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Children have many anatomical, physiological, immunological, developmental, and psychological considerations that can make them vulnerable to injury and response during disasters. A fundamental principle of pediatric disaster preparedness is to ensure that children's medical and psychological needs are met during and after a disaster, so we talked to a professor of public health pediatrics at the University of Southern California about the all-hazards approach to disaster preparedness, the global scope of health, and how research on disease prevention can be applied to children.

[How are children different?]

As every pediatrician knows, children should not be treated as small adults.
Children have different anatomical, physiological, immunologic, developmental, and psychological considerations that can potentially affect their vulnerability to injury and response during a disaster.
Pediatricians can and should meet the needs of children in the triage, diagnosis, and management of patients during disasters. 

1) Anatomical differences

▶Size:
-Smaller bodies hold less fluid, so bleeding that is easily handled by adults can cause hemorrhagic shock in children.

-Children have a higher frequency of multiple organ injuries due to their smaller mass.

-Children are more vulnerable to toxic substances because of their smaller body size.

▶Structure:
-Children's heads are supported by a shorter neck, which transmits greater forces to the brain, making them more vulnerable to injury.
-Children's skeletons are more flexible than adults and are more susceptible to fractures.
-Children's rib cages do not protect the upper abdominal organs as much as an adult's, which can lead to internal organ damage.

2) Physiological differences

- Because children can compensate and maintain their heart rate in the early stages of hypovolemic shock, they can be mistaken for normal and resuscitated with too little fluid. 

- Children's ability to regulate their body temperature is greatly affected by their body fat to body mass ratio as well as their thin skin, making them more susceptible to heat loss.

-Children are more likely to absorb larger amounts of substances before they are removed (filtered) from the lungs. 

3) Immunologic differences

- Children have immature immune systems, making them vulnerable to many infections.

4) Developmental differences

- They have limited language skills to communicate their wants and needs.

- They don't have the motor skills needed to escape the scene of an accident.

- Limited ability to figure out how to get out of danger or follow instructions from others.

5) Psychological differences

- The psychological impact of disasters on children is not uniform or universal, which complicates treatment.

[Types of disasters]

A disaster is an event or situation that results in injury, death, and/or destruction of property. Some disasters happen without warning, while others you have time to prepare for. There are many different types of disasters, including:

[Process of Disaster response for pediatric populations]

The United States has built a robust emergency medical assistance infrastructure to respond to disasters at the local, state, and federal levels. Despite this, certain populations, such as newborns, adolescents, and other pediatric populations, still have limited access to rapidly available assistance during disasters. Because disaster victims often include children, they have special healthcare needs. Planning before an emergency or disaster with the help of parents and pediatricians, who know the child best, can be very helpful. 

The pediatrician's intervention process during a disaster refers to four basic phases

1. Mitigation: Actions are taken to eliminate or reduce the likelihood of a disaster occurring. These include building codes, vulnerability analysis, tax incentives and disincentives, zoning and land use management, building use codes, safety regulations, interstate resource sharing, vaccinations, preventive health care, and public education. Pediatricians assist with immunizations, vaccine storage, preventive health care, health education, and more.

2. Preparedness: Pediatricians provide education on pediatric issues to disaster response teams, participate in disaster or healthcare coalitions, assist with exercises and drills, provide emergency medical services for children (EMSC), public health, and more.

3. Response Phase: This is the phase of emergency response to an actual disaster. Pediatricians can participate in disaster response in the following ways Caring for patients, directing families and colleagues to disaster assistance resources, addressing the needs of children in shelters, supporting reunions of separated families, monitoring public health messages, and participating in national or state responses.

4. Recovery: During the recovery period, pediatricians help care for victims and families, restore access to health care, and support the safety of childcare facilities and schools.

[How to Triage Pediatric Disaster Patients] (Source: Pediatric Emergency Medicine Journal)

There are several different triage methods for categorizing patients based on severity in disaster situations. For children, who are less likely to be quickly assessed in the field than adults, the Jump-START triage method is a slight variation of the adult START triage method. 

The Jump-START triage differs from the START triage in the following ways

Sort-Assess-Lifesaving intervention Treatment/Transport (SALT) can be applied to pediatrics and adults simultaneously. SALT is a way to identify patients with severe injuries from a large group of patients. Triage can be accomplished by shouting or using a loudspeaker.  

Tier 3: Patients who are ambulatory.

Tier 2: Patients with limited mobility who can wave or make intentional movements on command.

Tier 1: Patients who are immobile or have a clear medical emergency, such as uncontrolled bleeding.

[Disaster Management and Response in Pediatrics: Professor Rita Burke]

GIRE is supporting a research experience with Professor Rita Burke from the University of Southern California to delve deeper into 'Disaster Management and Response in Pediatrics'.

▶Research interests: #Health promotion #Disease prevention #Global health

▶Recommended Students: Students who want to develop a medical mindset to contribute to future society. Students who are interested in pediatric disaster preparedness and want to learn about the broader global scope of health measures.

These are the current research topics that Professor Rita has been working on.

▶Public safety messaging during super bowl LVI: A pilot study and modified framework (2023)

▶A qualitative analysis of public health officials' experience in California during COVID-19: priorities and recommendations (2023)

▶The Challenge of Mass Casualty Incident Response Simulation Exercise Design and Creation: A Modified Delphi Study (2023)

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