Course
- American Burn Association Sponsored Course
- Other Disaster Courses
- American Medical Association/National Disaster Life Support Foundation (AMA/NDLSF) Sponsored Courses
- Medical Society of the State of New York (MSSNY) Sponsored Course
- American Academy of Pediatrics/American College of Emergency Physicians (AAP/ACEP) Sponsored Course
- New York State Department of Health and the National Association of Emergency Medical Technicians (NAEMT) Sponsored Course
- Emergency Nurses Association (ENA) Sponsored Course
- American College of Surgeons (ACS) Sponsored Course
- Department of Homeland Security Sponsored Course
- Additional Trauma Courses
- Additional Critical Care and Disaster Courses
- Additional Websites for Disaster Preparedness Information
- Sources of Information for Emergency Preparedness for Childbirth
- Sources for Obstetric Simulators - Manufacturers' Websites
Disaster and emergency training includes education in both the core principles of disaster management and the emergency treatment of adult, obstetric and pediatric patients requiring basic, advanced and trauma life support.
All hospitals should address the pediatric and obstetric populations when planning training courses for staff who will likely respond during a disaster. Additionally, the hospital emergency preparedness planning committee should consider the "pediatric and obstetric surge capacity" of the current staffing, whether the hospital has these services or not.
To develop comfort in caring for pediatric and obstetric patients, staff are encouraged to enroll and/or to participate in additional pediatric and childbirth training courses, beyond that of basic proficiency.
Hospitals with Pediatric Service, but no Pediatric Intensive Care Unit (PICU)
Hospitals with general pediatric inpatient services should prepare for the same possibilities listed for hospitals with a PICU. In addition, critical pediatric patients might require intensive care and subsequent monitoring when transfer is not immediately possible. Possible locations for temporary placement of critical pediatric patients include:
- Adult Medical Intensive Care Unit;
- Adult Cardiac Care Unit;
- Surgical Care Unit;
- Post-Anesthesia Care Unit; or
- Another appropriate inpatient intensive care unit.
- The staff anticipated to be responsible for the various levels of pediatric care should have the appropriate basic pediatric disaster training. Since pediatric intensivists and pediatric critical care nurses are not available at these facilities, the applicable training recommendations are recommended for Medical and Surgical ICU nurses and physicians as well as for nurse practitioners.
Hospitals without Inpatient Pediatric Services
These hospitals should develop disaster plans that address all of the possibilities for needed pediatric care. While pediatric specialty staff may not normally be available at these facilities, it is recommended that certain staff be pre-identified and pre-designated to staff pediatric surge capacity areas. These pre-designated individuals should receive appropriate training necessary to provide adequate care to the pediatric population during a disaster.
Hospitals without Obstetric Services
During times of disasters, pregnant women are likely to experience greater rates of complications, including premature labor and birth, low birth weight infants and neonatal and infant deaths. Stress is increased during these times, and stress combined with lack of proper nutrition and hydration can result in premature delivery. During disasters, pregnant women need access to skilled professional health assessment and methods of hydration, including intravenous hydration.
All hospitals should develop disaster plans that address the possibility for admitting pregnant women who are affected by the disaster and laboring women in need of delivery. While obstetricians and midwives may not normally be available at these facilities, it is recommended that certain staff be pre-identified and predesignated to staff obstetric areas, should the service be needed. These pre-designated individuals should receive appropriate training necessary to provide adequate care to pregnant and laboring women and their neonates during a disaster.
Primary Disaster and Emergency Courses
Staff members who are anticipated to be assigned to pediatric inpatient surge capacity areas (in the event the usual hospital inpatient pediatric capacity is exceeded and these patients cannot be transferred) should receive training listed below:
|Training Recommendations for Pediatrics|
|All Direct Care Providers
(Nurses and Physicians)
|Training Recommendations for Obstetrics|
|All Direct Care Providers
(Nurses and Physicians)
American Heart Association Sponsored Courses:
Pediatric Advanced Life Support (PALS)
The American Heart Association PALS course is based on science evidence from the 2005 AHA Guidelines for CPR and ECC. The goal of the PALS course is to aid the pediatric healthcare provider in developing the knowledge and skills necessary to efficiently and effectively manage critically ill infants and children, resulting in improved outcomes. Skills taught include recognition and treatment of infants and children at risk for cardiopulmonary arrest; the systematic approach to pediatric assessment; effective respiratory management; defibrillation and synchronized cardioversion; intraosseous access and fluid bolus administration; and effective resuscitation team dynamics.
Approximately 14 hours
Pediatricians, emergency physicians, family physicians, physician assistants, nurses, nurse practitioners, paramedics, respiratory therapists, and other healthcare providers who initiate and direct advanced life support in pediatric emergencies.
