Schedule change with a baby

It’s difficult to emphasize how much life changes when a child comes into the picture. Caitlin Hudon made a chart to show how her daily schedule shifted dramatically.

For a while, it seems like all of your free time is gone for good, but ever so slowly, you get a little bit of it back as they grow more independent.

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Deaths from child abuse, a starting dataset

By way of the Child Abuse Prevention and Treatment Act, ProPublica and The Boston Globe requested records from each state. They compiled the many documents into a single dataset:

In each record, CAPTA requires states to list the age and gender of the child, and information about a household’s prior contact with welfare services. The information is supposed to help government agencies prevent child abuse, neglect and death, but reporting across states is so inconsistent that comparisons and trends are impossible to identify. ProPublica is releasing the data we’ve collected as a minimum count of child fatality records in the United States. Researchers and journalists can download the full records with summaries at the ProPublica Data Store.

Unfortunately, not all state agencies are compliant, but it’s a start.

Also, Jessica Huseman of ProPublica discussed some of the emotional challenges of working with such sensitive data.

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Protecting Our Future: Emergency Preparedness and Children’s Mental Health

Sad boy sitting against a brick wall with his face hidden

Among the many lessons learned during the 2017 Hurricane season, we recognized that addressing children’s mental and behavioral health needs is a major concern in hurricane-affected areas.

CDC’s At Risk Task Force (ARTF) was established in 2017 to ensure identification and prioritization of the mental and physical health needs of at-risk populations, including children. ARTF’s first Emergency Operations Center (EOC) activation was on Aug. 31, 2017, in response to Hurricane Harvey, the first of three consecutive hurricanes to hit the United States and its territories in a five-week period. ARTF’s mission was to address the needs of at-risk populations in affected areas throughout the response and recovery phases.

Early in the response, it became clear that the emotional impact of the storms and the mental health needs of people, particularly children, affected were a critical area of focus. ARTF worked closely with federal and non-government agencies to address these needs so that children and families had the best chance for recovery.

October 10 is World Mental Health Day. The theme this year is Young People and Mental Health in a Changing World. In light of this, we want to share our experiences to inform mental health interventions and improve outcomes for children after public health emergencies and natural disasters. First, let’s talk about what makes children more vulnerable in emergencies.

Why are children more vulnerable in emergencies?

Mental stress from a disaster can be harder on children. Children are more vulnerable in emergencies: Because they breathe in more air for their size than adults, children absorb harmful materials from the air more readily. Because they spend more time outside, are lower to the ground, and put their hands in their mouths more often than do adults. Because they may not be able to communicate their symptoms or feelings. Because they need medicines, and specifically designed equipment for emergency situations that are different from adults.Children are more vulnerable in emergencies because of their physical, developmental, behavioral, and emotional differences from adults. Children may have difficulty or may not be able to communicate symptoms or feelings. They may understand less about the situation and feel less able to control the events around them.

The aftermath of an emergency or disaster is also difficult for children because they have less experience coping with difficult situations.

The emotional impact of an emergency depends on a child’s characteristics and experiences, the social and economic circumstances of the family and their community, and the availability of local resources. Other factors may influence the emotional impact on children, causing them to be more vulnerable in emergencies. These include children with mental, behavioral, or developmental disorders. Children who have experienced trauma in the past may also have more difficulty coping with a disaster.  

What does the At Risk Task Force do for children’s mental health during a hurricane response?

During the 2017 hurricane season, the ARTF collaborated with federal and non-government partners to monitor behavioral health in affected areas and disseminate key messages and coping resources for children in schools and vulnerable populations in other contexts. ARTF coordinated a webinar for primary care physicians that focused on identification of common adjustment difficulties in children, provided strategies to promote effective coping skills in children and their parents, and explained the importance of self-care for professionals. The webinar was attended by more than 300 clinicians and other health care providers on Oct 26, 2017.

Public health professionals also play an important role in addressing short-term and enduring mental health needs of the population. Timely and accurate mental and behavioral health surveillance data, that includes specific information on children, could inform intervention efforts to improve developmental outcomes for children in the longer-term aftermath of disasters. It is important that mental health surveillance be incorporated into preparedness planning so that surveillance systems can be established or leveraged immediately when emergency response begins.

