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Treatment and triage recommendations for pediatric emergency mass critical care
Michael D Christian1, Philip Toltzis, Robert K Kanter
1Canadian Force, Department of National Defence, Canada. michael.christian@utoronto.ca
Insights
Pediatric emergency mass critical care guidelines address treatment and resource allocation for children during disasters. This Task Force provides recommendations for hospitals and discusses challenges in pediatric triage protocols.
Area of Science:
- Disaster Medicine
- Pediatric Critical Care
- Public Health Policy
Background:
- Existing mass critical care guidance overlooked pediatric needs.
- A dedicated Task Force was formed to address this gap.
- Expert consensus and literature review informed the recommendations.
Purpose of the Study:
- To develop recommendations for pediatric emergency mass critical care.
- To address resource allocation and triage challenges for children in mass critical care scenarios.
- To provide guidance for hospitals with and without existing pediatric critical care services.
Main Methods:
- A multi-disciplinary Steering Committee and a 36-member Task Force were convened.
- Literature reviews of MEDLINE and Ovid databases were conducted.
- Recommendations were developed through consensus-based study and expert feedback.
Main Results:
- The Task Force developed recommendations for pediatric emergency mass critical care.
- Guidance is provided for hospitals routinely providing pediatric care and those that do not.
- Key challenges in developing pediatric triage algorithms and resource allocation protocols are discussed.
Conclusions:
- Specific recommendations are outlined for different hospital settings during mass critical care events.
- The importance of tailored pediatric triage and resource allocation strategies is emphasized.
- This work provides a framework for improving pediatric preparedness in mass critical care.
Introduction:
This paper will outline the Task Force recommendations regarding treatment during pediatric emergency mass critical care, issues related to the allocation of scarce resources, and current challenges in the development of pediatric triage guidelines.
Methods:
In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations.Steering Committee members established subcommittees by topic area and performed literature reviews of MEDLINE and Ovid databases. The Steering Committee produced draft outlines through consensus-based study of the literature and convened October 6-7, 2009, in New York, NY, to review and revise each outline. Eight draft documents were subsequently developed from the revised outlines as well as through searches of MEDLINE updated through March 2010.The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. Feedback on each manuscript was compiled and the Steering Committee revised each document to reflect expert input in addition to the most current medical literature.
Task Force Recommendations:
Recommendations are divided into three operational sections. The first section provides pediatric emergency mass critical care recommendations for hospitals that normally provide care to pediatric patients. The second section provides recommendations for pediatric emergency mass critical care at hospitals that do not routinely provide care to pediatric patients. The final section provides a discussion of issues related to developing triage algorithms and protocols and the allocation of scarce resources during pediatric emergency mass critical care.
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