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Pediatric Triage and Allocation of Critical Care Resources During Disaster: Northwest Provider Opinion

Published online by Cambridge University Press:  23 September 2014

Erin Margaret Johnson*
Affiliation:
Children's Hospital of Pittsburgh, Pittsburgh, PennsylvaniaUSA
Douglas S. Diekema
Affiliation:
Treuman Katz Center for Pediatric Bioethics, Seattle, WashingtonUSA Seattle Children's Hospital, Seattle, WashingtonUSA University of Washington, Seattle, WashingtonUSA
Mithya Lewis-Newby
Affiliation:
Treuman Katz Center for Pediatric Bioethics, Seattle, WashingtonUSA
Mary A. King
Affiliation:
Seattle Children's Hospital, Seattle, WashingtonUSA
*
Correspondence: Erin Margaret Johnson Children's Hospital of Pittsburgh Faculty Pavillion Building 4401 Penn Ave Pittsburgh, Pennsylvania 15224-1342 USA E-mail erin.johnson3@chp.edu

Abstract

Introduction

Following Hurricane Katrina and the 2009 H1N1 epidemic, pediatric critical care clinicians recognized the urgent need for a standardized pediatric triage/allocation system. This study collected regional provider opinion on issues of care allocation and pediatric triage in a disaster/pandemic setting.

Methods

This study was a cross-sectional survey of United States (US) health care providers and public health workers who demonstrated interest in critical care and/or disaster care medicine by attending a Northwest regional pediatric critical care symposium on disaster preparation, held in 2012 at Seattle Children's Hospital in Seattle, Washington (USA). The survey employed an electronic audience response system and included demographic, ethical, and logistical questions. Differences in opinions between respondents grouped by professions and work locations were evaluated using a chi-square test.

Results

One hundred and twelve (97%) of 116 total attendees responded to at least one question; however, four of these responders failed to answer every question. Sixty-two (55%) responders were nurses, 29 (26%) physicians, and 21 (19%) other occupations. Fifty-five (51%) responders worked in pediatric hospitals vs 53 (49%) in other locations. Sixty-three (58%) of 108 successful responses prioritized children predicted to have a good neuro-cognitive outcome. Seventy-one (68%) agreed that no pediatric age group should be prioritized. Twenty-two (43%) of providers working in non-pediatric hospital locations preferred a triage system based on an objective score alone vs 14 (26%) of those in pediatric hospitals (P = .038).

JohnsonEM, DiekemaDS, Lewis-NewbyM, KingMA. Pediatric Triage and Allocation of Critical Care Resources During Disaster: Northwest Provider Opinion. Prehosp Disaster Med. 2014;29(5):1-6.

Type
Original Research
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

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References

1.US Census Bureau. Census 2000 Summary File 2009. http://www.census.gov/Press-Release/www/2001/sumfile1.html. Published 2009. Accessed November 10, 2012.Google Scholar
2. Methodology U.S. News and World Report Best Children's Hospitals 2012-1013. US News and World Report website. http://www.usnews.com/pubfiles/7-17PedsReport2012_June25.pdf. Accessed May 8, 2013.Google Scholar
3.Brantley, MD, Lu, H, Barfield, WD, Holt, JB, Williams, A. Mapping US pediatric hospitals and subspecialty critical care for public health preparedness and disaster response. Disaster Med Public Health Prep. 2012;6(2):117-125.CrossRefGoogle ScholarPubMed
4.Allen, GM, Parrillo, SJ, Will, J, Mohr, JA. Principles of disaster planning for the pediatric population. Prehosp Disaster Med. 2007;22(6):537-540.CrossRefGoogle ScholarPubMed
5.Gavagan, TF, Smart, K, Palacio, H, et al. Hurricane Katrina: medical response at Houston Astrodome/Reliant Center Complex. South Med J. 2006;99(9):933-939.CrossRefGoogle ScholarPubMed
6.Baldwin, S, Robinson, A, Barlow, P, Fargason, CA. Interstate transfer of pediatric patients during Hurricane Katrina. Pediatrics. 2006;117(S4):S416-S420.CrossRefGoogle ScholarPubMed
7.Van Cleve, WC, Hagan, P, Lozano, P, Mangione-Smith, R. Investigating a pediatric hospital's response to an inpatient census surge during the 2009 H1N1 influenza pandemic. Jt Comm J Qual Patient Saf. 2011;37(8):376-382.Google Scholar
8.Doshi, SS, Stauffer, KE, Parker Fiebelkorn, A, et al. The burden and severity of illness due to 2009 pandemic influenza A (H1N1) in a large US city during the late summer and early fall of 2009. Am J Epidemiol. 2012;176(6):519-526.CrossRefGoogle Scholar
9.Kanter, R. Pediatric mass critical care in a pandemic. Pediatr Crit Care Med. 2012;13(1):e1-e4.CrossRefGoogle ScholarPubMed
10.White, DB, Katz, MH, Luce, JM, Lo, B. Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009;150(2):132-139.CrossRefGoogle ScholarPubMed
11.Powell, T, Christ, KC, Guthrie, BS. Allocation of ventilators in a public health disaster. Disaster Med and Public Health Prep. 2008;2(1):20-26.CrossRefGoogle Scholar
12.Devereaux, A, Christian, MD, Dichter, JR, Geiling, JA, Rubinson, L. Summary of suggestions from the task force for mass critical care summit January 26-27, 2007. Chest. 2008;133(5 Suppl):1S-7S.CrossRefGoogle ScholarPubMed
13.Kissoon, N. Deliberations and recommendations of the pediatric emergency mass critical care taskforce. Pediatr Crit Care Med. 2011;12(6 Suppl):S103-S108.CrossRefGoogle Scholar
14.Persad, G, Wertheimer, A, Emanuel, EJ. Principles for allocation of scarce medical interventions. Lancet. 2009;373(9661):423-431.CrossRefGoogle ScholarPubMed
15.Antommaria, AH, Powell, T, Miller, JE, Christian, MD. Task force for pediatric emergency mass critical care: ethical issues in pediatric emergency mass critical care. Pediatr Crit Care Med. 2011;12(6 Suppl):S163-S168.CrossRefGoogle ScholarPubMed
16. Public Engagement Project on Medical Service Prioritization During an Influenza Pandemic. Public Health Seattle and King County web site. http://www.kingcounty.gov/health. Accessed December 8, 2012.Google Scholar
17. Poll: Children's needs should be prioritized in disaster planning, response, and recovery efforts. American Academy of Pediatrics web site. http://www.aap.org/en-us/about-the-aap/aap-press-room. Accessed May 8, 2013.Google Scholar