What are next steps for CDC?

Children’s mental health needs are a prominent concern in hurricane-Recommendations to help children cope during and after an emergency: • Share age-appropriate information • Encourage children to ask questions • Limit media exposure • Return to a routine • Reunite children with caregivers as soon as possibleaffected areas. There is still a gap in real-time information on mental health needs to inform intervention efforts and improve child outcomes. CDC is working internally to enhance efforts to monitor health impacts during and after natural disasters, including integrating mental health into standard data collection.

CDC is also working with partners to integrate children’s mental health in preparedness planning. Following the 2017 hurricane season, CDC collaborated with the American Academy of Pediatrics to develop an activity book for children and families, Coping after a Disaster, that focuses on feelings children might have after a disaster and coping strategies that may help. This book is part of a series that follows Ready Wrigley, a dog who helps her family prepare for emergencies and their impacts.

CDC is now partnering with the National Hazard Center to develop mental and behavioral health training modules for researchers conducting field research immediately following an extreme event, such as a hurricane. These free, online trainings will provide background information on mental health in the context of disasters, as well as a list of mental health assessment tools used following a disaster for various vulnerable populations (e.g., children, older adults). The trainings and associated resources will address current research gaps in mental health, help to organize research in this area, and share best practices with researchers.

On Sept. 12, 2018, CDC activated the EOC to respond to Hurricane Florence, which made landfall off the coast of North Carolina on Sept. 13. The ARTF was quickly activated to address the needs of vulnerable populations. As the storm decreased in intensity, North Carolina began reporting increased emergency department visits related to stress and anxiety. Mental health concerns in children, similar to 2017, are expected to remain a prominent focus throughout the response and recovery phases. The ARTF continues to monitor the situation and support the mental and behavioral health needs of children and vulnerable populations in affected areas.

Additional Resources:

Mapping opportunity for children, based on where they grew up

Opportunity Atlas, a collaboration between Opportunity Insights and the Census Bureau, is the product of ongoing research on the demographics of people, based on the neighborhood they grew up in.

The Opportunity Atlas provides data on children’s outcomes in adulthood for every Census tract in the United States through an interactive map providing detailed research on the roots of these outcomes, such as poverty and incarceration rate, back to the neighborhoods in which children grew up. This tool will enable policy makers, practitioners, and the public the unprecedented ability to look within their city to understand better where opportunity exists and how each neighborhood shapes a child’s future economic and educational success.

The map application was developed by Darkhorse Analytics. Zoom in to an area of interest, subset on demographics such as income level, race, and gender, and see how the people who grew up in those areas fared later in life. You can also download the tract-level data to look for yourself.

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After the Storm: Helping Kids Cope

A boy and his mother wait to cross the street on their way to school.

Changing schools is hard for any kid. Imagine picking up without any notice and moving to a new school in a brand new place with a different climate, culture, and maybe even a different primary language.  Harder still is the thought of moving because your home and community have been devastated by a major hurricane. The truth is, this is the reality for the tens of thousands of students from Puerto Rico and the U.S. Virgin Islands (USVI) who moved to the continental U.S. after Hurricane Irma and Hurricane Maria.

Recognizing a need

As a Massachusetts native, I subscribe to news alerts from the Boston area. One morning before heading to work in CDC’s Joint Information Center, I saw a news article about the influx of PuertoCDC's Joint Information Center (JIC): The JIC Outreach Team is responsible for reaching hard-to-reach and at-risk audiences with important health and safety information during and after a public health emergency. Rican children displaced by the hurricanes who were relocating to the cities of Springfield and Holyoke in western Massachusetts.  Both cities have large Puerto Rican populations, and many residents were taking in relatives and friends from the devastated island. Schools in the territories would be closed for months after the storm, so many families were coming to the continental U.S. so their kids could keep going to school.

Children who were displaced as a result of the hurricanes faced the challenges of leaving behind their homes, communities, and schools, family and friends, and even their pets.  Kids in middle and high school were old enough to understand the uncertainty facing their families. They had to stay strong to support their parents and siblings, while finding a routine at a new school and keeping up with their academics.

