Carden Johnston

The pediatrician and disaster preparedness

For decades, emergency planning for natural disasters, public health emergencies, workplace accidents, and other calamities has been the responsibility of government agencies on all levels and certain nongovernment organizations such as the American Red Cross. In the case of terrorism, however, entirely new approaches to emergency planning are under development for a variety of reasons. Terrorism preparedness is a highly specific component of general emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, terrorism preparedness must consider several additional issues, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if they are not monitored carefully. This article is designed to provide an overview of key issues for the pediatrician with respect to disaster, terrorism, and public health emergency preparedness. It is not intended to be a complete compendium of didactic content but rather offers an approach to what pediatricians need to know and how pediatricians must lend their expertise to enhance preparedness in every community. To become fully and optimally prepared, pediatricians need to become familiar with these key areas of emergency preparedness: unique aspects of children related to terrorism and other disasters; terrorism preparedness; mental health vulnerabilities and development of resiliency; managing family concerns about terrorism and disaster preparedness; office-based preparedness; hospital preparedness; community, government, and public health preparedness; and advocating for children and families in preparedness planning.

Temperature relationship to distance and flow rate of warmed IV fluids

STUDY OBJECTIVE To determine whether therapeutic benefit is obtained by administering warmed IV fluid to hypothermic children. DESIGN Saline at 37 C in standard IV tubing was subjected to temperature measurements within a fluid warmer and at 5, 25, 45, 65, 85, and 105 cm distally. Flow rates varied from 20 to 1,000 mL/hr. SETTING The Childrens Hospital of Alabama emergency department. TYPE OF PARTICIPANTS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Temperature readings were made every minute until the volume required to flush the tubing had infused. Only at rates of 750 and 1,000 mL/hr did the fluid remain warmer than 32 C more than 25 cm from the warmer. CONCLUSION At flow rates usual in pediatrics, hypothermic patients must be connected to fluid warmers by lengths of IV tubing shorter than customary or practical in the ED to benefit from this treatment modality.

Critical care interhospital transports: predictability of the need for a pediatrician.

The Childrens Hospital of Alabama Critical Care Transport System provides a mobile intensive care unit for interhospital transfer of critically ill pediatric patients. The transport team consists of a pediatrician, a pediatric emergency nurse, and a respiratory therapist. We studied whether it was possible to determine in advance whether it was always necessary for a physician to be on the team. The transport physician made a determination of need for a physician based on data available prior to transport (preassessment). After the transport was completed, the physician made a retrospective determination of actual need for a physician (postassessment). Over a period of eight months, 148 questionnaires were analyzed. In 108 transports (73%), there was minimal or no change in need for a physician between the pre- and posttransport assessments. Therefore, an accurate prediction of need for a physician was possible in advance. Of the remaining transports in which the determination was significantly changed, 37 (25%) indicated a decrease in actual need for a physician after completion of the transport. There was a significant increase over the prediction in the actual need for a physician in only three cases (2%).

Pediatric critical care transport survey: team composition and training, mobilization time, and mode of transportation

A survey was conducted to determine the current standard of care with regard to team composition and training, mobilization time, and vehicle use for pediatric critical care transport. An evaluation of 30 pediatric referral centers revealed that 60% provide a critical care transport team. Of those teams, the mean number of transports per year was 304. Response time ranged from 10 to 90 minutes. All teams included a physician all or most of the time; 100% of teams included a critical care nurse, and 50% always included a respiratory therapist. Ambulances alone are used in 28% of systems, with the remainder using combinations of ambulances, helicopters, and fixed wing aircraft. A proposal is presented for future standards in pediatric critical care transport with regard to the factors discussed.

Introduction: Why Beat a Tired Horse?

Geographic circumstances: At the time of Hurricane Katrinas landfall, I was 300 miles away in Birmingham, Alabama. About the authors: I teach and consult in the pediatric emergency medicine division at UAB School of Medicine. None of my professional or geographical moves have been related to Hurricane Katrina. For the American Academy of Pediatrics, I was head of a group of concerned pediatricians called the DPT (disaster preparedness team), helping disaster preparedness become more formalized. I edited the 2006 Pediatrics supplement on Katrina. Katrina. Five years after landfall, the name still reverberates with memories of confusion and inadequate preparation for a predictable … Address correspondence to Carden Johnston, MD, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Ave S, Birmingham, AL 35233. E-mail: cjohnston{at}aap.org

Katrina’s legacy

How long does it take to heal? Is six years long enough? Pediatricians who primarily provided critical services during the pounding and aftermath of Hurricane Katrina report ongoing consequences. In a supplement to the August issue of Pediatrics (<http://pediatrics.aappublications.org/content/128/