Pediatricians play an important role in preparing for natural and man-made disasters as well as treating families during and after such unpredictable and unpreventable events, the American Academy of Pediatrics reported in a policy statement.
Despite the unpredictability of disasters, “pediatricians and others involved in the care and well-being of children can prepare for and mitigate their effects, encourage preparedness and resiliency among children and families and within communities, and ensure that children’s needs, including those of children and youth with special health care needs, are not neglected in planning, response, and recovery efforts,” wrote the Disaster Preparedness Advisory Council of the AAP Committee on Pediatric Emergency Medicine ( Pediatrics. 2015 Oct 19 doi: 10.1542/peds.2015-3112 ).
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The policy statement contains a list of resources available online to help families prepare for disasters, develop emergency plans, and deal with the fallout and effects of disasters. Another table lists educational and training resources available for pediatricians.
First among the dozen policy recommendations is the need for all levels of government – national, state, tribal, local, and regional – to address the “unique physical, mental, behavioral, developmental, communication, therapeutic, and social needs of all children.” This recommendation requires the participation of pediatricians in disaster planning, response, and recovery in multiple roles, including as representatives of practices or institutions.
The unique needs of children need to be considered. “Children’s rapid minute ventilation, large surface area relative to body mass, more permeable skin, and proximity to the ground increase their risk of adverse outcomes from exposure to environmental hazards. … Children are in a critical period of development when toxic exposures can have profound negative effects.
“Children may lack the developmental ability to flee hazards, or they may even approach them out of curiosity or inadequate comprehension of risk. Limited ability to understand the nature of the disaster can also lead to stress, fear, anxiety, inability to cope, and exaggerated response to media exposure. All of these responses can manifest as developmental regression, withdrawal, clinginess, tantrums, enuresis, or somatic complaints, among other symptoms,” the committee explained.
Sufficient equipment, medications, and supplies for children should be on hand so that children’s needs can be met to the same degree as adults’ needs during a disaster. Because this has not always been true in the past, the committee called for more research into knowledge gaps and best practices regarding the treatment of children in disasters.
In addition to training children in disaster drills how to respond as victims and responders during a disaster, communities must consider children’s needs, physiology, and development during mass casualty triage, the committee recommended. Providers also can play a role in teaching children and families how to prepare for disasters and strategies for resiliency in their presence and their aftermath.
The committee encourages pediatricians to seek ongoing postgraduate education on disaster issues and to sign up with various public health disaster response systems, including Health Alert Network communications, the Centers for Disease Control and Prevention Clinician Outreach and Communication Activity announcements, the Emergency System for Advance Registration of Volunteer Health Professionals registries, the Medical Reserve Corps teams, state medical assistance teams, and disaster medical assistance teams.
“Finally, pediatricians should remember that they are not immune to the stress of disaster,” the committee wrote. “Pediatricians may have experienced their own losses, yet they will still be tasked with delivering care in difficult environments, all the while hearing of others’ tragic stories. Caregiver fatigue threatens the pediatrician’s well-being; the ability to provide consistent, high-quality care to others; and the desire to continue serving the community.” Resources for providers’ mental and physical health and resiliency include the AAP, local AAP chapters, medical societies, and state and federal governments, as well as other pediatricians monitoring the well-being of their colleagues.
During potentially lengthy recovery processes, pediatricians “can provide a crucial source of stability by quickly restoring access to routine and familiar medical care” as well as serving as advisers and advocates for the needs of children in the community, the committee advised.
No external funding or disclosures were reported.