Assessing Trust in Physician and Vaccine Hesitancy Among Hispanic/Latinx Parents

Introduction: Representing the USA's largest ethnic/racial group, Hispanic/Latinx (HL) experience health challenges of proportional magnitude. This study investigates the prevalence of vaccine hesitancy among HL adults and trust in their child's pediatrician. Methods: HL parents of children who receive medical care at one of the largest Federally Qualified Health Centers in the United States completed a survey examining associations between physician trust, vaccine hesitancy, and demographics. Data were subjected to ANOVA via SAS9 version 9.0 (Cary, NC) and SPSS version 27 (Chicago, IL) software. Results: With a total of 500 surveys completed (51% response rate; 81% completion rate), the prevalence of vaccine hesitancy amounted to 15.4% (n = 77). Parents with university-level education displayed higher levels of trust and perceptions in favor of routine vaccination practices (p < .01). When medical visits were conducted in Spanish, parents exhibited lower levels of trust and were more vaccine-hesitant (p < .01). Conclusions: Vaccine literacy must be prioritized in early education to reach parents who may not achieve college degrees. Ensuring language concordance within patient-physician dyads may maximize the potential for vaccine uptake and physician trust.

A qualitative analysis of public health officials' experience in California during COVID-19: priorities and recommendations

Objectives

The aim of this study was to collect qualitative data regarding the violence faced by public health officials during the COVID-19 pandemic and create a guideline of recommendations to protect this population moving forward.

Methods

Two focus groups were conducted virtually from April 2022 to May 2022. All nine participants were public health officials from across California. A grounded theory approach was used to analyze the data from these focus groups.

Results

The main recurrent experiences among public health officials were harassment, psychological impact, systemic backlash, and burnout. Several recommendations for supporting public health officials were highlighted, including security and protection, mental health support, public awareness, and political/institutional support.

Conclusion

Our study captures the violent experiences that health officials have faced during the COVID-19 pandemic. To maintain the integrity of the public health system, timely changes must be made to support and protect health officials. Our guideline of recommendations provides a multi-faceted approach to the urgent threats that officials continue to face. By implementing these solutions, we can strengthen our public health system and improve our response to future national emergencies.

The Challenge of Mass Casualty Incident Response Simulation Exercise Design and Creation: A Modified Delphi Study

BACKGROUND

A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder (FR) competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain FR competencies. The translational science (TS) T0 question was asked: how can FRs achieve similar MCI competencies as a FSEx through the use of MCI simulation exercises?

METHODS

T1 stage (Scoping Review): PRISMA-ScR was conducted to develop statements for the T2 stage modified Delphi (mD) study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.T2 stage (mD study): Selected experts were presented with 27 statements derived from T1 data with instruction to rank each statement on a 7-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤ 1.0.

RESULTS

After 3 mD rounds, 19 statements attained consensus and 8 did not attain consensus.

CONCLUSIONS

MCI simulation exercises can be developed to achieve similar competencies as FSEx by incorporating the 19 statements that attained consensus through the TS stages of a scoping review (T1) and mD study (T2), and continuing to T3 implementation, and then T4 evaluation stages.

Super Bowl LVI: Coordinating the Joint Information Center

OBJECTIVE

The Super Bowl is one of the biggest annual sporting events that creates unique challenges for public health preparedness. The objective of this brief is to discuss the successes and challenges of the Joint Information Center (JIC) during Super Bowl LVI.

METHODS

This study analyzed the JIC within 4 realms: pre-activation planning, public safety and alert messaging, communication, and credentialing and access.

RESULTS

Pre-activation planning was not attended by all agencies, which made it difficult for effective communication during the activation period. Innovative platforms and social media themes were successfully deployed to enhance inter-operational communications and public safety messaging. Lastly, delayed credentialing and access to the Super Bowl Stadium decreased the ability to have context to safety preparedness.

CONCLUSIONS

This study recommends that many of the JIC's successes should be translated to future mass-gathering events. Additionally, we urge that all agencies participate during pre-activation and activation periods to enhance safety operations and communications moving forward.

Public safety messaging during super bowl LVI: A pilot study and modified framework

OBJECTIVE

The Super Bowl is one of the most widely attended sporting events and requires proper communication to ensure emergency preparedness for everyone in the city. This pilot study used Super Bowl LVI as a setting to inform future research evaluating the effectiveness of the public health messaging during mass-gathering events.

METHODS

This pilot study modifies past theoretical frameworks and research tools to create a novel survey instrument focused on public safety message effectiveness. This survey was sent to all of those that opted-in to the Joint Information Center's notification platform during Super Bowl LVI.

RESULTS

The results show that message comprehension, source credibility, and perceived risk might not be associated with proactive behavior for public safety messaging. However, modality preference results showed that individuals might prefer to receive public safety and emergency alerts by text message.

CONCLUSIONS

Factors that influence proactive response towards public safety messaging might differ from emergency alerts. This pilot study has yielded results from a major mass-gathering event that can be used to understand errors that arise during public health and emergency preparedness and strengthen future disaster planning and research.

Epidemiology of rabies immune globulin use in paediatric and adult patients in the USA: a cross-sectional prevalence study

OBJECTIVES

To compare the epidemiology of paediatric and adult patients receiving rabies immune globulin (RIG).

DESIGN

Cross-sectional prevalence study.

SETTING

Eligible participants from the Symphony Integrated Dataverse presenting between 2013 and 2019.

PARTICIPANTS

All adult and paediatric patients with integrated claims and demographic data associated with RIG use from the Symphony Integrated Dataverse from 2013 to 2019.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence of diagnoses and procedures associated with paediatric and adult patient population based on frequency of International Classification of Diseases (ICD-9/ICD-10) and Current Procedural Terminology codes, respectively.

METHODS

We used mutual information to identify features that differentiate the paediatric from adult patient population. Prevalence ratios were calculated to compare adult and paediatric patients.

RESULTS

There were 79 766 adult and 20 381 paediatric patients who met the inclusion criteria. Paediatric patients had a 5.92-fold higher prevalence of 'open wounds to the head; neck; and trunk', 3.10-fold higher prevalence of 'abrasion or friction burn of face; neck; and scalp except eye; without mention of infection', 4.44-fold higher prevalence of 'open wound of scalp; without mention of complication' and 6.75-fold higher prevalence of 'laceration of skin of eyelid and periocular area | laceration of eyelid involving lacrimal passages'. Paediatric patients had a 3.83-fold higher prevalence of complex repairs compared with adult patients (n=157, 0.7% vs n=157, 0.2%, respectively).