Advanced Cardiac Life Support (ACLS)
The American Heart Association ACLS course is totally redesigned for healthcare providers who either direct or participate in the resuscitation of a patient, whether in or out of hospital. Through the ACLS course, providers will enhance their skills in the treatment of the adult victim of a cardiac arrest or other cardiopulmonary emergencies. ACLS emphasizes the importance of basic life support CPR to patient survival; the integration of effective basic life support with advanced cardiovascular life support interventions; and the importance of effective team interaction and communication during resuscitation.
ACLS is based on simulated clinical scenarios that encourage active, hands-on participation through learning stations where students will practice essential skills individually, as part of a team, and as team leader. Realistic simulations reinforce the following key concepts: proficiency in basic life support care; recognizing and initiating early management of periarrest conditions; managing cardiac arrest; identifying and treating ischemic chest pain and acute coronary syndromes; recognizing other life-threatening clinical situations (such as stroke) and providing initial care; ACLS algorithms; and effective resuscitation team dynamics.
13½ hours, approximately, including breaks
Medical providers such as physicians, nurses, emergency medical technicians, paramedics, respiratory therapists, and other professionals who may respond to a cardiovascular emergency.
Emergency Nurses Association Sponsored Courses
Emergency Nursing Pediatric Course (ENPC)
ENA developed the Emergency Nursing Pediatric Course (ENPC) to improve the care of the pediatric patient by increasing the knowledge, skill, and confidence of the emergency nurse. This course provides core-level pediatric knowledge and psychomotor skills needed to care for pediatric patients in the emergency care setting. ENPC is the only pediatric emergency nursing course written by pediatric nurse experts.
Nurses who are expected to care for pediatric patients following a disaster. Although the course is geared towards nurses in an emergency setting, the content can easily be utilized by nurses who will need to provide care to pediatric patients who may require inpatient hospital services.
American College of Surgeons Sponsored Courses
Advanced Trauma Life Support (ATLS)
The doctor who first attends to the injured patient has the greatest opportunity to impact outcome. This course provides an organized approach for evaluation and management of seriously injured as well as a foundation of common knowledge for all members of the trauma team. The objectives for the course include: (1) Assess the patient's condition rapidly and accurately; (2) Resuscitate and stabilize the patient according to priority; (3) Determine if the patient's needs exceed a facility's capabilities; (4) Arrange appropriately for the patient's definitive care; and, (5) Ensure that optimum care is provided.
2 or 2.5 days
Doctors who care for injured patients.
American Burn Association Sponsored Courses
Advanced Burn Life Support (ABLS)
The course provides guidelines in the assessment and management of the burn patient during the first 24 hours post injury. Following a series of lectures, case studies are presented for group discussions. An opportunity will be given to work with a simulated burn patient to reinforce the assessment, stabilization, and the American Burn Association transfer criteria to a Burn Center. Final testing consists of a written exam and practical assessment return demonstration.
Physicians, nurses, physician assistants, nurse practitioners, therapists, and paramedics.
Other Disaster Courses
American Medical Association/National Disaster Life Support Foundation (AMA/NDLSF) Sponsored Courses:
Core Disaster Life Support (CDLS)
(Also available as eCDLS, for those who prefer an online learning format.)
The awareness level course is presented in a didactic format, providing an overview of disasters including natural and accidental manmade events, traumatic and explosive events, nuclear and radiologic events, biological events, and chemical events. The focus of the course is to discuss and apply a unique approach to disaster management called the D-I-S-A-S-T-E-R paradigm. The overarching aim is to introduce participants to basic concepts and terms that are reinforced in detail in the BDLS and ADLS courses.
EMTs, allied health workers and technicians, law enforcement, entry-level Medical Reserve Corps, some office-based health care professionals, police, firefighters, emergency management personnel, government officials, health care administrators, social workers, disaster relief workers, and anyone needing an introductory program.
Decon Disaster Life Support
The ability to decontaminate a large number of victims from a chemical or radiological event will require large numbers of personnel trained and equipped to provide decontamination. Although healthcare providers in PPE will be needed to render immediate care and triage victims, the majority of the workforce that provides decontamination in a disaster of this nature should be non-clinical, hospital-based personnel. This program is designed to meet this need.
Physicians, physician assistants, nurse practitioners, nurses, emergency medical technicians, paramedics, allied health professionals, medical students, law enforcement officers, fire fighters, first responders, hospital administrators, decontamination personnel, emergency managers, hospital safety/security personnel and non-clinical personnel.
Basic Disaster Life Support (BDLS)
(Also available as eBDLS, for those who prefer an online learning format.)
