Pediatric disaster response in developed countries: ten guiding principles

Mass casualty incidents and large-scale disasters involving children are likely to overwhelm a regional disaster response system. Children have unique vulnerabilities that require special considerations when developing pediatric response systems. Although medical and trauma strategies exist for the evaluation and treatment of children on a daily basis, the application of these strategies under conditions of resource-constrained triage and treatment have rarely been evaluated. A recent report, however, by the Institute of Medicine did conclude that on a day-to-day basis the U.S. healthcare system does not adequately provide emergency medical services for children. The variability, scale, and uncertainty of disasters call for a set of guiding principles rather than rigid protocols when developing pediatric response plans. The authors propose the following guiding principles in addressing the well-recognized, unique vulnerabilities of children: (1) terrorism prevention and preparedness, (2) all-hazards preparedness, (3) postdisaster disease and injury prevention, (4) nutrition and hydration, (5) equipment and supplies, (6) pharmacology, (7) mental health, (8) identification and reunification of displaced children, (9) day care and school, and (10) perinatology. It is hoped that the 10 guiding principles discussed in this article will serve as a basic framework for developing pediatric response plans and teams in developed countries.