Catherine J. Goodhue

Disaster and mass casualty events in the pediatric population

Recent disasters involving pediatric victims have highlighted the need for pediatric hospital disaster preparedness. Although children represent 25% of the U.S. population, there are significant gaps in pediatric disaster preparedness across the country. Disaster planners and others tend to overlook pediatric needs, and therefore plans are often inadequate. To establish an effective hospital and community-based pediatric disaster management system, administrative and hospital leadership are key. Disaster planners and hospital leadership should establish and improve their management of pediatric victims in the event of a disaster through staff training, family reunification planning, and use of available pediatric disaster management tools.

Willingness to Respond in a Disaster: A Pediatric Nurse Practitioner National Survey

OBJECTIVE The objective of this study was to examine factors associated with pediatric nurse practitioners (PNPs) reporting to work in the event of a disaster. METHODS An anonymous national survey of PNPs was conducted. Several domains were explored, including demographics, personal preparedness plans, disaster training, prior disaster experience, and likelihood of responding in the event of a disaster. A logistic regression analysis was conducted to determine which factors were associated with the respondents likelihood of responding in the event of a disaster. RESULTS Factors associated with increased likelihood of responding included gender (being a male PNP), military experience, and disaster training. The most significant factor associated with an increased likelihood of responding to work during a disaster was having a specified role in the workplace disaster plan. PNPs with a specified role were three times more likely to respond than were those without a specified role. CONCLUSIONS PNPs are health care workers with advanced skill sets. This untapped resource is available to provide care for a vulnerable population: our children. Disaster planners should explore the possibility of utilizing these highly skilled health care workers in their disaster plans.

Limiting chest computed tomography in the evaluation of pediatric thoracic trauma.

BACKGROUND Computed tomography (CT) of the chest (chest CT) is overused in blunt pediatric thoracic trauma. Chest CT adds to the diagnosis of thoracic injury but rarely changes patient management. We sought to identify a subset of blunt pediatric trauma patients who would benefit from a screening chest CT based on their admission chest x-ray (CXR) findings. We hypothesize that limiting chest CT to patients with an abnormal mediastinal silhouette identifies intrathoracic vascular injuries not otherwise seen on CXR. METHODS All blunt trauma activations that underwent an admission CXR at our Level 1 pediatric trauma center from 2005 to 2013 were retrospectively reviewed. Patients who had a chest CT were evaluated for added diagnoses and change in management after CT. RESULTS An admission CXR was performed in 1,035 patients. One hundred thirty-nine patients had a CT, and the diagnosis of intra-thoracic injury was added in 42% of patients. Chest CT significantly increased the diagnosis of contusion or atelectasis (30.3% vs 60.4%; p < 0.05), pneumothorax (7.2% vs 18.7%; p < 0.05), and other fractures (4.3% vs 10.8%; p < 0.05) on CXR compared to chest CT. Chest CT changed the management of only 4 patients (2.9%). Two patients underwent further radiologic evaluation that was negative for injury, one had a chest tube placed for an occult pneumothorax before exploratory laparotomy, and one patient had a thoracotomy for repair of aortic injury. Chest CT for select patients with an abnormal mediastinal silhouette on CXR would have decreased CT scans by 80% yet still identified patients with an intrathoracic vascular injury. CONCLUSIONS The use of chest CT should be limited to the identification of intrathoracic vascular injuries in the setting of an abnormal mediastinal silhouette on CXR. LEVEL OF EVIDENCE Therapeutic study, level IV; diagnostic study, level III.

Can a pediatric trauma center improve the response to a mass casualty incident

ABSTRACT Recent events including the 2001 terrorist attacks on New York; Hurricane Katrina; the 2010 Haitian and Chilean earthquakes; and the 2011 earthquake, tsunami, and nuclear disaster in Japan have reminded disaster planners and responders of the tremendous scale of mass casualty disasters and their resulting human devastation. Although adult disaster medicine is a well-developed field with roots in wartime medicine, we are increasingly recognizing that children may comprise up to 50% of disaster victims, and response mechanisms are often designed without adequate preparation for the number of pediatric victims that can result. In this short educational review, we explore the differences between the pediatric and adult disaster and trauma populations, the requirements for designation of a site as a pediatric trauma center (PTC), and the magnitude of the problem of pediatric disaster patients as described in the literature, specifically as it pertains to the availability and use of designated PTCs as opposed to trauma centers in general. We also review our own experience in planning and simulating pediatric mass casualty events and suggest strategies for preparedness when there is no PTC available. We aim to demonstrate from this brief survey that the availability of a designated PTC in the setting of a mass casualty disaster event is likely to significantly improve the outcome for the pediatric demographic of the affected population. We conclude that the relative scarcity of disaster data specific to children limits epidemiologic study of the pediatric disaster population and offer suggestions for strategies for future study of our hypothesis. LEVEL OF EVIDENCE Systematic review, level III.

Admission hematocrit predicts the need for transfusion secondary to hemorrhage in pediatric blunt trauma patients.