BDLS is targeted to multiple disciplines including emergency medical service (EMS) personnel, hazardous materials personnel, public health personnel, and health care providers. The course is designed to teach a group of multiple disciplines simultaneously, with the goal of developing a commonality of approach and language in the healthcare community. This will improve the care and coordination of response in Weapon of Mass Destruction (WMD) disasters and public health emergencies. The BDLS course is a review of the all-hazards topics including natural and accidental man-made events, traumatic and explosive events, nuclear and radiological events, biological events, and chemical events. Also included is information on the health care professional's role in the public health and incident management systems, community mental health, and special needs of underserved and vulnerable populations.
Physicians, registered or licensed practical nurses, paramedics or national intermediate EMTs, physician assistants, allied health professionals, dentists, pharmacists, public health professionals, veterinarians, health professions students, and mental health professionals.
Advanced Disaster Life Support (ADLS)
ADLS is an advanced practicum of the principles introduced in Basic Disaster Life Support (BDLS). ADLS includes lectures on the following: MASS Triage in detail, community and hospital disaster planning, media and communications during disasters, and mass fatality management. In addition, small group interactive sessions allow students to work through a series of difficult questions of disaster management in a tabletop format.
Physicians, nurse practitioners, physician assistants, nurses, emergency medical technicians, paramedics, pharmacists, allied health professionals, and medical students.
Medical Society of the State of New York (MSSNY) Sponsored Course
Biological, Chemical, and Nuclear Emergencies Course (BCNE)
This curriculum is a 16-module program designed to assist physicians in obtaining experience in bio-terrorism preparedness training. There are eleven Biological Agents, four Chemical Agents including a Chemical Overview and one Nuclear Radiological Emergencies modules. These modules will provide valuable information during any public health emergency involving these agents.
For physician members; however, non-members are eligible to enroll. Bioterrorism Reference Cards can be down loaded from this link or may be obtained free of charge from MSSNY.
American Academy of Pediatrics/American College of Emergency Physicians (AAP/ACEP) Sponsored Course
Advanced Pediatric Life Support (APLS)
Covers basics of pediatric emergency medicine. The course curriculum is designed to present the information physicians need to assess and care for critically ill and injured children during the first few hours in the emergency department or office-based setting.
Physicians. Also available for nurses, paramedics.
Pre-hospital Pediatric Care Course (PPCC)
The New York State EMSC Prehospital Pediatric Care Course (PPCC), a continuing education course for EMTs, was designed to reinforce or enhance the knowledge and skills of all pre-hospital providers in assessing and treating children in the field.
1 to 2 days
Emergency medical technicians and paramedics.
Emergency Nurses Association (ENA) Sponsored Course
Trauma Nursing Core Course (TNCC)
ENA developed and implemented the TNCC for national and international dissemination as a means of identifying a standardized body of trauma nursing knowledge. The TNCC (Provider) is a 16- or 20-hour course designed to provide the learner with cognitive knowledge and psychomotor skills. Nurses with limited emergency nursing clinical experience, who work in a hospital with limited access to trauma patients, or who need greater time at the psychomotor skill stations are encouraged to attend courses scheduled for the 20-hour format. The purpose of TNCC is to present core-level knowledge, refine skills and build a firm foundation in trauma nursing.
16 or 20 hours
Nurses; other healthcare providers may attend as observers.
American College of Surgeons (ACS) Sponsored Course
Disaster Management and Emergency Preparedness (DMEP)
This course is both didactic and interactive. It addresses core competencies as outlined by the American College of Surgeons (ACS) Committee on Trauma (COT) Disaster and Mass Casualty Management Committee. Major topics addressed include planning, triage, incident command, injury patterns and pathophysiology, and consideration for special populations. Small group discussions are based on illustrative scenarios. The course requires a pre and post test, which are reviewed onsite. A comprehensive syllabus and supportive CD with resource material is provided.
Acute care providers (i.e., surgeons; anesthesiologists; emergency medicine physicians; ER, OR, ICU and trauma nurses; and pre-hospital professionals) who will most likely be the first receivers of casualties following major disasters. Other health care providers, administrators, public health personnel, and emergency managers are also encouraged to attend.
Department of Homeland Security Sponsored Course
Hospital Emergency Response Training (HERT) for Mass Casualty Incidents (MCI) Train-the-Trainer Course (at the Alabama Noble Training Center)
This course prepares the Hospital Emergency Response Team for mass casualty incidents.
2.5 or 3 days
Hospital administrators, physicians, nurses, security personnel and other hospital staff who are part of or manage their hospital's Emergency Response Team.