CONCLUSIONS

Paediatric patients represent a significant proportion of the patient population receiving RIG, and are associated with higher prevalence of codes reporting repair of larger, more complex wounds in highly innervated anatomical regions. Dosing and administration of RIG must be informed by animal bite wound characteristics; clinicians should understand the differences between presentations in adults and children and treat accordingly.

Compression-Only Versus Rescue-Breathing Cardiopulmonary Resuscitation After Pediatric Out-of-Hospital Cardiac Arrest

BACKGROUND

There are conflicting data regarding the benefit of compression-only bystander cardiopulmonary resuscitation (CO-CPR) compared with CPR with rescue breathing (RB-CPR) after pediatric out-of-hospital cardiac arrest (OHCA).

OBJECTIVES

This study sought to test the hypothesis that RB-CPR is associated with improved neurologically favorable survival compared with CO-CPR following pediatric OHCA, and to characterize age-stratified outcomes with CPR type compared with no bystander CPR (NO-CPR).

METHODS

Analysis of the CARES registry (Cardiac Arrest Registry to Enhance Survival) for nontraumatic pediatric OHCAs (patients aged ≤18 years) from 2013-2019 was performed. Age groups included infants (<1 year), children (1 to 11 years), and adolescents (≥12 years). The primary outcome was neurologically favorable survival at hospital discharge.

RESULTS

Of 13,060 pediatric OHCAs, 46.5% received bystander CPR. CO-CPR was the most common bystander CPR type. In the overall cohort, neurologically favorable survival was associated with RB-CPR (adjusted OR: 2.16; 95% CI: 1.78-2.62) and CO-CPR (adjusted OR: 1.61; 95% CI: 1.34-1.94) compared with NO-CPR. RB-CPR was associated with a higher odds of neurologically favorable survival compared with CO-CPR (adjusted OR: 1.36; 95% CI: 1.10-1.68). In age-stratified analysis, RB-CPR was associated with better neurologically favorable survival versus NO-CPR in all age groups. CO-CPR was associated with better neurologically favorable survival compared with NO-CPR in children and adolescents, but not in infants.

CONCLUSIONS

CO-CPR was the most common type of bystander CPR in pediatric OHCA. RB-CPR was associated with better outcomes compared with CO-CPR. These results support present guidelines for RB-CPR as the preferred CPR modality for pediatric OHCA.

Prehospital Emergency Provider's Knowledge of and Comfort With Pediatric and Special Needs Cases: A Cross-Sectional Study in Los Angeles County

The current study assesses the relationship between continuing education (CE) with a focus on pediatrics and children with special heath care needs and how CE influences the knowledge and comfort levels of prehospital providers who treat these cases. Data are survey responses provided by paramedic and emergency medical technician (EMT) level providers (N = 575) in Los Angeles County. Regression models assessed the relationship between pediatric-focused continuing education and EMTs' knowledge of and comfort with pediatric cases, adjusting for relevant covariates. EMTs' participation in continuing education focusing on pediatrics and special health care needs was significantly associated with an increase in perceived comfort and knowledge. Among EMTs who did not receive continuing education focused on either pediatrics or special health care needs, the most frequently reported barrier to education was a perceived lack of availability. The impact of continuing education on perceived comfort and knowledge was more pronounced than the effect of prior experience, especially considering the limited prevalence of provider exposure to pediatric and childhood special health care needs cases compared to adult cases. Expanding educational opportunities is a promising approach to increasing the comfort and knowledge of EMTs who transport and care for pediatric cases.

A mixed-method analysis: Disaster preparedness of families with children with access and functional needs

INTRODUCTION

The aim of this study is to evaluate challenges to disaster preparedness of families with children with access and functional needs (CAFN). CAFN are a particularly vulnerable population, with increased risk of morbidity and mortality in the event of an emergency. Families with CAFN require specialized preparedness plans and support from multidisciplinary teams; however, previous research has shown that they are not adequately prepared.

METHODS

A mixed-methods approach was used involving twenty parents/guardians of CAFN. Questionnaires and focus groups were conducted in three school districts in a large metropolitan county. Data were analyzed using a content analysis approach.

RESULTS

Majority of CAFN had behavioral and sensory impairment. Eighty-five percent of families did not have a written communication plan, and forty percent did not have a three-day emergency kit. Sixtyfive percent did not have a copy of their child's medical emergency plan. Focus groups identified multiple barriers to preparedness, including coping with disability, poor communication, difficulty with knowledge acquisition, social-cognitive factors, and external factors.

CONCLUSION

Disaster preparedness among families with CAFN is low. The presence of chronic medical conditions, disabilities, and technology or medication dependence requires more detailed and strategic planning on the part of the parents, schools, healthcare providers, and communities.

Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children

BACKGROUND

Peripancreatic fluid collection and pseudocyst development is a common sequela following non-operative management (NOM) of pancreatic injuries in children. Our purpose was to review management strategies and assess outcomes.

METHODS

A multicenter, retrospective review was conducted of children treated with NOM following blunt pancreatic injury at 22 pediatric trauma centers between the years 2010 and 2015. Organized fluid collections were called "acute peripancreatic fluid collection" (APFC) if identified < 4 weeks and "pseudocyst" if > 4 weeks following injury. Data analysis included descriptive statistics Wilcoxon rank-sum, Kruskal-Wallis and t tests.

RESULTS

One hundred patients with blunt pancreatic injury were identified. Median age was 8.5 years (range 1-16). Forty-two percent of patients (42/100) developed organized fluid collections: APFC 64% (27/42) and pseudocysts 36% (15/42). Median time to identification was 12 days (range 7-42). Most collections (64%, 27/42) were observed and 36% (15/42) underwent drainage: 67% (10/15) percutaneous drain, 7% (1/15) needle aspiration, and 27% (4/15) endoscopic transpapillary stent. A definitive procedure (cystogastrostomy/pancreatectomy) was required in 26% (11/42). Patients with larger collections (≥ 7.1 cm) had longer time to resolution. Comparison of outcomes in patients with observation vs drainage revealed no significant differences in TPN use (79% vs 75%, p = 1.00), hospital length of stay (15 vs 25 median days, p = 0.11), time to tolerate regular diet (12 vs 11 median days, p = 0.47), or need for definitive procedure (failure rate 30% vs 20%, p = 0.75).

