The New York City Pediatric Disaster Coalition Has Moved to the Maimonides Infants and Children’s Hospital!
Emily Raisch, Program Director
Maimonides Medical Center has just become the new home of the NYC Pediatric Disaster Coalition (PDC). The PDC was established by the NYC Department of Health and Mental Hygiene (DOHMH) in 2007 in response to the threat that a mass casualty event producing a large number of critically injured pediatric victims would likely overwhelm pediatric critical care units both in New York City and the region. If the system were to become overtaxed we might not be able to provide optimal care to all pediatric victims.
The PDC, previously housed at Cohen’s Children’s Hospital in Queens, is comprised of experts in emergency preparedness, pediatric critical care, surgery, emergency medicine, and representatives from DOHMH, NYC Office of Emergency Management (OEM) and Fire Department of New York (FDNY). Currently 18 of 25 major NYC Pediatric Critical Care (PCC) capable hospitals are participating in the coalition.
Who We Are
The PDC is headed up by Co-PI George Foltin, Vice Chair, Clinical Services at the Infant and Children’s Hospital, PI Dr. Michael Frogel, Chief General Pediatrics, Cohen Children’s Hospital, Program Director Emily Raisch and Project Coordinator Nora Caplan. When Dr. Foltin joined Maimonides as Vice Chair of Pediatrics, the PDC followed. Now Dr. Foltin, Emily and Nora are happy to be part of the Maimonides community!
The PDC’s primary goals are to build a coalition for New York City of hospitals, public health, municipal services and community groups to ensure effective use of critical assets during and after a large-scale disaster affecting children.
What We Have Accomplished
Pediatric Surge Planning and Drills
There are 25 hospitals with PCC services in NYC, with a total of 233 Pediatric Intensive Care Unit (PICU) beds. Between 2009-2011 eight major hospitals with a total of 120 PCC beds have used our surge plan guidelines in creating their PCC surge plans, thereby adding 107 surge beds (45% bed increase once the plans are operationalized). Ten additional hospitals are in various stages of plan development. Five of those hospitals successfully tested those plans through table top discussions and then full scale exercises.
Prehospital Triage Criteria
The PDC has formulated and implemented a Pediatric Triage/Transport Plan in collaboration with FDNY/EMS. It includes:
1. A modified START MCE triage algorithm that adds 5 rescue breaths for unresponsive children and an up-triage option for those in respiratory distress
2. Specific pediatric MCE triage criteria that match acuity and severity of illness to appropriately tiered pediatric disaster receiving hospitals (PDRHs)
3. Evacuation and primary transport to these hospitals
4. A pediatric intensivist consultant for secondary transport.
These specific pediatric triage and transport protocols have been integrated into regional EMS system protocols. Approximately 3,000 EMS personnel and 12 pediatric transfer consultants have been trained in these protocols.
Hospital Destination Criteria
A list of Pediatric Disaster Receiving Hospitals was created and divided into Tier 1 and Tier 2 based on resources. Tier 1 and Tier 2 pediatric disaster receiving hospitals are staffed by specialized pediatric emergency medicine physicians and pediatric surgeons, specialized pediatric nurses and therapists, emergency department medical staff and nurses who work as a coordinated team to manage treatment and facilitate the recovery of pediatric patients.
Interhopsital Transport Criteria
The PDC has established a pediatric intensivist response team (PIRT) in partnership with FDNY for the purpose of recommending secondary transport priority to FDNY. A priority rating scale was created for this purpose, which will allow PIRT physicians to remotely assess patients and rate their need for inter-hospital transportation during an emergency.
In coordination with the NYC DOHMH we have created a New York City Hospital Pediatric Resource Directory and a New York City Neonatal Intensive Care Unit Resource Directory. The directories list all the known hospitals with pediatric in-patient pediatric resources including PICU, General Pediatric Medical Surgical Beds, NICUs, Pediatric emergency departments, and well-baby nursery’s including hospitals that will receive transfers to those units. These directories will be posted at http://www.nyc.gov/html/doh/html/em/emergency-ped.shtml.
The PDC continues to grow and welcomes new members. If you are interested in joining us please contact:
George Foltin, MD: Co-PI firstname.lastname@example.org
Michael Frogel, MD: P.I. MFrogel@NSHS.edu
Emily Raisch Program Director: email@example.com
Nora Caplan Project Coordinator: firstname.lastname@example.org