BACKGROUND Pediatric trauma uses a substantial amount of resources. Quick and cost-effective measures that can be used to identify children with clinically relevant injuries are essential to resource allocation and optimization of patient care. Admission hematocrit is rapid and inexpensive, causes minimal harm, and can potentially aid in critical decision making. We hypothesize that admission hematocrit predicts the need for transfusion in pediatric blunt trauma patients. METHODS Records of trauma patients age 0 year to 17 years (2005–2013) who presented to a pediatric Level 1 trauma center were retrospectively reviewed. Data collected include demographics, computed tomographic scan findings, need for an intervention secondary to bleeding (blood transfusion, angioembolization, or operation), and admission hematocrit. RESULTS We found a significant decrease in admission hematocrit between patients requiring a transfusion and patients who did not (27% vs. 36%, p < 0.01). We evaluated a subset of patients who had an abdominal computed tomographic scan and found a significant decrease in admission hemocrit between those who required a transfusion for an intra-abdominal injury and those who did not (29% vs 37%, p < 0.01). In this subset, serial hematocrit values remained significantly lower in the patients requiring a transfusion up to 67 hours after admission (p = 0.04). A cutoff admission hematocrit of 35% or less has a sensitivity of 94% and a negative predictive value of 99.9% in identifying children who need a transfusion after blunt trauma. CONCLUSION An admission hematocrit of 35% or less provides a reliable screening test because of its low false negative rate and high specificity for identifying patients at an increased risk of bleeding after injury. Admission hematocrit could be widely implemented to identify patients who may need a transfusion with low expense and minimal harm for our pediatric patients and may be able to alter the entire course of their trauma resuscitation. LEVEL OF EVIDENCE Epidemiologic/prognostic study, level III.

Mixed-Methods Pilot Study Disaster Preparedness of Families With Children Followed in an Intestinal Rehabilitation Clinic

BACKGROUND Children with special healthcare needs are a vulnerable population in disasters. Special-needs families tend to be less prepared for a disaster than the general public. The purpose of this pilot project was to examine the disaster preparedness levels of families in an intestinal rehabilitation (IR) clinic. MATERIALS AND METHODS We administered an anonymous survey to a convenience sample of IR clinic families and conducted 2 focus groups. Descriptive analyses were used for survey data; Atlas.ti was used to analyze focus group data. RESULTS Survey findings revealed that 69% of families lacked an emergency supply kit, and 93% did not have a clinician-completed emergency information form. On a scale of 1-10, the mean confidence in their familys disaster preparations was 4.9. The overarching theme from focus group discussions was challenges and/or barriers to disaster preparedness. CONCLUSION IR clinic families are generally unprepared for a disaster. These findings are highly relevant to our goal of developing a disaster survival toolkit for the IR families. Toolkits are being distributed in the IR clinic.

NAPNAP Research Agenda Revisions: Preliminary Survey Results

Rita H. Pickler, PhD, RN, PNP-BC, FAAN, Christina Calamaro, PhD, CRNP, Sharron Docherty, PhD, PNP-BC, Catherine J. Goodhue, MN, RN, CPNP-PC, Tracy Magee, PhD, RN, CPNP, Ann Marie McCarthy, PhD, RN, FAAN, Lois Sadler, PhD, PNP-BC, FAAN, Leigh Small, PhD, RN, CPNP-PC, FNAP, Regena Spratling, PhD, RN, CPNP, Susan N. Van Cleve, DNP, CPNP-PC, PMHS, Jennifer D Auria, PhD, RN, CPNP, &Dolores C. Jones, EdD, RN, CPNP, CAE

Self-assessment of team performance using T-NOTECHS in simulated pediatric trauma resuscitation is not consistent with expert assessment.

BACKGROUND The Trauma NOn-TECHnical Skills (T-NOTECHS) tool has been used to assess teamwork in trauma resuscitation, but its reliability and validity for self-assessment is unknown. Our purpose was to determine the reliability and validity of self-administered T-NOTECHS in pediatric trauma resuscitation. METHODS Simulated in situ resuscitations were evaluated using T-NOTECHS in real time by experts and immediately afterwards by team members. Reliability was analyzed with linear-weighted kappa and intra-class correlation. T-NOTECHS scores were compared between expert (gold-standard) and self-assessment. RESULTS Fifteen simulations were examined. T-NOTECHS scores were similar between self- and expert assessment for leadership. Self-assessment scores were higher than expert for the other domains and total composite score. Inter-rater reliability for total score was similar between the two groups, but differences were observed in the domains. CONCLUSIONS Self-assessment is not interchangeable with expert rating when using T-NOTECHS. Future studies need to determine how self-assessment can be best utilized. LEVEL OF EVIDENCE Studies of diagnostic accuracy - Level 2.

Academic-community partnership to develop a novel disaster training tool for school nurses: emergency triage drill kit

As children spend approximately 28% of their day in school and disasters may strike at any time, it is important for school officials to conduct emergency preparedness activities. School nurses, teachers, and staff should be prepared to respond and provide support and first aid treatment. This article describes a collaborative effort within the Los Angeles Unified School District to enhance disaster preparedness. Specifically, the article outlines the program steps and tools developed to prepare staff in mass triage through an earthquake disaster training exercise.

NAPNAP Research Agenda: 2014-2019

Regena Spratling, PhD, RN, CPNP, Rita H. Pickler, PhD, RN, PNP-BC, FAAN, Christina Calamaro, PhD, CRNP, Juanita Conkin Dale, PhD, RN, CPNP-PC, Sharron Docherty, PhD, RN, PNP-BC, FAAN, Catherine J. Goodhue, MN, CPNP, Jill Kilanowski, PhD, RN, APRN, CPNP, FAAN, Ann Marie McCarthy, PhD, RN, FAAN, Mary C. O’Laughlen, PhD, RN, FNP-BC, FAAAAI, Lois S. Sadler, PhD, RN, PNP-BC, FAAN, Leigh Small, PhD, RN, CPNP-PC, FNAP, FAANP, FAAN, Kathleen Speer, PhD, RN, PPCNP-BC, Tami Thomas, PhD, RN, CPNP, RNC, FAANP, Susan Van Cleve, DNP, RN, CPNP, PMHS, Jennifer D Auria, PhD, RN, CPNP, & Dolores C. Jones, EdD, RN, CPNP