CONCLUSIONS

Following NOM of blunt pancreatic injuries in children, organized fluid collections commonly develop. If discovered early, most can be observed successfully, and drainage does not appear to improve clinical outcomes. Larger size predicts prolonged recovery.

LEVEL OF EVIDENCE

III STUDY TYPE: Case series.

Race/Ethnicity and Neighborhood Characteristics Are Associated With Bystander Cardiopulmonary Resuscitation in Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Study From CARES

Background

Whether racial and neighborhood characteristics are associated with bystander cardiopulmonary resuscitation (BCPR) in pediatric out‐of‐hospital cardiac arrest (OHCA) is unknown.

Methods and Results

An analysis was conducted of CARES (Cardiac Arrest Registry to Enhance Survival) for pediatric nontraumatic OHCAs from 2013 to 2017. An index (range, 0–4) was created for each arrest based on neighborhood characteristics associated with low BCPR (>80% black; >10% unemployment; <80% high school; median income, <$50 000). The primary outcome was BCPR. BCPR occurred in 3399 of 7086 OHCAs (48%). Compared with white children, BCPR was less likely in other races/ethnicities (black: adjusted odds ratio [aOR], 0.59; 95% CI, 0.52–0.68; Hispanic: aOR, 0.78; 95% CI, 0.66–0.94; and other: aOR, 0.54; 95% CI, 0.40–0.72). Compared with arrests in neighborhoods with an index score of 0, BCPR occurred less commonly for arrests with an index score of 1 (aOR, 0.80; 95% CI, 0.70–0.91), 2 (aOR, 0.75; 95% CI, 0.65–0.86), 3 (aOR, 0.52; 95% CI, 0.45–0.61), and 4 (aOR, 0.46; 95% CI, 0.36–0.59). Black children had an incrementally lower likelihood of BCPR with increasing index score while white children had an overall similar likelihood at most scores. Black children with an index of 4 were approximately half as likely to receive BCPR compared with white children with a score of 0.

Conclusions

Racial and neighborhood characteristics are associated with BCPR in pediatric OHCA. Targeted CPR training for nonwhite, low‐education, and low‐income neighborhoods may increase BCPR and improve pediatric OHCA outcomes.

Pediatric trauma-associated acute respiratory distress syndrome: Incidence, risk factors, and outcomes

BACKGROUND/PURPOSE

Acute Respiratory Distress Syndrome (ARDS) results in significant morbidity and mortality in pediatric trauma victims. The objective of this study was to determine risk factors and outcomes specifically related to pediatric trauma-associated ARDS (PT-ARDS).

METHODS

A retrospective cohort (2007-2014) of children ≤18 years old from the American College of Surgeons National Trauma Data Bank (NTDB) was used to analyze incidence, risk factors, and outcomes related to PT-ARDS.

RESULTS

PT-ARDS was identified in 0.5% (2660/488,381) of the analysis cohort, with an associated mortality of 18.6% (494/2660). Mortality in patients with PT-ARDS most commonly occurred in the first week after injury. Risk factors associated with the development of PTARDS included nonaccidental trauma, near drowning, severe injury (AIS ≥ 3) to the head or chest, pneumonia, sepsis, thoracotomy, laparotomy, transfusion, and total parenteral nutrition use. After adjustment for age, injury complexity, injury mechanism, and physiologic variables, PT-ARDS was found to be independently associated with higher mortality (adjusted OR 1.33, 95% CI 1.18-1.51, p < 0.001).

CONCLUSIONS

PT-ARDS is a rare complication in pediatric trauma patients, but is associated with substantial mortality within 7 days of injury. Recognition and initiation of lung-protective measures early in the postinjury course may represent the best opportunity to change outcomes.

LEVEL OF EVIDENCE

Level 3 - Epidemiologic.

Two-thumb-encircling advantageous for lay responder infant CPR: a randomised manikin study

OBJECTIVE

Paediatric health providers and educators influence infant mortality through advocacy and training within families and communities. This research sought to establish the efficacy and training of two-finger versus two-thumb-encircling techniques for lone responder infant chest compressions with ventilations in initially trained infant caregivers.

DESIGN

This is a randomised, cross-over educational intervention assessed on instrumented manikins using the 2015 guideline measures of quality infant cardiopulmonary resuscitation (CPR). Additional subjective data on the experience were collected through self-reporting.

SETTING

Non-healthcare community organisations and secondary school classrooms.

PARTICIPANTS

Fourteen years or older, fluent in English and had not taken infant CPR in the last 5 years.

INTERVENTIONS

Groups of eight participants were randomised to learn one technique, practised and then tested for 8 min. After a 30 min rest, the group repeated the process using the other technique.

MAIN OUTCOME MEASURES

Mean chest compression depth and rate, compression fraction, and correct hand position; tiredness and pain as reported by the caregiver.

RESULTS

The two-thumb-encircling technique achieved a deeper mean compression depth over the 8 min period (2.0 mm, p<0.01), closer to the minimum recommendation of 40 mm; the two-finger technique achieved higher percentages of compression fraction and complete recoil. Caregivers preferred the two-thumb technique (64%), and of these 70% had long fingernails.

CONCLUSIONS

The two-thumb-encircling technique improved compression depth, over an 8 min scenario, and was preferred by caregivers. This adds to the existing literature on the advantages of two-thumb-encircling as a technique for lone and team infant CPR, which counters current guidelines.

Formative research experiences in pediatric surgeons: a mixed methods study of Pediatric Trauma Society members

PURPOSE

A career in pediatric surgery has historically required extensive research experience, but the optimal research training is not well defined. The purpose of this study was to explore the formative research experiences among pediatric surgeons.

METHODS

A 1-h focus group was held with 14 pediatric surgeons at the 2017 Pediatric Trauma Society annual meeting. A 17-item survey was also administered. Questions were intended to elicit discussion of prior research experiences. A qualitative analysis of the dialogue was performed.

RESULTS

Seventy-seven percent of respondents completed a research fellowship. Most (77%) currently conduct clinical research. Participants most frequently desired additional training in study design (50%), NIH funding (43%), and grant preparation (43%). Seven themes were identified from the focus group: (1) Early research exposure is rudimentary; (2) Resume-building was a motivation; (3) Mentorship is important; (4) Institutional resources are vital; (5) Independent learning is necessary; (6) Protected time is limited; and (7) Basic science research is not always practical.

CONCLUSIONS

Many pediatric surgeons feel that their research training can be improved upon. Formal mentorship, dedicated research time, and institutional resources were perceived to be important factors. Education in research study design, grant writing, and NIH funding may be beneficial.

