Texas Children’s Hospital spearheads initiative to prioritize pediatrics in disaster planning
Children tend to be an afterthought in disaster planning — despite most people agreeing that children should be prioritized in emergencies.
One of the lessons the COVID-19 pandemic taught health care professionals is that the state of pediatric care in the U.S. is tenuous. Many children’s hospitals nationwide are underprepared for widespread disasters, from treating an influx of pediatric patients to delivering highly specialized care, obtaining critical supplies, maintaining operations, ensuring continuity of care and reunifying families.
Should children’s hospitals become overwhelmed in a crisis, there are significant shortcomings in the broader health care system. General hospitals that provide adult care are not equipped to care for children. They do not have deployable emergency teams related to pediatrics. Health care coalitions, agencies and government entities typically lack a pediatric perspective.
This is why the Administration for Strategic Preparedness and Response (ASPR) awarded a $3 million federal grant to Texas Children’s Hospital and Baylor College of Medicine “to create and lead the Gulf-7 (G7) Pediatric Disaster Network as a Pediatric Center of Excellence.” The grant was issued in September 2022.
Addressing risks in the Gulf Coast region
The goal of G7 is to combine pediatric expertise throughout the Gulf Coast region — breaking down the silos that often characterize the work of major hospitals and health care practitioners — to develop coordinated responses to disasters that impact children in highly specialized areas of medicine, such as:
Behavioral health
Burns
Exposure to chemical, biological, radiological and nuclear agents
Infectious diseases
Trauma
G7 encompasses Texas, Louisiana, Mississippi, Alabama, Georgia, Florida and Puerto Rico — an area so broad it covers three Federal Emergency Management Administration (FEMA) regions. As the regional leader, Texas Children’s serves as a hub for all planning activities, knowledge and resource sharing.
“No one wants to build the ark while it is raining,” said Amy Arrington, MD, PhD, Assistant Professor of Pediatrics, Divisions of Critical Care Medicine and Tropical Medicine; Medical Director of the Special Isolation Unit (SIU); and G7 Regional Medical Director and Co-lead of the Clinical Resources Domain. “The goal is to be prepared in advance so you can weather the storm when a crisis inevitably happens.”
“If you are a smaller hospital, where do you even start when thinking about natural disasters, pandemics or chemical exposures? At a minimum, you need budgets, checklists, processes, training and personnel to start these programs. At Texas Children’s Hospital, we have extensive resources and clinical capabilities at our fingertips. For other hospitals, creating these things takes so much time and effort that does not exist alongside competing priorities. Sharing what we know and have with others is a real gift,” Dr. Arrington said.
G7 is the third ASPR-funded region in the U.S., following the Western Regional Alliance for Pediatric Emergency Management (WRAP-EM), based at the University of California at San Francisco Benioff Children’s Hospital, and Region V for Kids, based at Rainbow Babies & Children’s Hospital in Ohio.
Localizing knowledge and resources
“In creating these smaller regions within the U.S., we are keeping subject matter expertise local and focused on individuals in the pediatric health care field who deal with the same threats routinely,” said Brent Kaziny, MD, Emergency Physician, Co-director of the Disaster Domain for Emergency Medical Services for Children and G7 Principal Investigator at Texas Children’s. “There is no need to start from scratch or reinvent the wheel when blueprints exist for managing these threats successfully.”
On the Gulf Coast, examples of common natural threats include hurricanes, floods and tornadoes.
“I am often contacted by hospitals around the country for advice on a range of different resources. Usually, these individuals are unaware of someone in their own backyard who is an expert on the subject matter, and collaboration will be the key to future improvements,” Dr. Kaziny said.
Dr. Kaziny looks forward to this endeavor bringing new expertise to the table.
“In my past involvement with federally funded grants, it is often the same 20 people across the country who participate. I enjoy meeting new people who are equally invested in disaster preparedness and learning about subject matter experts in my region who have not been involved before but are now,” he said.
Partners in the G7 network
Texas Children’s works with seven federally funded partners in pediatric health care to improve disaster readiness:
Children’s Hospital of Alabama
Children’s Healthcare of Atlanta
Children’s Hospital of Mississippi
Children’s Hospital of New Orleans
University of Miami
University Pediatric Hospital in Puerto Rico
Southeast Regional Advisory Council
“Eventually, once we get preparations in order at our partner institutions, we want to expand our work to smaller children’s hospitals and general hospitals,” Dr. Arrington said.
An ambitious agenda
The ASPR grant funds a variety of disaster readiness activities at Texas Children’s and funded sites:
Education — In collaboration with the Texas A&M Engineering Extension Service (TEEX), which delivers world-renowned disaster readiness training, Texas Children’s is launching a two-day, on-site disaster training course, Pediatric Preparedness for Health Care Professionals. TEEX and Texas Children’s will also implement an annual, full-scale emergency drill across specialties at each funded location. Additional training on specific topics will be available online.
Communities of Practice — Texas Children’s shares its contact list and encourages other institutions to identify their go-to disaster coordinator and compile a database of contacts to exchange information across the region. Additionally, G7 partners are prompted to work with their local and state health care infrastructure to incorporate pediatric perspectives.
Informatics and Technology — Hospitals will focus on leveraging telemedicine capabilities in a disaster and developing data from each site to improve real-time situational awareness across the region. For example, region-wide pediatric dashboards can show ICU and hospital bed availability, supply chain issues and resource requests.
Operations and Logistics — Working as co-lead with Mark Baker, MD, MPH, of Children’s Hospital of Alabama, Texas Children’s personnel are assessing emergency management-centric activities and exploring how to standardize these across the network. This initiative includes incorporating pediatrics into pre-existing teams and potentially creating pediatric emergency deployable teams for the region. Supply chain experts at each site are encouraged to plan together for sharing resources.
Clinical Resources — Texas Children’s is developing a group of subject matter experts across disciplines to standardize the delivery of care across the network in a crisis and is building models for real-time responses.
“If we can achieve one-tenth of what we set out to do this year, Gulf Coast preparedness to handle another emergency will be much improved,” Dr. Arrington said.