Children comprise more than a quarter of the U.S. population and account for a fifth of all hospital emergency department visits. Yet in 2013 when the National Pediatric Readiness Project assessed approximately 5,000 U.S. emergency departments, less than half of the 82 percent of hospitals that responded reported having written disaster plans addressing the specific needs of children.
The physical and psychological needs of children in disasters aren’t the same as those of adults, and healthcare workers need specific training and equipment to provide this care on both a day-to-day basis as well as during a disaster. Now there’s a tool to help healthcare facilities plan for children’s unique health needs in disasters.
Treating children requires clinicians to have different sized equipment and training in order to perform the procedures needed in an emergency situation, for example, to start IV-lines or ventilators. Pediatric patients require different medication dosages, and they have different health needs based on age, height, weight and emotional development. Young children tend to be less verbal, yet children of all ages are often more fragile and more affected by the stress of disasters than adults and often display these effects in different ways than adults. Disasters can take a heavy toll on a child’s development if not handled with care.
There are legal implications, too, that need to be considered in disasters. Children can’t consent to their own care, so parents and children may need to be treated in the same hospital to avoid the legal and emotional issues that result from separation. Hospital planners also need to consider that parents may not be willing to be treated in a different hospital than their children. Communities face similar dilemmas in planning for evacuation since children’s needs in emergency shelters differ from adults’ and must be considered in advance.
Medical surge also presents very differently for children than for adults. Surge may require that providers who don’t usually treat children do so in disasters. This possibility is important to account for in all surge planning. In addressing surge capacity for children’s care, one approach communities could take is to identify tiers of hospitals that treat pediatric patients as well as adults. Working as part of healthcare coalitions, hospitals can distribute resources and patients to support the community effectively and cost-efficiently.
To help hospitals and communities plan for such differences, ASPR worked with the HHS Health Resources and Services Administration (HRSA) and the HRSA Emergency Medical Services for Children (EMSC) Program to create a unique checklist to address pediatric domains to support hospital administrators and leaders when trying to incorporate pediatrics into their existing disaster plans; it is available as an interactive or downloadable tool.
The team consulted with a wide range of subject matter experts (SME’s) to develop consensus on ten essential domains of pediatric planning that should be incorporated into disaster policies for all hospitals. Then they identified and built on existing resources to create a checklist to help administrators and clinical leaders incorporate pediatric elements into hospital disaster plans. The team even incorporated real-world experiences, like New York University Hospital’s experience evacuating neo-natal patients after Hurricane Sandy.
To help promote the needs of children in disasters, the team included an online compendium of resources related to medical and public health issues for children in disasters and emergencies. Then they pilot tested the new tool.
Let’s move the dial from less than 50 percent to 100 percent of hospitals and healthcare facilities planning for the needs of children in disasters. The next level, of course, is to exercise those plans.
Has your facility cared for children and families in disasters? If so, share your best practices and lessons learned by commenting on this blog.
“Everybody can be great because anybody can serve....You only need a heart full of grace. A soul generated by love. And you can be that servant.” - Dr. Martin Luther King, Jr.
Each time that individuals unite to help others, a step is taken to make Dr. Martin Luther King, Jr.’s dream for a better world come true. Volunteer service is a great way to serve our communities and help make that dream a reality.
Millions of people throughout the country will participate in Dr. King’s legacy on January 19, 2015 as part of this year’s Martin Luther King, Jr. Day of Service. This service day is part of United We Serve’s national call to service initiative and honors Dr. King’s life and ideals by empowering individuals throughout the nation to work together to serve the needs of the community through volunteerism.
Volunteers can dedicate their time and skills to help ensure that their communities are more resilient by volunteering with programs like the Medical Reserve Corps (MRC). The MRC is a national network of locally based and run groups of volunteers, organized and committed to strengthening public health, improving emergency response capabilities, and building the resiliency of their communities. It is a great example of people united from all walks of life that have a variety of skills, experiences, and backgrounds but unified by their mission.
Local MRC units and their volunteers are trained and work within their community’s local health, preparedness, and response infrastructure to be available to ensure there is a sufficient medical surge capacity and workforce in the event of an emergency. MRC volunteers also promote preparedness and serve as public health ambassadors to their communities in order to help reduce potential risks and vulnerabilities in their communities should an incident occur.