LEVEL OF EVIDENCE

V, expert opinion.

Impact of Simulation-Based Training on Perceived Provider Confidence in Acute Multidisciplinary Pediatric Trauma Resuscitation

PURPOSE

Simulation-based training has the potential to improve team-based care. We hypothesized that implementation of an in situ multidisciplinary simulation-based training program would improve provider confidence in team-based management of severely injured pediatric trauma patients.

METHODS

An in situ multidisciplinary pediatric trauma simulation-based training program with structured debriefing was implemented at a free-standing children's hospital. Trauma providers were anonymously surveyed 1 month before (pre-), 1 month after (post-), and 2 years after implementation.

RESULTS

Survey response rate was 49% (n = 93/190) pre-simulation, 22% (n = 42/190) post-simulation, and 79% (n = 150/190) at 2-year follow-up. These providers reported more anxiety (p = 0.01) and less confidence (p = 0.02) 1-month post-simulation. At 2-year follow-up, trained providers reported less anxiety (p = 0.02) and greater confidence (p = 0.01), compared to untrained providers.

CONCLUSIONS

Implementation of an in situ multidisciplinary pediatric trauma simulation-based training program may initially lead to increased anxiety, but long-term exposure may lead to greater confidence.

LEVEL OF EVIDENCE

II, Prospective cohort.

Pediatric dog bites: a population-based profile

BACKGROUND

Previous studies have identified risk factors for dog bites in children, but use data from individual trauma centers, with limited generalizability. This study identifies a population risk profile for pediatric dog bites using the National Trauma Data Bank. We hypothesized that the population at risk was younger boys, that such bites occur at home, are moderately severe, and are on the face or neck.

METHODS

For this retrospective cross-sectional study, a sample of 7912 children 17 years old and younger with International Classification of Diseases (ICD)-9 event code E906.0, for dog bites, were identified. Datasets from 2007 to 2014 were used. Data included patient's gender, age, ICD-9 primary and location E-codes, AIS body region and AIS severity.

RESULTS

Most children were 6-12 years old and female, but a similar number fell into the narrower range of 0-2 years old. Injuries in the younger group frequently occurred at home, on the face and head, and with minor severity. Age of the child predicts the location of incident (P<0.001), the severity of injury (P<0.001) and the body region of the injury (P<0.001). Body region of the injury predicted its severity (P<0.001).

DISCUSSION

Younger children are more likely to receive dog bites, and bites incurred are likely of greater severity. Children this young cannot yet be taught how to properly interact with a dog.

CONCLUSIONS

Dog bites are a significant source of morbidity for children. Based on the population risk factors profile generated, this study recommends targeting live dog education towards the parents of young children.

Utilization patterns of extracorporeal membrane oxygenation in neonates in the United States 1997-2012

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) remains one of the most intensive therapies for newborns in the United States. However, there is limited information on resource utilization for neonates receiving ECMO.

METHODS

We conducted a retrospective data analysis of the Kids' Inpatient Database from 1997 to 2012. Bivariate and multivariate analysis was completed to identify predictors of LOS, hospital costs and mortality. Cardiac and non-cardiac diagnoses of neonates receiving ECMO were also included in the bivariate and multivariable analysis.

RESULTS

Of the 5151 ECMO cases, survival to discharge was 62%. 22% had a principal cardiac diagnosis. After adjusting for covariates, increased mortality was associated with treatment in the midwest compared to the northeast region (aOR=2.0, p<0.01) and decreased among neonates with a non-cardiac diagnosis (aOR=0.4, p<0.01). Living in midwest was associated with longer LOS by 13days and increased hospital costs by 63,000 dollars (p<0.01). When stratified by non-cardiac diagnoses, infants with a diagnosis of congenital diaphragmatic hernia was associated with increased mortality (2.3, p<0.01) and longer LOS (25, p<0.01) and increased costs (11,100, p<0.01).

CONCLUSION

Neonates who received ECMO in certain regions of the United States were associated with poorer survival outcomes as well as increased LOS and hospital costs.

TYPE OF STUDY

Retrospective study.

LEVEL OF EVIDENCE

Level III.

Hospital admission unnecessary for successful uncomplicated radiographic reduction of pediatric intussusception

PURPOSE

After radiologic reduction, patients with ileocolic intussusception are often admitted. We hypothesize that discharge of stable patients after 4 h of emergency department (ED) observation does not result in an increase of adverse outcomes.

METHODS

We retrospectively reviewed pediatric patients with ileocolic intussusception between 2011 and 2016, managed with either 24-h inpatient or 4-h ED observation. Outcomes included length of stay, adverse outcomes, and total hospital charges.

RESULTS

Fifty-one patients were managed with ED observation and 79 with inpatient observation. Recurrence rates, time to recurrence, and adverse outcomes were similar in both protocols. Total recurrence rates for ED observation was 15% versus 14% for inpatient observation. ED observation reduced time in the hospital by 26.8 h (4.9 versus 31.7 h).

CONCLUSION

Discharging patients following uncomplicated hydrostatic reduction of ileocolic intussusception after a 4-h observation period does not result in an increase in adverse outcomes.

Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry

IMPORTANCE

There are few data on the prevalence or outcome of bystander cardiopulmonary resuscitation (BCPR) in children 18 years and younger.

OBJECTIVE

To characterize BCPR in pediatric out-of-hospital cardiac arrests (OHCAs).

DESIGN, SETTING, AND PARTICIPANTS

This analysis of the Cardiac Arrest Registry to Enhance Survival database investigated nontraumatic OHCAs in children 18 years and younger from January 2013 through December 2015.

EXPOSURES

Bystander CPR, which included conventional CPR and compression-only CPR.

MAIN OUTCOMES AND MEASURES

Overall survival and neurologically favorable survival, defined as a Cerebral Performance Category score of 1 or 2, at the time of hospital discharge.