Understanding the issue

During my meeting with the Hurricane Emergency Response Communication Teams, I brought up the article I had read that morning. Dr. Melissa Mercado-Crespo, a behavioral health scientist at CDC’s National Center for Injury Prevention and Control, took a special interest in the well-being of the families who had been displaced by the hurricanes. Dr. Mercado serves on the StopBullying.gov Editorial Board, and grew up in Puerto Rico. Most of her family and loved ones still live there, and when the storms hit, her husband was deployed to the island with the U.S. Army Reserves.

In collaboration with the CDC At-Risk Task Force, Dr. Mercado and I reached out to federal and local partners to find out how many hurricane-displaced students from Puerto Rico and USVI had enrolled in the middle of the semester. Through media and local sources, we learned that most of the students had enrolled at schools in Florida and New York, as well as cities in western Massachusetts. The Center for Puerto Rican Studies at Hunter College, City University of New York, confirmed our findings. They estimated that after September 20, 2017 – the day Hurricane Maria hit Puerto Rico – 10,324 Puerto Rican students enrolled in Florida schools. The Puerto Rico Department of Education reported that nearly 25,000 students have left the island and are no longer enrolled in the Puerto Rico public school system.

Taking action

My former colleagues in Boston put me in touch with José Claudio of the New North Citizens’ Council, a community organization that provides public and human services to residents in the Springfield area. He mentioned that many of the students were struggling to adapt to their new setting and that there were misunderstandings between the permanent students and their new peers. We wanted to provide teachers and youth organizations with tools and resources that could help make the transition easier for everyone.

To help address these challenges, we pulled together a list of resources to help teachers and youth organization leaders plan activities to prevent and reduce the emotional challenges new students may face and help them cope with the trauma following hurricanes. We published the list in a Spotlight issue of the CDC Emergency Partners Newsletter that was reviewed by CDC behavioral health experts and representatives from StopBullying.gov, SAMHSA, and the National Child Traumatic Stress Network (NCTSN). The newsletter went out to partners, and we received positive feedback from teachers, school counselors, and organizations that serve Hispanic populations in the U.S.

The messaging needs and target audiences change before, during, and after every emergency. We identified a new target audience during the 2017 Hurricane Response – children from Puerto Rico and USVI who left their schools and homes behind after the storms. Our hope is this is the first step in concrete efforts to help ensure they are no longer left behind.

Learn more

Subscribe! CDC Emergency Partners Newsletter

6 Things You Need to Know About This Flu Season

Sick boy lying in bed having his temperature taken with a thermometer.

Seasonal flu activity has been intense this season.  As of February 16, 2018 most of the United States continues to experience intense and widespread flu activity, with record-breaking levels of influenza-like-illness and hospitalization rates recorded. While H3N2 viruses are still most common, there is an increasing number of influenza B viruses being detected. It’s not uncommon for second waves of B virus activity to occur during a flu season. It’s likely that flu activity will continue for several more weeks.

Here are some important things to know right now to protect yourself and your loved ones from flu:

1.  What are the symptoms of flu?

Flu viruses can cause mild to severe illness, and at times can lead to death. The flu is different from a cold. The flu usually comes onIf you have the emergency warning signs of flu sickness, you should go to the emergency room. These include: In children • Fast breathing or trouble breathing • Bluish skin color • Not drinking enough fluids • Not waking up or not interacting • Being so irritable that the child does not want to be held • Flu-like symptoms improve but then return with fever and worse cough • Fever with a rash; In addition to the signs above, get medical help right away for any infant who has any of these signs: • Being unable to eat • Has trouble breathing • Has no tears when crying • Significantly fewer wet diapers than normal; In adults • Difficulty breathing or shortness of breath • Pain or pressure in the chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu-like symptoms that improve but then return with fever and worse cough. suddenly. People who have the flu often feel some or all of these symptoms:

  • Fever* or feeling feverish/chills
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches
  • Headaches
  • Fatigue (tiredness)
  • Some people may have vomiting and diarrhea, though this is more common in children than adults

* It’s important to note that not everyone with flu will have a fever.