The Martin Luther King, Jr. Day of Service is a great reminder to take a day, give back, and make a difference in our communities! However, volunteering is something that we can do throughout the year as well. The MRC is a great opportunity to get involved with the local community to make it more resilient, safe, and healthy.
For more information about volunteering or partnering with the MRC, please visit http://www.medicalreservecorps.gov. To learn more about Martin Luther King, Jr. Day of Service, visit http://www.nationalservice.gov/special-initiatives/days-service/martin-luther-king-jr-day-service-0.
We often hear that natural disasters are stressful and, in public health, we recognize that people may have difficulty coping. It’s easy to see why. Homes, businesses, daycares, healthcare facilities and doctors’ offices are physically destroyed. Impacts on the local economy and personal financial stability are visible. What we don’t often consider is that disease outbreaks can be just as stressful and that coping may be just as difficult. The unknown or unfamiliar nature of diseases breeds fear and concern that hold very real consequences for our communities. Distress and concern, if unaddressed, can lead to unneeded quarantine directives and income loss, as well as unnecessary medication purchases or surges in emergency room visits.
After the emergence of Severe Acute Respiratory Syndrome (SARS) in 2005 and of the H1N1 flu in 2009, researchers and practitioners examined the psychological impacts on patients who were quarantined. These patients expressed feelings of anger, sadness, guilt, loneliness, and fear for the welfare of friends and family. In addition, patients worried that they would lose income due to quarantine and that their contacts, families, and friends would be stigmatized. These concerns are now being expressed by health professionals working on the front lines to combat Ebola.
These emotions and their consequences must be considered as public health agencies and health care professionals talk about a new or emerging disease. Leveraging risk communication can help. Risk communication research demonstrates the importance and effectiveness of addressing fear and concern. The research shows that unless we address the emotions tied to the situation, the scientific facts will be ignored.
During the 2009, H1N1 outbreak, the National Preparedness and Response Science Board (formerly the National Biodefense Science Board) provided guidance and recommendations for public health agencies on how to integrate behavioral health into interventions and how to address communication and messaging around pandemic flu for the public. These recommendations aligned with decades of research into the practice of risk communication and remain relevant today.
The board’s recommendations included:
- Provide messaging to reduce stigmatization of groups as needed, and utilize trusted community and faith-based leaders to help promote healthy behaviors
- Take into account factors such as culture and ethnicity, age, disability, and medical conditions (including serious mental illness and pharmacologically dependent)
- Maintain sensitivity to terminology and need for actionable guidance
- Discourage use of imprecise term “worried well”
- Provide a short explanation of why people are being asked to refrain from usual behavior and tell them what action to take instead
Public health and healthcare professionals can move risk communication principles and this advisory board’s expert recommendations into practice not only by informing and advising the public on protecting health, but also by acknowledging and normalizing the emotional response to the situation, including an infectious disease outbreak. When we are anxious, worried, or scared, our bodies and thought processes don’t perform optimally; we’re less able to process instructions, follow directions, or even remember that we received information on what to do.
When our fears and concerns are acknowledged, we immediately want to know what our community leaders are doing to protect us now and in the future and – just as important – what we can do to protect ourselves, have a voice in decisions that impact us, and feel in control of the situation. This information, too, helps support the behavioral health of our patients, family, friends, the community and the nation.
Among the most important elements in helping people “get the message” is listening. Incorporating what we learn through psychological first aid into our communications can help. The World Health Organization provided recommendations based on the principles of Psychological First Aid which reflects the emerging science on how to support people in the immediate aftermath of extremely stressful events.
Offering psychological first aid means that we look to check for serious distress reactions; ask about needs and concerns; actively listen; help people address basic needs and access services; give actionable information, and connect people with loved ones and social support.
By identifying the behavioral health concerns of disease outbreaks and acknowledging and addressing these concerns in the way we communicate, public health and health care professionals can make an important impact on the way the community copes with the situation. We can help community members make sound decisions, protect health and, overall, boost our community’s resilience.
Want to know more addressing the psychological impacts of diseases? Check out this video webcast on the Psychological Impact of Pandemics made during the H1N1 pandemic.