RESULTS

Of the 3900 children younger than 18 years with OHCA, 2317 (59.4%) were infants, 2346 (60.2%) were female, and 3595 (92.2%) had nonshockable rhythms. Bystander CPR was performed on 1814 children (46.5%) and was more common for white children (687 of 1221 [56.3%]) compared with African American children (447 of 1134 [39.4%]) and Hispanic children (197 of 455 [43.3%]) (P < .001). Overall survival and neurologically favorable survival were 11.3% (440 of 3900) and 9.1% (354 of 3900), respectively. On multivariable analysis, BCPR was independently associated with improved overall survival (adjusted proportion, 13.2%; 95% CI, 11.81-14.58; adjusted odds ratio, 1.57; 95% CI, 1.25-1.96) and neurologically favorable survival (adjusted proportion, 10.3%; 95% CI, 9.10-11.54; adjusted odds ratio, 1.50; 95% CI, 1.21-1.98) compared with no BCPR (overall survival: adjusted proportion, 9.5%; 95% CI, 8.28-10.69; neurologically favorable survival: adjusted proportion, 7.59%; 95% CI, 6.50-8.68). For those with data on type of BCPR, 697 of 1411 (49.4%) received conventional CPR and 714 of 1411 (50.6%) received compression-only CPR. On multivariable analysis, only conventional CPR (adjusted proportion, 12.89%; 95% CI, 10.69-15.09; adjusted odds ratio, 2.06; 95% CI, 1.51-2.79) was associated with improved neurologically favorable survival compared with no BCPR (adjusted proportion, 9.59%; 95% CI, 6.45-8.61). There was a significant interaction of BCPR with age. Among infants, conventional BCPR was associated with improved overall survival and neurologically favorable survival while compression-only CPR had similar outcomes to no BCPR.

CONCLUSIONS AND RELEVANCE

Bystander CPR is associated with improved outcomes in pediatric OHCAs. Improving the provision of BCPR in minority communities and increasing the use of conventional BCPR may improve outcomes for children with OHCA.

The Role of Adult Perceptions and Supervision Behavior in Preventing Child Injury

Supervision is an important factor in reducing injury risk. There are multiple factors that can affect the appropriate level of supervision including risk perception, anticipation of injury, and distracted behaviors. This study examined the perceived risks of child injury among parents and child caregivers and their supervision behavior among adults in an urban playground. Participant data from 25 individuals were collected through observations and anonymous self-reported surveys. More than half of the participants indicated practice of appropriate supervisory behavior, including attentiveness to their child's behavior and proximity to their child during play. Caregivers were more likely to report more careful levels of supervision. One-fourth of participants reported a change in the supervisory behavior during periods of distraction, specifically with phone use. Of the variables tested, there was a significant association between the variable 'talking to other adults' during supervision and 'prior injury' (P value = 0.04, 95% CI 0.03-0.91). Parents were more likely to report that they would leave their child unattended if they believed that the playground was a safe environment for play. There was a difference between self-reported behaviors and actual observed behavior, which is likely due to varying perspectives regarding child safety and injury prevention. In regards to injury risk, findings highlight the important role of appropriate supervisory behaviors and risk perceptions in preventing child injuries.

Factors associated with preparedness of the US healthcare system to respond to a pediatric surge during an infectious disease pandemic: Is our nation prepared?

OBJECTIVE

Recent incidents have demonstrated that the US health system is unprepared for infectious pandemics resulting in a pediatric surge. Development of efficient plans and a structured and coordinated regional response to pediatric pandemic surge remains an opportunity. To address this gap, we conducted a literature review to assess current efforts, propose a response plan structure, and recommend policy actions.

DESIGN

A literature review, utilizing MEDLINE and PubMed, through March 2017 identified articles regarding infectious disease pandemics affecting the US pediatric population. After review of current literature, a proposed response plan structure for a pediatric pandemic surge was designed.

RESULTS

Inclusion and exclusion criteria reduced an initial screening of 1,787 articles to 162 articles. Articles ranged in their discussion of pediatric pandemic surge. Review of the articles led to the proposal of organizing the results according to 4 S's; (1) Structure, (2) Staff, (3) Stuff (Resources), and (4) Space.

CONCLUSION

The review has supported the concern that the US health system is unprepared for a pediatric surge induced by infectious disease pandemics. Common themes suggest that response plans should reflect the 4Ss and national guidelines must be translated into regional response systems that account for local nuances.

Checklist use in evaluating pediatric disaster training

OBJECTIVE

Disaster preparedness training has a small but growing part in medical education. Various strategies have been used to simulate disaster scenarios to safely provide such training. However, a modality to compare their effectiveness is lacking. The authors propose the use of checklists, which have been a standard in aviation safety for decades.

DESIGN

Residents at four different academic pediatric residency programs volunteered to participate in tabletop simulation of a timed, pediatric disaster scenario. Resident teams were required to properly triage and manage simulated patients. Care intervention requests corresponding to each of the patients were recorded on a premade checklist.

RESULTS

Thirty-six teams provided a total of 1,476 possible care intervention requests for three pediatric patients: one with crush injury, one with increased intracranial pressure, and a nonverbal child. Some interventions were more likely to be omitted than others, and some teams performed extra interventions. Twenty-five entries from the checklist intervention responses were missing, affecting three of the teams. On average, teams requested 65 percent, were prompted to request 11 percent, and missed 22 percent of all checklist interventions with only 2 percent of all items not being recorded. Chi-square tests were performed for each patient scenario using R software. Categories compared included total counts of "requested," "prompted," and "missed" responses. Chi-square values were all statistically significant (p value < 0.05).

CONCLUSIONS

In the checklist use during a tabletop disaster simulation, the authors have demonstrated that the checklist allows trainees to receive near immediate feedback. This training exercise provided them an opportunity to explore their own preparedness for a disaster scenario in a low-stress environment and allows for evaluation of such preparedness in a safe environment.

Observed child restraint misuse in a large, urban community: Results from three years of inspection events

PROBLEM

Child restraints (CRs) are vital for optimizing child passenger safety and reducing the risk of pediatric injury and fatality in motor vehicle crashes. However, most CRs are installed improperly.

METHODS

This present study was an assessment of observed instances of CR misuse. Participants were recruited through advertisements for CR inspection events in Los Angeles County, California. Child Passenger Safety Technicians collected information about each child passenger, vehicle, and aspects of CR selection and installation.

RESULTS

Of 693 CRs installed upon arrival, only 3.8% were used with no instances of misuse. The most common misuses were inappropriate use of the top tether and failure to secure the seatbelt in locked mode.

CONCLUSIONS

The majority of observed CRs were installed with instances of misuse. CRs in newer vehicles were less likely to be installed in front of airbags and more likely to have the seatbelt routed inappropriately compared to those in older vehicles. Older children were more likely to be prematurely restrained in the front vehicle seat.

PRACTICAL APPLICATIONS

The majority of CRs are installed improperly. We identified specific instances of CR misuse that are common in a large, urban community and present recommendations to improve child passenger safety practices and education.

