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Pediatric Insight to Humanitarian and Trauma Crisis Response: Operation Allies Refuge and Operation Allies Welcome at
Caitlin McSorley1, Margaret Shields1, Melinda Funk2
1Uniformed Services University, Bethesda, Maryland 20814, United States.
Insights
Pediatric patients, including those injured in the Hamid Karzai International Airport (HKIA) bombing, required significant medical resources during Operation Allies Refuge/Welcome. Blast victims, though fewer, utilized more intensive care and procedures than infection cases.
Area of Science:
- Disaster medicine
- Pediatric critical care
- Military medicine
Background:
- Pediatric patients represent a significant burden on medical resources during humanitarian crises.
- Operation Allies Refuge/Welcome (OAR/OAW) in 2021 highlighted the critical role of military hospitals in managing pediatric evacuees.
- Landstuhl Regional Medical Center (LRMC) provided essential care to Afghan evacuees, including children with complex medical needs.
Purpose of the Study:
- To characterize the spectrum of pediatric injuries and diseases encountered during OAR/OAW.
- To define the medical resource utilization patterns of pediatric patients admitted to LRMC.
- To inform future disaster preparedness for pediatric populations.
Main Methods:
- Retrospective review of medical charts for pediatric patients admitted to LRMC during OAR/OAW.
- Data extraction included demographics, injury mechanisms, diagnoses, length of stay (LOS), intensive care unit (ICU) LOS, mechanical ventilation days, procedures, and disposition.
- Injury patterns were classified using diagnosis codes and procedural data.
Main Results:
- Eighty-two pediatric patients (≤17 years) were identified; 31 were infants born at LRMC.
- Non-birth admissions were most commonly due to infection (39.2%), followed by Hamid Karzai International Airport (HKIA) bomb attack injuries (25.5%), chronic conditions (19.6%), and acute medical/surgical needs (15.7%).
- HKIA blast victims experienced longer LOS, higher ICU admission rates, and required more procedures compared to other patient groups.
Conclusions:
- The study highlights the diverse pediatric medical needs during a complex disaster involving mass evacuation and a bombing event.
- While infections were the most frequent reason for admission among non-births, HKIA blast survivors demanded the highest level of medical resources.
- Ensuring availability of pediatric-trained personnel and specialized equipment is vital for military hospitals during disaster response.
Introduction:
Pediatric patients account for disproportionate medical resource utilization in times of disaster and war. This was demonstrated in 2021 during Operation Allies Refuge/Operation Allies Welcome (OAR/OAW) following withdrawal of U.S. troops from Afghanistan. Landstuhl Regional Medical Center (LRMC), a U.S. military hospital in Germany, played a pivotal role in medical support for evacuees from Afghanistan, including critically injured children. The objective of this study is to define the injury and disease patterns of pediatric patients admitted to LRMC during OAR/OAW.
Materials And Methods:
A retrospective chart review of pediatric patients was performed to extract data elements including demographic variables, mechanism of injury, primary and secondary diagnoses, length of stay (LOS), LOS in the intensive care unit (ICU), number of days requiring mechanical ventilation, procedures, and final disposition. Injury patterns were determined based on diagnosis codes and procedures performed.
Results:
A total of 82 pediatric patients ≤17 years of age were identified. Of these, 37.8% (N = 31) were infants born at LRMC to families who had evacuated. Infants had a median LOS of 3 days (range 1-14 days), with 3 infants requiring neonatal ICU care. Outside of births, the most common reason for admission was infection (39.2%, N = 20), followed by those injured in the Hamid Karzai International Airport (HKIA) bomb attack in Kabul, Afghanistan (25.5%, N = 13), chronic medical conditions (19.6%, N = 10), and acute medical/surgical needs (15.7% N = 7). HKIA blast victims had longer lengths of stay, were more likely to require ICU admission, and underwent more procedures.
Conclusions:
This study provides a snapshot of pediatric care needs at one institution in the setting of a complex disaster that was affected by both mass population evacuation and a bombing event. Although patients with infections constituted the majority of non-birth pediatric admissions, HKIA blast victims required the most resource utilization. The need for pediatric-trained medical providers and pediatric equipment is crucial in upholding a high standard of care in military support hospitals during disaster relief operations.
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