2.  What do I do if I get sick?

Most people with the flu have mild illness and do not need medical care or antiviral drugs. If you get flu symptoms, in most cases you should stay home and avoid contact with other people, except to get medical care.

CDC recommends that antiviral drugs be used early to treat people who are very sick with the flu (for example, people who are in the hospital) and people who are sick with the flu and are at high risk of serious flu complications, either because of their age or because they have a high risk medical condition.

3. Is it too late to get a flu shot?

No!  As long as flu viruses are still circulating, it is not too late to get a flu shot.  Flu vaccination is the best way to prevent flu illness and serious flu complications, including those that can result in hospitalization. Unfortunately, flu vaccines don’t work as well against H3N2 viruses, which means that some people who got vaccinated will still get sick; however, there are some data to suggest that flu vaccination may make illness milder. Flu vaccines usually work better against H1N1 viruses, which is another good reason to get vaccinated, since H1N1 is circulating too.

4.  Why should I get a flu shot?

In addition to protecting yourself, getting vaccinated also protects people around you, including people who are more vulnerable to serious flu illness, like babies and young children, older people, pregnant women and people with certain chronic health conditions.

5.  Does the flu shot work?

Vaccine effectiveness data for this season are not available yet, but we know that flu vaccines do not work as well against H3N2 viruses, which are predominant so far this season.

6.  What else can I do to protect myself from flu?

Definitely try to avoid close contact with sick people.  If you do get sick, limit contact with others as much as possible to keep from infecting them. Stay home for at least 24 hours after your fever is gone without the use of fever-reducing drugs (unless you need medical care or other necessities).

Other tips for stopping the spread of germs:

  • Make sure you cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water.
  • Avoid touching your eyes, nose, and mouth. Germs spread this way!
  • Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

Educating Children After Hurricane Maria

In September 2017, Hurricanes Irma and Maria roared through the Caribbean just 12 days apart. The schools on St. Croix and St. Thomas in the U.S. Virgin Islands (USVI) did not re-open until October 24. Teachers talked about how many of the books and materials in their classrooms were moldy and how teachers and staff had to help the janitorial staff clean up classrooms. Parents shared stories of their children coming home from school with mosquito bites all over their arms and legs. Schools could not always run the air-conditioning because they were operating using generators.

Finding a natural fit

As a team lead in the Division of Adolescent and School Health, I have expertise in how health departments and federal agencies should work with schools. So when I was deployed to support health communication activities in the US Virgin Islands after Hurricane Maria, I offered to support the USVI Department of Health doing health communication outreach to schools. We worked quickly to connect with schools and distribute materials to students and their families about how to stay safe and healthy after a hurricane.

Making a vision a realityChildren are the key to primary prevention because they are the drivers of the health behaviors we hope to change. -Malaika Washington

I worked with Director of Public Relations, Nykole Tyson, at the USVI Department of Health and the USVI Department of Education to determine how many children were enrolled on St. Croix, St. Thomas, and St. John and which educational materials from CDC to distribute. With support from the CDC Foundation, we printed and distributed flyer packets for over 16,000 K-12 students on the three islands to take home to their families. The packets contained CDC-developed materials about how to stay safe after a hurricane, including tips for food and water safety, how to prevent mosquito bites, the health risks from mold, how to avoid carbon monoxide poisoning, and mental health. Since 35% of the children on St. Croix speak Spanish, we made the messages available in both English and Spanish.

Each child was also given a copy of the Ready Wrigley Flooding and Mold Activity Book as part of the flyer packet. Ready Wrigley is a series of CDC-developed activity books for children 5-9 years old and their families to help them talk about and prepare for emergencies. There are nine Ready Wrigley books that provide tips, activities and a story about disaster preparedness. The flooding and mold activity book talks specifically about safe mold clean-up after a flood and how kids should never touch mold and always tell a grown-up if they see mold.

Giving children a voice

Malaika Washington reading the Ready Wrigley Flooding and Mold activity book to students in USVI.
Sharing the Ready Wrigley Flooding and Mold activity book with students in USVI.