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 family's 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.

Assessing medical care availability for student athletes of a large urban high school district

BACKGROUND

The need for medical care for student athletes is mounting, as participation in high school athletics is continuing to rise. This study assessed medical care available to high school student athletes in a large, urban school district in California that has not been studied since 2002. By surveying athletic directors and coaches, we expected to find inadequate availability of medical care in the studied district and predicted that care would be more widely available for student athletes at larger high schools.

METHODS

We developed and validated a questionnaire assessing practice and game coverage, emergency preparedness, treatment, and injury prevention measures. The survey was administered to athletic directors and coaches at a school district athletic directors' meeting.

RESULTS

Forty-three (57%) of 75 distributed surveys were completed. We found that 70% of schools did not staff a healthcare provider for practices, 28% did not staff home games, and 30% did not staff away games, for any sports. We found no significant differences between school sizes with respect to physician referrals after a student was injured, provision of health education, or implementation of emergency action plans.

CONCLUSIONS

Although these data do not support our hypothesis of larger schools providing better medical care, it suggests that there are multiple areas of inadequate healthcare regardless of school size. We identified numerous gaps; thus, future work will examine the impact of these gaps.

Assessment of parental knowledge and attitudes toward pediatric sports-related concussions

Background:

Parents of young athletes play a major role in the identification and management of sports-related concussions. However, they are often unaware of the consequences of concussions and recommended management techniques.

Hypothesis:

This study quantitatively assessed parental understanding of concussions to identify specific populations in need of additional education. We predicted that parents with increased education and prior sports- and concussion-related experience would have more knowledge and safer attitudes toward concussions.

Study Design:

Cross-sectional survey.

Level of Evidence:

Level 5.

Methods:

Participants were parents of children brought to a pediatric hospital and 4 satellite clinics for evaluation of orthopaedic injuries. Participants completed a validated questionnaire that assessed knowledge of concussion symptoms, attitudes regarding diagnosis and return-to-play guidelines, and previous sports- and concussion-related experience.

Results:

Over 8 months, 214 parents completed surveys. Participants scored an average of 18.4 (possible, 0-25) on the Concussion Knowledge Index and 63.1 (possible, 15-75) on the Concussion Attitude Index. Attitudes were safest among white women, and knowledge increased with income and education levels. Previous sports experience did not affect knowledge or attitudes, but parents who reported experiencing an undiagnosed concussion had significantly better concussion knowledge than those who did not.

Conclusion:

Parents with low income and education levels may benefit from additional concussion-related education.

Clinical Relevance:

There exist many opportunities for improvement in parental knowledge and attitudes about pediatric sports-related concussions. Ongoing efforts to understand parental knowledge of concussions will inform the development of a strategic and tailored approach to the prevention and management of pediatric concussions.

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.

Assessing American Red Cross First Aid mobile app user trends: Implications for resilience

OBJECTIVE

Disasters have devastated communities, impacted the economy, and resulted in a significant increase in injuries. As the use of mobile technology increasingly becomes a common aspect of everyday life, it is important to understand how it can be used as a resource. The authors examined the use of American Red Cross mobile apps and aimed to characterize user trends to better understand how mobile apps can help bolster individual and community preparedness, resilience, and response efforts.

DESIGN/MAIN OUTCOME MEASURES

Tornado data were obtained from the National Oceanic and Atmospheric Administration and the National Weather Service. Data for the mobile apps were provided by the American Red Cross. All data were reviewed for 2013, 2014, and three specific tornado events. Data were organized in Microsoft Excel spreadsheets and then graphed or mapped using ArcMap 10.2(™).

RESULTS

Between 2013 and 2014, 1,068 tornado watches and 3,682 tornado warnings were issued. Additionally, 37,957,560 Tornado app users and 1,289,676 First Aid app users were active from 2013 to 2014. Overall, there was an increase in the use of American Red Cross mobile apps during tornado occurrences. Yet the increase does not show a consistent correlation with the number of watches and warnings issued.

CONCLUSIONS

Mobile apps can be a resourceful tool. This study shows that mobile app use increases during a disaster. The findings indicate that there is potential to use mobile apps for building resilience as the apps provide information to support individuals and communities in helping before, during, and after disasters.

Meeting children's needs: a mixed-methods approach to a regionalized pediatric surge plan-the Los Angeles County experience

INTRODUCTION

Children are one of the most vulnerable populations during mass casualty incidents because of their unique physiological, developmental, and psychological attributes. The objective of this project was to enhance Los Angeles County's (LAC) pediatric surge capabilities. The purpose of this study was threefold: (1) determine gaps in pediatric surge capacity and capabilities; (2) double pediatric inpatient capacity; and (3) document a plan to address gaps and meet pediatric inpatient surge. We hypothesized that LAC would be able to meet the identified pediatric surge target by leveraging resources of hospitals within the region. Deliverables included a pediatric surge plan for LAC, pediatric surge training resources, and pediatric supplies for hospitals participating in LAC's Hospital Preparedness Program (HPP).

METHODS

After Institutional Review Board approval, the authors used a mixed-methods approach to explore gaps in hospital capacity and capabilities in a large urban county. Hospitals were surveyed via Qualtrics® on 38 questions regarding capacity, staffing, availability of pediatric supplies, and existing pediatric surge plans. Publicly available inpatient bed data were collected from the Office of Statewide Health Planning and Development for the year ending June 2010 and supplemented by hospital survey responses. Population data was used from US Census 2010. This combined dataset was analyzed for capacity, pediatric designations, and capabilities. To supplement this data, three focus groups were conducted between April 2011 and May 2012. Focus group topics included: supplies and training needed for pediatric surge, surge targets, and plan development and functionality.

RESULTS

Hospitals varied in pediatric capacity and capability. Forty-six percent of facilities provide inpatient pediatric services. Forty-one hospitals are designated as an Emergency Department Approved for Pediatrics. Identified gaps included: limited pediatric bed capacity, geographic variability, limited pediatric intensive care unit capacity, limited pediatric specialty physician resources, varying availability of pediatric trained staff, less availability of pediatric critical care supplies, and limited ability to accept and receive children. Focus group stakeholders requested advance and just-in-time training and reference guides to supplement the plan.

CONCLUSION

LAC was able to create a pediatric surge plan that doubles pediatric acute and pediatric intensive care bed capacity by using participating HPP hospitals. A tiered system was created based on capacity and capability with varying surge targets and guidance on types of patients that could be cared for at each tier. This plan will assist the LAC Emergency Medical Services Agency distribute pediatric patients during a surge event that disproportionately impacts children.