Additional Trauma Courses
Society of Trauma Nurses (STN) Sponsored Course
Advanced Trauma Care for Nurses (ATCN)
This advanced course, designed for the registered nurse interested in increasing his/her knowledge in management of the multiple trauma patient, is only run in conjunction with a colocated ATLS course. Nurse participants audit the ATLS lectures. During the ATLS skill and testing stations, the nurses are separated from the physician group and directed through ATCN skill stations. ATCN skill stations include: initial assessment and management, airway and ventilatory management, pediatric trauma, hemorrhagic shock, musculoskeletal & spinal trauma, and head trauma.
National Association of Emergency Medical Technicians (NAEMT) in Collaboration with the American College of Surgeons (ACS) Committee on Trauma Sponsored Course
Pre-Hospital Trauma Life Support Course (PHTLS)
The course focuses on trauma patients in the pre-hospital environment, teaching how to identify, manage, and transport them with the highest level of care and give them the greatest chance of survival.
1 day for EMTs, 2 days for paramedics
EMTs, nurses, and physicians.
Additional Critical Care and Disaster Courses
Society of Critical Care Medicine (SCCM) Sponsored Courses
Fundamentals of Critical Care Support (FCCS)
- http://www.sccm.org/FCCS_and_Training_Courses/FCCS/Pages/default.aspx (1 day, all medical providers, includes pediatric considerations)
This course addresses fundamental management principles for the first 24 hours of critical care. Student objectives include prioritization of assessment needs for the critically ill patient, selection of appropriate diagnostic tests, identification and response to significant changes in the unstable patient, recognition of and management of acute life-threatening conditions, and determination of the need for expert consultation and/or patient transfer and preparation for accomplishing optimal transfer.
All medical providers, includes pediatric considerations.
Fundamentals of Disaster Medicine (FDM)
- http://www.sccm.org/FCCS_and_Training_Courses/FDM/Pages/default.aspx (1 day, all medical providers, includes pediatric considerations)
Fundamental Disaster Management (FDM) prepares healthcare professionals to treat victims of natural or manmade mass casualty events. It arms critical care professionals with the expertise to manage the critical care response to large-scale disasters. This course focuses on critically ill patients who are admitted to your hospital and is "a must" for healthcare providers who may come in contact with critically ill and/or injured patients after a mass casualty event.
Critical care health professionals including pharmacists, respiratory care professionals, nurses, nurse practitioners, physician assistants, and physicians. Also, persons who have successfully completed Society of Critical Care Medicine's Fundamental Critical Care Support (FCCS) course and who are expected to have significant critical care responsibilities during an emergency.
Hospital Disaster Management (HDM)
How do you manage a sudden surge in critically ill or injured patients that overwhelms your critical care capacity? The Society's Hospital Mass-Casualty Disaster Management (HDM) course addresses this challenge within the context of disaster preparedness and response. This course prepares non-critical care healthcare professionals to augment hospital inpatient capacity, specifically critical care capacity, in the wake of a disaster.
Non-critical care healthcare providers.
Additional Websites for Disaster Preparedness Information
Agency for Healthcare Research and Quality (AHRQ)
Agency for Healthcare Research and Quality site with general preparedness information.
American Academy of Family Physicians
American Academy of Family Physicians website with links to emergency/disaster preparedness and disaster training opportunities.
Center for Trauma Response, Recovery and Preparedness for Health Care Communities
Center for Trauma Response, Recovery and Preparedness for Health Care Communities website with links to educational materials for disaster and emergency preparedness.
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention site with links to Emergency Preparedness and Response.
Critical Illness and Trauma Foundation, Inc.
URL is for ordering "Bioterrorism & Trauma Training: An All Hazards Approach to Multiple Casualty Events", a CD-ROM written by Critical Illness and Trauma Foundation, Inc.
Emergency Medicine Services for Children (EMSC)
EMSC website with links to resources and toolboxes regarding disaster preparedness.
Illinois Emergency Medical Services for Children
Illinois EMS-C site with additional links to disaster and emergency preparedness websites.
Jumpstart Pediatric Mass Casualty Incident (MCI) Triage Tool
Links to information about JumpSTART triage system.
National Center for Disaster Preparedness
Pediatric Preparedness for Disasters and Terrorism: A National Consensus Conference, Executive Summary 2003.
Sources of Information for Emergency Preparedness for Childbirth
Blue Cross Blue Shield of Massachusetts
Childbirth emergency preparedness for non-clinicians and laypersons.
World Health Organization
Birth and emergency preparedness in antenatal care: Integrated management of pregnancy and childbirth (IMPAC), Standards for Maternal and Neonatal Care, 2006.
Managing complications in pregnancy and childbirth – A guide for midwives and doctors.
The Journal of Perinatal Education
Introducing emergency preparedness into childbirth education.
American College of Nurse Midwives
Giving birth "in place," emergency preparedness for childbirth.
Johns Hopkins University
Emergency Obstetric Care: Quick Reference Guide for Frontline Providers, 2003.