May 03, 2019
A mass incident involving children can happen anyplace, at any time. A bridge might collapse with a school bus on it. A Boy Scout troop might tour a factory at which an explosion occurs on-site. An outbreak of a disease previously thought to be eradicated might affect many children in the same city.
It's a parent's worst nightmare: finding out that a son or daughter has been involved in a mass trauma or other disaster. No parent — or citizen, for that matter — wants to think about many children being harmed in an incident.
For health care professionals in the state of Minnesota, however, it's critical to think about it. What would happen, for instance, if 30 children hurt in a crash in transit to a field trip, 100 affected by a carbon monoxide leak or 25 with minor to major gunshot wounds arrived at one facility all at the same time?
According to a study published in the July 2006 issue of Maternal and Child Health Journal, preparedness for mass incidents involving children may have been overlooked with the assumption that treating children involved in a disaster is akin to serving adult patients.
"Even if a health care facility is trauma ready, it doesn't mean it is pediatric surge ready," says Denise B. Klinkner, M.D., M.Ed., a Mayo Clinic pediatric surgeon in Rochester, Minnesota, and medical director of Mayo Clinic's Level I Pediatric Trauma Center.
Thus, a committee including representatives from the Minnesota Department of Health, pediatric trauma centers and health coalitions statewide has been thinking through issues such as: How would we make sure we had enough child-sized equipment if so many pediatric patients arrived at once? How would we triage them, or find beds for them all? Have the right specialists on hand?
The result of these efforts is called the Minnesota Pediatric Surge Plan, which provides guidance available online 24/7 for operations across the state in case of a disaster involving a large number of children requiring care.
"Most trauma professionals know how to do adult management because that's what they do," says Dr. Klinkner. "When an event like a mass shooting involving children occurs, however, you don't have time to look up information. This surge plan is readily supplying the education — in an engaging format — so trauma staff can review it on a regular basis and be ready in a worst-case scenario."
Plan contents are available at the Minnesota Department of Health website, and they include an operations plan in the event of an incident and the Pediatric Surge Toolkit, which provides tools for assessment, planning, education and training, exercises, and response. Videos were specifically designed to be completed within 20 minutes or less and aimed at non-pediatric specialists, similar to those in the previous burn surge plan.
This 2019 plan highlights several themes in preparing for a mass pediatric incident in the state of Minnesota:
Spans a wider array of incidents
Beyond covering just large-scale trauma incidents, the new pediatric surge plan addresses incidents such as anti-terrorism, common influenza and bird flu.
Preserves normal operations
Trauma personnel at the facility where children arrive after a mass pediatric incident would call the next-level trauma center that they would customarily contact, which would then coordinate the event. Requiring just one phone call to a familiar partner and not creating a whole new — and potentially confusing — system was a critical requirement for the new plan.
Targets care close to home
Though in a large incident health care professionals will identify patients who need to be transferred to facilities with specialized care, the goal in the new plan is to provide care in patients' home region whenever possible.
Assesses resources and equipment
The plan includes evaluation of Minnesota hospitals' pediatric readiness with regard to equipment and addresses questions such as, "What if we run out of ventilators?"
Presents a disbursement plan
The plan explains procedures for rapidly distributing needed supplies to facilities providing care after a mass disaster involving children.
Includes emergency medical services
Previous plans did not include the role of these personnel, key first responders when a mass incident involving children takes place.
Incorporates rural capabilities
The new plan not only more fully takes advantage of the capabilities of health care facilities in rural areas but also includes providing assistance to these locales.
Includes input from all levels. Development of the Minnesota Pediatric Surge Plan incorporated personnel at all levels associated with children's health: administration, physicians, social workers, bedside nurses, public health educators and others.
Significance for Minnesota
According to Dr. Klinkner, who helped develop the new plan, having a set algorithm to direct care in case of an incident prompting a surge of pediatric patients will optimize the care of every child affected.
"Not a minute will be lost wondering what procedures will be followed, which beds to utilize or from where extra pediatric blood pressure cuffs will materialize," says Dr. Klinkner. "This is exactly what we'd want to see with a large disaster affecting Minnesota children: organized, efficient care to reduce morbidity and mortality as much as possible. These events don't happen very often, but when something like that does happen, we have to be prepared for it."
For more information
Pediatric surge. Minnesota Department of Health.
Ginter P, et al. Creating a regional pediatric medical disaster preparedness network: Imperative and issues. Maternal and Child Health Journal. 2006;10:391.