Survival of pediatric blunt trauma patients presenting with no signs of life in the field

BACKGROUND

Prehospital traumatic cardiopulmonary arrest is associated with dismal prognosis, and patients rarely survive to hospital discharge. Recently established guidelines do not apply to the pediatric population because of paucity of data. The study objective was to determine the survival of pediatric patients presenting in the field with no signs of life after blunt trauma.

METHODS

We conducted a retrospective analysis of the National Trauma Data Bank research data set (2002-2010). All patients 18 years and younger with blunt traumatic injuries were identified (DRG International Classification of Diseases-9th Rev. codes 800-869). No signs of life (SOL) was defined on physical examination findings and included the following: pulse, 0; respiratory rate, 0; systolic blood pressure, 0; and no evidence of neurologic activity. These same criteria were reassessed on arrival at the emergency department (ED). Furthermore, we examined patients presenting to the ED who underwent resuscitative thoracotomy (Current Procedural Terminology code 34.02). Our primary outcome was survival to discharge from the hospital.

RESULTS

There were a total of 3,115,597 pediatric patients who were found in the field after experiencing blunt trauma. Of those, 7,766 (0.25%) had no SOL. Seventy percent of the patients with no SOL in the field were male. Survival to hospital discharge of all patients presenting with no SOL was 4.4% (n = 340). Twenty-five percent of the patients in the field with no SOL were successfully resuscitated in the field and regained SOL by the time they arrived to the ED (n = 1,913). Of those patients who regained SOL, 13.8% (n = 265) survived to hospital discharge. For patients in the field with no SOL, survival to discharge was significantly higher in patients who did not receive a resuscitative thoracotomy than in those who did.

CONCLUSION

Survival of pediatric blunt trauma patients in the field without SOL is dismal. Resuscitative thoracotomy poses a heightened risk of blood-borne pathogen exposure to involved health care workers and is associated with a significantly lower survival rate.

LEVEL OF EVIDENCE

Prognostic study, level III; therapeutic study, level IV.

Polymorphisms of peroxisome proliferator-activated receptors and survival of lung cancer and upper aero-digestive tract cancers

BACKGROUND

Peroxisome proliferator-activated receptors (PPARs) are transcriptional factors involved in several biological processes such as inflammation, cancer growth, progression and apoptosis that are important in lung and upper aero-digestive tract (UADT) cancer outcomes. Nonetheless, there are no published studies of the relationship between PPARs gene polymorphisms and survival of patients with lung cancer or UADT cancers.

METHODS

1212 cancer patients (611 lung, 303 oral, 100 pharyngeal, 90 laryngeal, and 108 esophageal) were followed for a median duration of 11 years. We genotyped three potentially functional single nucleotide polymorphisms (SNPs) using Taqman - rs3734254 of the gene PPARD and rs10865710 and rs1801282 of the gene PPARG - and investigated their associations with lung and UADT cancer survival using Cox regression. A semi-Bayesian shrinkage approach was used to reduce the potential for false positive findings when examining multiple associations.

RESULTS

The variant homozygote CC (vs. TT) of PPARD rs3734254 was inversely associated with mortality of both lung cancer (adjusted hazard ratio [aHR]=0.63, 95% confidence interval [CI]=0.42, 0.96) and UADT cancers (aHR=0.51, 95% CI=0.27, 0.99). Use of the semi-Bayesian shrinkage approach yielded a posterior aHR for lung cancer of 0.66 (95% posterior limits=0.44, 0.98) and a posterior aHR for UADT cancers of 0.58 (95% posterior limits=0.33, 1.03).

CONCLUSION

Our findings suggest that lung-cancer patients with the CC variant of PPARD rs3734254 may have a survival advantage over lung-cancer patients with other gene variants.

Evaluation of a child passenger safety class in increasing parental knowledge

BACKGROUND

Child passenger restraint systems have been found to greatly reduce the risk of injury and death among child passengers. However, nearly half of the children who died in 2009 as a result of motor vehicle crashes were completely unrestrained. Our global hypothesis is that parents and other caregivers failed to restrain children due to a lack of child passenger seat education and practice. In this report, we postulate that a car seat class will improve the basic understanding of child passenger safety. The objective of the study was to evaluate the effectiveness of a car seat class in increasing parental knowledge about child passenger safety.

METHODS

Car seat classes were held at a Level 1 pediatric trauma center every other Tuesday for ten months. The curriculum consisted of: child passenger safety laws discussion, a 21-min video on the use of child safety seats followed by a 15-min discussion about the video, 15min of discussing the different types of car seats, and hands-on training on how to properly install and use child restraints. Free car seats were provided to eligible parents. The pre-test was administered at the beginning of class and the post-test at the end of the class. McNemar's test and a paired t-test were used to compare pre- and post-test scores. Test scores were also stratified by language spoken.

RESULTS

Forty-four classes were held and a total of 491 parents/caregivers attended the classes. An increase in knowledge was found for all survey questions. Mean knowledge score for the post-test was 3.10 points higher compared to the mean knowledge score from the pre-test. Mean difference in knowledge scores for English-speaking participants were higher than Spanish-speaking participants.

CONCLUSION

Lack of knowledge and low risk perception have frequently been cited as barriers for the use of child passenger restraints. Our intervention attempted to eliminate these barriers. We found that this intervention was effective at increasing parental knowledge about child passenger safety. The results of this study may be used to design and implement future interventions in multicultural settings.

Disaster preparedness education in South Los Angeles faith-based organizations: a pilot study in promoting personal and community preparedness and resiliency

INTRODUCTION

Faith-based organizations (FBOs) often provide crucial services to their communities during and after disasters, but they largely operate outside of the formal structures that manage disaster preparedness and response. Their status within communities and ability to reach broad populations make them potentially powerful groups to lead and promote health and safety initiatives. Thus, there is opportunity to reduce health and knowledge disparities and increase disaster resiliency by providing disaster preparedness education through FBOs.

PROBLEM

This pilot study aims to assess and enhance the current level of disaster knowledge and preparedness of congregation members from six FBOs in the Los Angeles County South Service Planning Area (SPA 6) to promote their community's disaster resiliency.

METHODS

A structured basic disaster education curriculum was implemented at six FBOs, and participants completed a questionnaire, pre-test and post-test, and satisfaction survey. Frequency distributions of survey questions and mean differences of pre- and post-test scores were obtained.