Are people in your community stressed about Ebola? Refer them to the Disaster Distress Helpline, 1-800-985-5990. The HHS Substance Abuse and Mental Health Services Agency offers a wealth of other resources, too, from tips to training to a cell phone app.
Our nation achieved a milestone in preparing for pandemic influenza with the FDA approval Friday of Rapivab (peramivir) to treat acute, uncomplicated influenza infection in adults 18 years and older.
Rapivab is the third neuraminidase inhibitor approved by the FDA to treat flu infection, but the first approved in an IV formulation that can be administered in a single dose. This distinction is important for patients who may be unable to swallow pills or inhale a medication.
BARDA has long recognized the need to have antiviral drugs readily available for the treatment of influenza. Each year 5-20 percent of the U.S. population develop seasonal flu and could benefit from antiviral treatment. During influenza pandemics, the number of people who become ill can increase rapidly before an influenzavaccine is available and frequently exceeds 25 percent of the total population. Having effective antiviral drugs readily available is a pillar of our preparedness for such public health emergencies.
Neuraminidase inhibitors are commonly used to treat flu infection. These drugs inhibit an enzyme called a neuraminidase, which releases viral particles from infected cells so the virus cannot infect the body’s uninfected cells. This means your body can fight the infection faster and reduces the time and severity of flu symptoms.
So beginning in 2007, we awarded a $234.8 million contract to BioCryst in 2007 to develop peramivir for use in pandemic influenza infections. The safety data collected under this development program allowed FDA, during the 2009 H1N1 pandemic, to issue the first Emergency Use Authorization in its history for an unapproved product to treat patients with severe influenza.
The drug becomes the 15th product sponsored by BARDA to earn FDA approval to prevent, diagnose or treat influenza. That’s tremendous progress in less than 10 years. We are proud to have supported development of this influenza therapeutic and so many others to help meet the needs of influenza-infected patients during a public health emergency and every day
As we are in the throes of the season of giving, we consider all the ways we can contribute – to our families, places of work, and communities. We reflect on the past year and look ahead to a new beginning. It is the time to consider ways to improve and grow in the future. One way that we can do that is through service. This year, we saw struggles with natural and public health events, including the Oso Mudslide and Ebola. In the midst of crises, there are those who step up to serve. These are the the backbone to communities’ resilience. Whether an emergency response or on-going work to support the health of a community, volunteers give their time, expertise, and heart.
The Medical Reserve Corps (MRC) offers an outstanding opportunity to help keep your community healthy, safe and strong. The MRC is a national network of units made up of medical and public health volunteers, as well as others, with a mission to improve the public health, emergency response, and resiliency of communities.
Volunteers assist in many roles, including communications, logistics, safety and training. MRC teams help promote everyday health as well as volunteering during disasters. They teach people how to develop a family preparedness plan, provide screening for high blood pressure and diabetes, vaccinate members of their communities against the flu, and so much more. No matter the size of the disaster or the magnitude of the crisis, it is the first responders and the local volunteers that understand the needs, know the lay of the land, and are there from the first call to the end of recovery. They are the ones there between the disasters, caring for their neighbors, and providing the on-going - and sometimes unrecognized - support that is needed to keep the towns, cities, and counties in good health.
Through the efforts made every day to improve the lives of those around them, people in the MRC and other volunteer organizations are reducing risk and increasing the capability and capacity of a community to bounce back from tragedy. As we look to the future, we take from the success of the past, as well as the shortfalls, to build our skillsets, strengthen our capabilities, identify our needs, train to better respond, and create communities of health and resilience.
When you now think of how and where you can give, consider volunteering. In fact, those who give find themselves happier and healthier. So you might just find yourself the recipient of more joy in 2015 when you make the time to give. The best part is that anyone can volunteer. There is a role and a place for every person that wishes to share of themselves. It is important to remember during this busy and often overwhelming time of year that giving is not always monetary and that often, the greatest presents are from the heart and handmade. With that said, I ask you, what better gift could you give than your time and expertise as a volunteer?
Responding effectively to a catastrophic incident involving the release of hazardous chemicals could be a daunting challenge. In the United States approximately 25 million people live near chemical facilities. In a catastrophic incident, up to 10,000 of those living nearest to those facilities could be at risk of chemical exposure. The potential for chemical terrorism or warfare, like the sarin gas attack in Syria in 2013, poses similar challenges.