American Education Week takes place every November. The USVI Department of Education contacted Director Tyson and asked her to read to elementary school students on St. Croix. She asked me if I would like to join her visits to kindergarten and first grade classrooms. I jumped at the chance to interact with students in-person and suggested we read the Ready Wrigley Flooding and Mold Activity Book. I even colored the pictures in the book and completed the activities so the children could follow along. We shared the Ready Wrigley books with the teachers at each school we visited, giving teachers enough copies of the book for every student to take one home.

All of the students really wanted their stories heard. One first grader recounted how his mother and grandparents told him to stay far away from the cleaning products while they cleaned up the mold in their home. Another little girl shared how she was personally impacted by mold. She had to sleep on the sofa in her home because there was mold all over her bed and the other furniture in her bedroom. Several other children described the mold they found on the front door of their homes after the hurricane.

Fulfilling a passion

Working with school-aged children is so rewarding. This deployment experience was the best I could have hoped for. The time I spent in the USVI made me realize my personal and professional goal to provide public health education materials to children and their families. I have always believed that public health prevention work should begin with school-aged youth and it is my lifelong public health mission to ensure that they have a voice.

Malaika Washington has been a Commissioned Corps Officer in the United Stated Public Health Service since October 2009. She is a team lead in the Division of Adolescent and School Health, the only division at CDC that funds education agencies directly. Her deployment to the U.S. Virgin Islands for the 2017 HHS Hurricane Response was the first time she deployed for a public health emergency.

Everyone can be a flu vaccine advocate!

Little girl getting a bandaid.
Children, especially those younger than 5 years, are at higher risk for serious flu-related complications. The flu vaccine offers the best defense against getting the flu and spreading it to others.

With the holidays quickly approaching, there will be more opportunities to spend time with family and friends.  Now is the time to ensure that you and those around you are protected from flu. Now is the time to get your seasonal flu vaccine if you haven’t already gotten it. It takes about two weeks after vaccination for antibodies that protect against flu to develop in the body.—so it’s  important to get vaccinated now, before the flu begins circulating in your community.

Whether you are a doctor, school nurse, grandchild, best friend, or coworker, you can play a role in reminding and encouraging  other people to get their flu vaccine. Get your flu shot and talk to others about the importance of everyone 6 months and older getting a flu shot every year.

Talking to Friends and Family about Flu ShotsGet yourself and your family vaccinated.

Need some tips for talking about the importance of flu vaccine? CDC is a great source of information about the serious risk of flu illness and the benefits of flu vaccination, as well as information to correct myths about the flu vaccine. Below are several examples of the benefits of flu shots and corrections of common flu myths. Find out more about the benefits of getting your annual flu vaccine on CDC’s Vaccine Benefits webpage, here.

  • Flu can be a serious illness, even for otherwise healthy children and adults. While most people will recover from flu without complications, anyone can experience severe illness, hospitalization, or death. Therefore, getting vaccinated is a safer choice than risking serious illness for yourself or those around you.
  • The flu vaccine CANNOT give you the flu. Flu shots do NOT contain flu viruses that could infect you and cause flu illness. Flu shots either contain flu vaccines viruses that have been “inactivated” (or killed) and therefore are not infectious, or they do not contain any flu vaccine viruses at all (recombinant influenza vaccine).
  • Flu vaccination can keep you from getting sick with flu. Flu vaccines can reduce your risk of illness, hospitalization.
  • Getting vaccinated yourself may also help protect people around you, including those who are more vulnerable to serious flu illness, like babies and children, older people, and people with certain chronic health conditions.

Making a Flu Vaccine Recommendation to Your Patients

Woman talking to her doctor
Talking to patients about vaccines can be difficult. CDC has resources to help you make a strong flu vaccine recommendation.