RESULTS

Results of the questionnaire indicated that more than half of the participants had previous experience with disaster preparedness and had taken some steps toward stockpiling supplies but showed gaps in making concrete evacuation plans and meeting places. The mean disaster knowledge test score increased from 5.15 for the pre-test to 8.04 for the post-test (p < 0.0001). The participants reported high satisfaction with the seminar.

CONCLUSIONS

This pilot study demonstrated that there is interest, as well as need, within the faith-based community to increase personal and community disaster preparedness. The implementation of a structured disaster education seminar for congregation members showed significant immediate improvement in disaster knowledge of the participants.

Cell phones and young drivers: a systematic review regarding the association between psychological factors and prevention

OBJECTIVE

Cell phone use among young drivers has become increasingly common in recent years. Young people are the most likely to accept the use of new technology and least likely to understand the risks associated with cell phone use while driving (CPWD; defined here as talking on the phone only) and texting while driving (TextWD). Due to inexperience, young drivers are the most at risk when using cell phones while driving and therefore should be the target of the majority of prevention strategies. The intent of this review is to determine factors that influence young drivers to engage in CPWD and TextWD and suggest a basis for prevention campaigns and strategies that can effectively prevent current and future generations from using cell phones while driving.

METHODS

We conducted a search for original articles in PubMed, the Cochrane Library, and Web of Science. All abstracts were reviewed and for those that met the inclusion criteria, full articles were obtained and assessed.

RESULTS

Four hundred and twelve articles were identified in the search and, of those, 37 full-text articles were obtained. A total of 29 articles about the frequency of CPWD and the psychological effects influencing young driver's tendency to engage in CPWD were included. There was a high frequency of both CPWD and TextWD despite a high perceived risk of both behaviors. This discrepancy was explained by a high perceived controllability, the effect of social norms, call importance, and lack of effective law enforcement. The intervention strategies reviewed were also found to be ineffective over the long term.

CONCLUSIONS

The systematic review reveals that young drivers are an at-risk group for distracted driving. We propose preventative strategies based on identifying factors that influence drivers to engage in CPWD and TextWD as well as by reviewing strategies found in the reviewed articles. Further research is necessary to determine the effectiveness of these proposed strategies.

Pediatric Surge Pocket Guide: review of an easily accessible tool for managing an influx of pediatric patients

As seen in recent disasters, large-scale crisis events have the potential to cause significant pediatric death and injury. During such disaster situations, both distance and decreased mobility will likely limit access to pediatric hospitals. Thus, all hospitals, regardless if they regularly treat children or not, should anticipate an influx of pediatric patients in the event of a disaster. The Pediatric Surge Pocket Guide was developed for and distributed at a Pediatric Medical Surge Workshop held by the Los Angeles County Department of Public Health in June 2009. Designed both as a supplement to the workshop training and as an effective stand-alone resource, the Guide provides comprehensive pediatric-specific recommendations for hospitals experiencing a surge in pediatric capacity. Because of its unique pocket-size format, the Guide has the potential to be a readily accessible tool with application to a wide range of disaster or nondisaster situations, for use in hospital or nonhospital settings, and by pediatric specialists, nonspecialists, and nonclinicians alike.

Emergency management of pancreatic injury in a 5-year-old

Pediatric pancreatic injuries are less common than many other intra-abdominal organ traumatic injuries; failure to identify pancreatic injury during the emergency phase will result in delayed diagnosis, delayed treatment, and potentially poor health outcomes. Injured children may present to nontrauma center/nonpediatric hospitals or urgent care settings where practitioners may not be experienced in diagnosing and treating pediatric pancreatic injuries. This case study explores the medical course of a child with persistent abdominal pain after a fall from a horse. He was evaluated in a nonpediatric trauma center and was discharged home, continued with symptoms, presented to a different community emergency department, and then transferred to the emergency department at a Level 1 pediatric trauma center. Educating health care providers about pediatric pancreatic injuries in emergency or urgent care settings will help improve quality of care for injured children who are not initially evaluated in a pediatric specific hospital or trauma center.

Community engagement and pediatric disaster readiness in a large urban disaster resource hospital network: the case of "The Great California ShakeOut"

We examined the response of 11 Los Angeles County (LAC) hospitals designated as Disaster Resource Centers (DRCs) to a statewide, earthquake preparedness drill, LAC's most comprehensive earthquake disaster drill to date. Semistructured interviews were conducted with the coordinators of 11 of the 14 LAC DRCs within 3 weeks of the drill. Interviews were transcribed and thematic analysis was supported by analytical software (Atlas.ti). Except for one pediatric specialty DRC, most DRCs did little to fully test their institutions' capacity to manage pediatric patients. Few DRCs included children as mock victims. Little or no attention was focused on pediatric triage and other pediatric clinical, psychosocial, and resource issues. Respondents maintained that community readiness is hampered by compartmentalizing the preparedness planning, training, and drilling. Without a mandate to coordinate with other agencies, few DRCs reported coordination with other community entities. Those that did were in smaller submunicipalities within LAC. Community coordination is critical to effective response to disasters, yet disaster preparedness planning and drills are most often uncoordinated and compartmentalized. Drills and training need to be transdisciplinary and coordinated with other community entities likely to play a role in pediatric disaster management.

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 respondent's 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.

Using robotic telecommunications to triage pediatric disaster victims

PURPOSE

During a disaster, hospitals may be overwhelmed and have an insufficient number of pediatric specialists available to care for injured children. The aim of this study was to determine the feasibility of remotely providing pediatric expertise via a robot to treat pediatric victims.

METHODS

In 2008, Los Angeles County held 2 drills involving telemedicine. The first was the Tri-Hospital drill in which 3 Los Angeles County hospitals, one being a pediatric hospital, participated. The disaster scenario involved a Metrolink train crash, resulting in a large surge of traumatic injuries. The second drill involved multiple agencies and was called the Great California Shakeout, a simulated earthquake exercise. The telemedicine equipment installed is an InTouch Health, Inc, Santa Barbara, CA robotic telecommunications system. We used mixed-methods to evaluate the use of telemedicine during these drills.

RESULTS

Pediatric specialists successfully provided remote triage and treatment consults of victims via the robot. The robot proved to be a useful means to extend resources and provide expert consult if pediatric specialists were unable to physically be at the site.

CONCLUSION

Telemedicine can be used in the delayed treatment areas as well as for training first receivers to collaborate with specialists in remote locations to triage and treat seriously injured pediatric victims.

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.