National Center on Birth Defects and Developmental Disabilities Protecting a Child is the Public’s Health: An Integrated Approach to Children’s Preparedness Eric Dziuban, MD, DTM, CPH, FAAP Team Lead, Children’s Preparedness Unit Chief Medical Officer, Office of the Director Division of Human Development and Disability, NCBDDD, CDC AAP — Orange County Chapter May 14, 2016
Disclosure Neither I nor any member of my immediate family has a financial relationship or interest (currently or within the past 12 months) with any proprietary entity producing health care goods or services consumed by, or used on, patients related to the content of this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device.
Key Learning Objectives Identify the importance of preparedness planning for children at every level Gain a better understanding of the work being done by Children’s Preparedness Unit at CDC Improve capacity of Orange County pediatric health care providers to engage in disaster response efforts
Introducing CDC’s Children’s Preparedness Unit
Children’s Preparedness Unit (CPU)
Division of Human Development & Disability (DHDD) Primary programs: • State Disability & Health Programs • Public Health Practice & Resource Centers • Disability & Health Data System • Early Hearing Detection & Intervention • National Spina Bifida Patient Registry • Muscular Dystrophy Research Network • Fragile X Syndrome • Child Development Research & Interventions • ADHD • Tourette Syndrome • Legacy for Children™ • Children’s Mental Health • Children’s Preparedness
Mission and Pillars of CPU To champion the needs of children in emergency preparedness and response by integrating children into public health planning at the federal, state, and local levels. Increase awareness Build an evidence Offer technical Develop of the importance base of best assistance and partnerships with of incorporating practices, tools, and serve as SME to leaders in children in resources to guide federal, state, and preparedness preparedness planning local public health planning planning
CPU and AAP: Championing Needs of Children in Emergencies CDC and AAP: Partnering to integrate children in all aspects of emergency preparedness with a focus on the important role of pediatricians Children and Pediatrician Children’s Youth with and Public Hospital and Influenza Special Health Health Preparedness Preparedness Care Needs Exercise Calls Preparedness
Public Health Pediatrics
Children’s Needs in Disaster Response
Unique Needs of Children in an Emergency Children are vulnerable in times of disaster – Unique physiology, anatomy and developmental characteristics – Younger children partially or fully dependent on adults Both pediatric and non-pediatric resources can become overwhelmed quickly with an influx or surge of children
How are Children Different than Adults?
Clinical Management Challenges Triage – Normal range of vital signs different – Adult-based tools inaccurate in children Medications – Weight-based dosing in children – Different medication formulations – Need to consider countermeasure stockpiles Equipment – Need full range of sizes for pediatric care Oxygen masks, catheters, tubes – Adult-based devices may not work Ventilators, monitors, infusion pumps
Medical Countermeasures (MCM) for Children Children require weight-based dosing, and may need: – Different formulations in the Strategic National Stockpile – Different dispensing guidance for public health departments – Different guidance for the public Testing MCMs on children has serious ethical considerations Many MCMs are not FDA-approved for children – These MCMs must be administered under alternative regulatory mechanisms
CPU Disaster Priorities • Emerging infectious diseases (outbreaks and epidemics) • Bioterrorism agents • Radiation incidents • Influenza (seasonal and pandemic) • Chemical exposures (intentional and accidental) • Infectious disease concerns secondary to natural disasters • Natural disasters • Hurricanes, winter storms, flooding, tornadoes, wildfires, landslides, earthquakes, landslides, volcanoes • Intentional mass casualty events (shootings, explosives) • Unintentional mass casualty events • Road incidents, building collapses, fires
Examples of CPU Activities
Pillar 1 Build an evidence base of best practices, tools, and resources to guide planning • Integrate children into clinical guidelines, such as “Clinical Guidance for Smallpox Vaccine Use” and “ Clinical Guideline Support for Treatment of Botulism” • Perform analyses on flu outcomes for children with special healthcare needs
Pillar 2 Increase awareness of the importance of incorporating children in preparedness planning • Create and maintain a “Caring for Children in Disasters” web page • Produce a supplementary instructional video on pill crushing (Anthrax MCM ) that was tested with focus groups • Develop content for Ready Wrigley children’s activity books
Pillar 3 Offer technical assistance and serve as SME to federal, state, and local public health • Served as Children’s Health Team during Flint, MI Water Contamination response • Consult with regional and national disaster coalitions • Hosted Public Health and Pediatrics Tabletop Exercise
Pillar 4 Develop partnerships with leaders in preparedness planning • Participate in Children’s Health and Human Services (HHS) Interagency Leadership on Disasters (CHILD) Working Group • Facilitate meetings with SNS leadership and AAP’s Disaster Preparedness Advisory Council (DPAC) semi-annually
Mission and Pillars of CPU: What about Responses? To champion the needs of children in emergency preparedness and response by integrating children into public health planning at the federal, state, and local levels. Increase awareness Build an evidence Offer technical Develop of the importance base of best assistance and partnerships with of incorporating practices, tools, and serve as SME to leaders in children in resources to guide federal, state, and preparedness preparedness planning local public health planning planning
Emergency Operations Center (EOC): Activations Responses with CPU Content Examples: Involvement: • Pediatric medical • countermeasures H1N1 (2009-2010) • • Liaising with AAP and children’s H3N2v (2012) hospitals • Unaccompanied Minors • Children’s mental health (2014) • • Parental presence Ebola (2014-2015) • • Breastfeeding & transmission Zika (2016) • • Pediatric case investigations Flint, MI Water • Contamination (2016) Infant diagnostic guidelines • Pediatric FAQs
Summary of CPU Work CDC is committed to including children in preparedness and response planning The Children’s Preparedness Team does this work by consulting and collaborating with groups across CDC and with federal, local and state governments and partners organizations Our goal: ensure that children are thoughtfully included in all public health preparedness and response activities
Efforts in 2016 and Lessons Learned (so far …)
Pediatric and Public Health Tabletop Exercise CONCEPT – Increase connectedness between public health preparedness professionals and pediatricians at the state and local levels. – Improve pediatricians’ knowledge about public health emergency preparedness and response. – Improve public health professionals’ understanding of the needs of children in disasters and how pediatricians can help.
Pediatric and Public Health Tabletop Exercise OBJECTIVES – Determine collaborative strategies that AAP chapters, pediatric clinicians, and public health leaders could implement to advance pediatric preparedness at the state and local level. – Develop communication between public health/pediatrician leaders during a response to a public health emergency to sufficiently address pediatric needs. – Evaluate ways to optimize plans for distribution and dispensing of medical countermeasures suitable for pediatric care, relevant to the infectious disease threat/situation raised in the exercise scenario.
Meanwhile on January 26 th …
AAP Input: • National Leadership • Disaster Preparedness • Infectious Disease • Neonatology and Fetal Medicine • Neurology • Children with Disabilities
CDC Efforts in Flint, MI Example Objective: Develop and implement targeted public health messaging for lead exposure in collaboration with the Genesee County Health Department, the Michigan Department of Health and Human Services, and the US Environmental Protection Agency.
Conclusions
Pediatric Practices in Orange County: Are You Ready? Communication Coordination with emergency management Sheltering in place Plans and protocols Drills
Questions?
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