Developing consensus on appropriate standards of disaster care for children.

Area of Science:

• Disaster Medicine
• Healthcare Management
• Public Health Preparedness

Background:

• Lack of professional consensus and evidence for essential hospital disaster interventions.
• Need for a systematic method to identify critical interventions during mass casualty events.
• Importance of quantitatively balancing patient needs with available healthcare resources.

Purpose of the Study:

• To demonstrate a method for developing consensus on essential hospital disaster interventions.
• To quantitatively balance the needs of disaster victims with healthcare resource constraints.
• To identify interventions that can be realistically provided during a hospital surge.

Main Methods:

• A modified Delphi process involving pediatric acute care practitioners.
• Intervention selection based on maintaining staff workload below validated crisis limits (Therapeutic Intervention Scoring System).
• Modeling a disaster surge scenario with 4 times the usual patient load.

Main Results:

• Consensus was reached on essential interventions using defined assumptions.
• Several standard interventions exceed crisis workload limits.
• Exceeding interventions include detailed monitoring, vasoactive agents, invasive monitoring, dialysis, and tube feedings.

Conclusions:

• The developed quantitative methodology and consensus process can aid future disaster planning.
• Jurisdictional authorities should create action plans based on disaster scenarios, regional needs, and institutional capabilities.
• Expert groups must tailor disaster response plans to specific medical service regions and available resources.