For health care providers, CDC suggests using the SHARE method to make a strong vaccine recommendation and to provide important information to help patients make informed decisions about vaccinations. Remind patients that it is not too late for them to get vaccinated, and follow the SHARE strategies below:

  • S- SHARE the reasons why the influenza vaccine is right for the patient given his or her age, health status, lifestyle, occupation, or other risk factors.
  • H- HIGHLIGHT positive experiences with influenza vaccines (personal or in your practice), as appropriate, to reinforce the benefits and strengthen confidence in flu vaccination.
  • A- ADDRESS patient questions and any concerns about the influenza vaccine, including side effects, safety, and vaccine effectiveness in plain and understandable language.
  • R- REMIND patients that influenza vaccines protect them and their loves ones from serious flu illness and flu-related complications.
  • E- EXPLAIN the potential costs of getting the flu, including serious health effects, time lost (such as missing work or family obligations), and financial costs.

Be an advocate for flu vaccination. Get your flu vaccine and remind those around you to do the same! Visit www.cdc.gov/flu for more information and tips on flu vaccination and prevention.

Interested in learning more about flu? Check out other CDC Flu Blog-a-thon post throughout the week for personal stories, advice, and tips on flu and flu prevention. You can see all the participating blogs here: https://www.cdc.gov/flu/toolkit/blog-a-thon.htm.

Halloween Rules of the Road

Parent taking children trick or treating on Halloween.

Halloween is an exciting time for kids and adults – the delight of dressing up in a fun costume, all of the spooky decorations, and of course let’s not forget the candy. Traditionally, kids trick-or-treat at night – going house-to-house in their costumes. On average, children are more than twice as likely to be hit by a car and killed on Halloween than on any other day of the year. Children are at Trick-or-Treat Checklist: first aid kit, warm clothes, water, cell phone, emergency contact card, trick-or-treat route, reflective strips or tape, well-fitting costume, comfy shoes, flashlight or glow sticks, trick-or-treat baggreater risk of injury than adults because they are small, have trouble judging distances and speeds, and have little to no experience with traffic rules.

On the Trick-or-Treat trail?

As a parent or caregiver, there are a few important things you can do to protect your trick-or-treaters on the Halloween trail.

  • Light the way. Bring glow sticks or a flashlight with extra batteries so your trick-or-treater can see (and be seen) in the dark.
  • Be visible. Put reflective tape on clothes, costumes, and trick-or-treat bags so your trick-or-treater can be seen by passing motorists.
  • Use the crosswalk. Cross the street at a crosswalk or intersection. Never cross the street from between parked cars and don’t assume you have the right-of-way.
  • Stay on the sidewalk. If available, use the sidewalk. Otherwise walk on the shoulder facing traffic.
  • Pay attention. Distracted walking can be as hazardous as distracted driving so watch where you are going.
  • Review traffic safety. Talk to your trick-or-treater about basic traffic laws before leaving the house.

Driving on Halloween?

  • Remove distractions. The Spooky Truth: In 2015, 5,376 people died while walking along roads – 26 percent of those deaths happened at night. Nearly 1/3 of the deaths that happened in the fall months (i.e., September, October and November) of that year occurred in the evening hours between 6 and 9 p.m. Put your phone in the glovebox or the back seat.
  • Practice defensive driving. Be cautious and stay alert to reduce your risk of getting into a crash. Enter and exit driveways and alleys carefully.
  • Watch your speed. Pay attention to the speed limit and drive slower when you are around pedestrians.
  • Be prepared to stop. Trick-or-treaters may ignore crosswalks and traffic signals so stay alert. Do not pass a vehicle stopped at a crosswalk – they may be stopped for a pedestrian.
  • Do not drive under the influence. Every 51 minutes, one person in the United States dies in a motor vehicle crash that involves an alcohol-impaired driver.
  • Properly buckle kids no matter how short the trip. Properly buckling children in their car seats, booster seats, and seat belts when transporting them and making sure that their costumes don’t interfere with them being properly buckled.

Learn more

Have a fun and safe Halloween!

Preparing for the Worst-case Scenario

"ROTTERDAM, HOLLAND - SEPTEMBER 5, 2010: Demonstration of handling of car crash victim by medics at the annual World Harbor Days in Rotterdam, Holland on September 5"
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event.

Setting the Stage

Celia Quinn
Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success

Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.
Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs: