Emergency managers discuss the need to design disaster plans that will keep elderly, disabled and lower-income residents safe during disasters, but children are another uniquely disadvantaged population due to their limited mobility and inability to act independently of someone else's care.

In the wake of the increased frequency and mortality rates of disasters over the last 10 years, last year Congress created the National Commission on Children and Disasters to study how emergency managers and care providers could better provide for children's needs during disasters. When a disaster impacts a community, it impacts a child in more and different ways than it might impact an adult. In most cases, a children's need include food, shelter, clothing, and even school and social structure.

In terms of health care, the American Academy of Pediatrics found that fewer than 10 percent of emergency rooms have the required or suggested equipment to effectively treat pediatric emergency room patients on a day-to-day basis.

This creates the possibility of an emergency room being unprepared for a "disaster of one," never mind a hurricane or terrorist attack. "In this country, in rural America, if one child is hit by a car and taken to an emergency department that is underprepared for that child, that is already a disaster in my mind," said Dr. Michael Anderson, vice chairman of the commission. "And I don't think it's fair to expect emergency departments, [emergency medical services personnel and] local response networks to take care of 50 kids if we haven't done a good job of preparing for that one child."

The commission's interim report, to be released in October, will reflect an assessment of persistent gaps in emergency preparedness, response and recovery regarding children and will include recommendations to fill those gaps. "I think some of those acute medical needs and medical countermeasures for children, the whole process of emergency authorization use and stockpiling and all those very important, but very granular issues are going to be covered in some significant depth by our interim report and our final report as well," Anderson said.

Recommendations

The report's recommendations will include establishing offices within the Federal Emergency Management Agency and U.S. Department of Health and Human Services to advocate for children's needs during disaster planning. The report also will recommend standards for sheltering children and that child care is elevated to an essential community service eligible for federal reimbursement. "People are really thirsty for the proper training in how to recognize, take care of, and potentially triage and treat children when they are in disasters," Anderson said. "We are going to have some recommendations for the basics of training -- which are really competency-based -- that we want to see integrated into local, state, regional and, of course, federal responses."

Anderson noted that the Red Cross does a good job of managing shelters, but there are numerous other faith-based or smaller organizations that want to set up emergency shelters when disasters hit. "We really want to reach out with some basic guidelines that say ‘Hey, don't forget about 25 percent of your population,'" he said. "Make sure as best you can that you're ready for the needs of children, whether it's identification and reunification of families, whether it's separate areas for families ... [or] the basics of food and drink."

Anderson would also like to see an expansion of the number of federal Disaster Medical Assistance Teams (DMAT) with specialized pediatric training. He said there are about 40 DMAT teams nationwide, but only one or two pediatric-specific teams. "There are also some small studies that show that these DMAT teams need more equipment, need more training [and] need to integrate more within the pediatric network across this country," he said.

Making Children a National Priority

The commission is trying to work with the U.S. Department of Homeland Security and U.S. Department of Health and Human Services to ensure that state and local agencies include children in their emergency preparedness and response plans in alignment with national strategies when defining target capabilities and submitting grant proposals, according to Chris Revere, the commission's executive director.

"We want to make sure that kids are elevated in those documents, so that folks recognize that when they are putting their plans together and submitting grant proposals that if they're writing things around kids they're going to find that there will be monies available to support those planning functions," he said.

The commission is working with the departments on guidance for fiscal year 2010 that will define what expenditures will be eligible for grants and reimbursement by the federal government. The guidance is expected to be available in the fall.

[Photo courtesy of FEMA News Photos]