To protect health and save lives in such catastrophic incidents, first responders, medical providers, and public health officials will want to make decisions about how to decontaminate patients based on scientific evidence. Now the nation’s first evidence-based guidance is available to help our communities plan to do just that. The new guidance is flexible and scalable so it can be applied to various types and sizes of incidents, including those that affect a small number of people.
That’s important because while most people only think about chemical spills or attacks when the catastrophes hit the news, large quantities of hazardous chemicals are made, transported, stored, and used in homes, offices or industrial settings every day in the United States. Even taking every safety precaution, there still is a risk that the chemicals could be released into the environment either by accident or intentionally to cause harm. In fact, an estimated 15,000 chemical incidents occurred in the U.S. in 2012, according to the Agency for Toxic Substances Disease Registry.
Many toxic chemicals are readily absorbed into the body and cause injury and illness quickly. Decontaminating patients can prevent or limit absorption of the chemical and minimize adverse health effects. Decontamination also can prevent the spread of contamination to other people (including responders and receivers) and to health care equipment and facilities. In fact, since it can protect health, patient decontamination is considered a medical countermeasure.
ASPR and the U.S. Department of Homeland Security’s Office of Health Affairs led the effort to develop this first-ever evidence-based guidance. Joining us were experts in emergency response, emergency medicine, toxicology, risk communication, behavioral health, and other relevant fields from academic and non-government organizations and federal, state, and local agencies.
The guidance covers mass casualties, chemical release, external contamination, and decontamination of people (not animals, not inanimate objects, not facilities). To shape and substantiate the recommendations, this working group of experts sought out and used all of the evidence available. The new guidance also incorporates public comments received last spring.
In crafting the guidance, the team recognized that the primary goal of patient decontamination should be improved health outcomes. The team also acknowledged that as a medical countermeasure, patient decontamination needs to be coordinated with other medical aspects of the emergency response and that patient decontamination is a whole community issue.
The final guidance encourages communities to have a risk and crisis communication strategy in place pre-incident to reach all community members. System-wide coordination and responder communication is essential, too, especially between on-scene responders and hospital-based receivers. So the working group recommended a tiered, risk-based approach which matches the nature and extent of decontamination to the characteristics of the incident.
To be sure the guidance is easy to use recommendations are organized by functional components of a response. In the extensive process to develop this guidance, the team found that more research is needed to answer many of the essential questions. So the guidance will be updated periodically as new evidence becomes available.
Responders and public health officials: if you’ve experienced a chemical spill in your community, you can share your experience and your thoughts on the new guidance by commenting on this blog.
The holiday season is usually one of the busiest and most chaotic times of the year and it can be easy to neglect one of the most important items on your to do list – getting a flu vaccination. In particular, parents and guardians of young children need to make time to get the whole family vaccinated. While the importance of getting the flu shot is confirmed by public health and medical professionals, many parents and guardians still ask, “Does it really make a difference for my child?”
The answer is yes. The Centers for Disease Control and Prevention (CDC) recommends an annual flu vaccine for every person six months and older as the first and best way to protect against the flu. Children younger than five, and especially those younger than two, are at high risk for severe flu complications. Children with chronic medical conditions including asthma and seizures are at even higher risk. On average, 20,000 children under the age of 5 in the U.S. are hospitalized annually with flu-related complications. An annual flu vaccination is one of the quickest, easiest, and best ways to help protect your child.
Children are at risk for contracting the flu throughout the season. If your child is being cared for by a child care provider, in a preschool, or at a Head Start center, then you know that your child is spending time with lots of other children and adults who can carry the virus. Even if your child stays home, he or she probably frequents playgrounds, play groups and other places where children and adults gather. Getting a flu vaccination protects your child and keeps him or her from spreading the virus to others.
Vaccination can also help keep your child healthy if a disaster strikes. Disasters don’t usually give much warning and it takes a couple of weeks for your vaccination to protect you from the virus. Flu vaccinations should be integrated into preparedness plan alongside actions such as making a preparedness kit and creating a family reunification plan. During or after a disaster, the last thing you want to worry about is whether or not your child could become sick with the flu – or how to keep your child safe if he or she already has it when disaster strikes.
Getting your child vaccinated is easy and it can even be painless. Your child can get vaccinated by their healthcare provider or you can find a place to have your child vaccinated with the Flu Vaccine Finder. And remember that a flu vaccine doesn’t have to mean a flu shot. Recent studies indicate that the nasal spray flu vaccine may work better than the flu shot in children age 2 through 8. However, the nasal spray is not for children under 2 years old. If your child is under 6 months old, your child can’t get the flu vaccine, so it is especially important to make sure that everyone else in the house has gotten vaccinated. To learn more about your options, check out Flu.gov or talk to your pediatrician.
Even with a flu vaccine, your child could get the flu. However, the flu vaccine can help reduce the severity of the flu in case your child does become ill. If your child has the flu, symptoms may include a fever, headache, coughs, chills, sore throat, fatigue, runny or stuffy nose, vomiting and diarrhea, or body aches. If you suspect your child has the flu, see your pediatrician.
The Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Administration for Children and Families (ACF) encourage you to take steps to protect your children from the flu so that you can keep them safe and healthy in disasters and every day.
Every day, we rely on antibiotics to stay healthy – and having effective antibiotics is even more critical to help treat bacterial disease during a disaster or infectious disease outbreak caused by bacteria. Though we know that disasters will strike again and disease outbreaks will continue to happen, we can’t be sure that the antibiotics that we rely on will continue to be effective in fighting bacterial infections.
The antibiotic pipeline responsible for developing new antibiotics has been crumbling over the last 30 years. Antibiotics are costly to develop so many companies have shifted their focus to medicines to treat chronic diseases, since these medicines bring larger and more reliable returns on their investments than antibiotics.
To reverse the decline of the antibiotic pipeline, we need a strategy for creating a market, promoting public-private partnerships, and providing funding. The White House has recently put a series of plans and strategies in place to support those objectives.
On September 18, 2014, President Obama signed an Executive Order on Combating Antibiotic Resistant Bacteria. The Executive Order expanded BARDA’s authority to develop new and next generation countermeasures that target antibiotic-resistant bacteria that present a serious threat to public health. This allows BARDA to use its resources more efficiently and increases the breadth of technological solutions we can bring to bear.
As one example of how these new authorities can be used, BARDA can now support narrow spectrum or pathogen-specific products such as monoclonal antibodies against Pseudomonas aeruginosa. This infection strikes patients in hospitals, especially those on breathing machines, using devices such as catheters, with wounds from surgery, or with wounds from burns. In the wake of a major disease outbreak, hospitals rely on these devices for patient care, thus increasing risk of Pseudomonas aeruginosa. In a disaster that involves an increased number of injuries and burn victims, you would also expect to see increased instances of Pseudomonas aeruginosa. By finding a way to combat this disease, BARDA is supporting an all-hazards medical response.
The National Strategy for Combatting Antibiotic Resistant Bacteria was created, in part, help find a solution that creates the required business case for additional antibiotic development. The national strategy called for the expansion of opportunities for public-private partnerships like those already active within the Broad Spectrum Antimicrobials (BSA) Program as well as the establishment of a biopharm incubator to accelerate research on new antibiotics and other tools to combat resistant bacteria. Public-private partnerships are the foundation of the BSA program and have been used successfully to date to engage companies developing novel antibacterial therapeutics.
In their Report the President on Combatting Antibiotic Resistance, the Presidential Council of Advisors on Science and Technology (PCAST) recommended that BARDA receive $400 million in advanced research development funding annually. In addition, the report recommended that an Antibiotic Incentive Fund be established at a funding level of $4 billion over ten years. The fund would be used to incentivize companies developing antibiotics thru milestone payments; advance market commitments; and reimburse late stage development or post marketing commitments. Legislative action will be needed to enact any of these recommendations.
Reversing the decline in antibacterial drug development will require a response similar to the one BARDA and the rest of the U.S. government used to overcome market failures in combating influenza and chemical, biological, radiological and nuclear threats to our nation’s health security. Dedicated funding for antibiotic development, flexible appropriations, the continued ability to enter into innovative partnerships, and a clear mandate will better enable BARDA to help our nation combat these threats.
Leveraging experience and investments to help respond to the Ebola outbreak
BARDA is moving forward in innovative ways to close the gap in vaccines and therapeutics needed to protect the public’s health from Ebola. One promising therapeutic candidate is ZMapp, a unique monoclonal antibody therapeutic that consists of three antibodies targeting the Ebola virus. These antibodies, which are produced in genetically modified tobacco plants, are combined together in a “cocktail” that has shown great promise in animal studies. So far it has been used to treat five patients, four of whom have survived. This is great news, of course, but it is too early to make any claims about the product’s efficacy based on this limited data.
On September 2, 2014, BARDA awarded a contract to Mapp Biopharmaceutical to accelerate the development and testing of ZMapp. BARDA is providing funding as well as technical assistance to scale up manufacturing of ZMapp. We hope to have enough drug by January 2015 to begin clinical studies with ZMapp and increasing quantities will be available over time for additional clinical studies as we improve our capability to manufacture it.
BARDA routinely provides assistance to vaccine and therapeutic manufacturers to help them increase the production capacity of their products to commercial scale. BARDA is currently supporting the manufacture of sufficient doses of ZMapp for initial clinical safety and efficacy studies and it is working with other domestic manufacturers who can produce monoclonal antibodies in tobacco plants in order to maximize the production of ZMapp.
In addition to providing direct support to Mapp Biopharmaceutical, BARDA is utilizing its Centers for Innovation in Advanced Development and Manufacturing (CIADMs) to produce monoclonal antibodies like those found in ZMapp to fight Ebola. The CIADMs were established in 2012 to develop and manufacture medical countermeasures during a public health emergency. In parallel, we are working with other manufacturers to develop and manufacture other Ebola monoclonal antibodies using specialized mammalian cells and state-of-the art antibody development and manufacturing technologies.
Once a therapeutic drug or, in this case, monoclonal antibody cocktail has been produced, it will still need to be packaged and vialed for use in clinical settings. As part of our pandemic preparedness efforts, BARDA established a Fill Finish Manufacturing Network to fill vials and finish packaging after the product has been produced. This network, which celebrated its first anniversary last month, will be used to formulate and fill Ebola antibody and vaccine products into vials for studies and other uses.
We have these capabilities today because of the effective plans and investments that we put in place starting in 2010. Because of these investments, we may be able to produce a lifesaving medical countermeasure against Ebola more quickly today. The Ebola crisis is validating these investments in real time.
These national assets will serve us well and highlight how important such investments are. They stand among ongoing preparedness efforts that better position us nationally to deal with Ebola and other public health threats.
Leveraging the assets, partnerships, and processes we’ve established over the past decade, we will fight this epidemic more effectively, expand the options for preventing and treating Ebola, and ultimately defeat this threat to our national and global health security.
It is hard to predict when a disaster will strike, how severe it will be, or exactly how it will impact a community’s health. But here’s something that we do know: Communities that are connected before a disaster strikes are more capable of safely dealing with that disaster; more flexible in their response to the diverse challenges it brings; and ultimately, better able to protect the health and safety of their members.
So, what does a connected community look like?
A connected community has diverse partnerships, high levels of trust and the ability to work together. All three of those things take time to develop, but once they are established, they can make the community better able to mobilize their networks and respond to or recover from a disaster. Ultimately, they can work together to reduce the impacts of the disaster and help protect people’s health and safety.
Daniel Aldrich, an associate professor of political science Purdue University, argues that social capital —formal and informal bonds that tie individuals together—can foster more effective long-term recovery. He has studied disasters and found that social capital and the trust, or lack thereof, between individuals and organizations in disaster-affected communities can help us understand why some communities are able to bounce back from an emergency event while others struggle with recovery.
Community connectedness can happen at many levels. Individuals can engage with their local civic organizations or just get to know their neighbors. Community organizations can work with each other and with state or local governments to plan on ways that they can help one another every day – and especially when disaster strikes.
Building these connections can be a challenge for many communities, but the benefits of creating a more connected community can include everything from healthier individuals and families, lives saved and communities that are more resilient in the face of a disaster. Ultimately, more connected communities contribute to our national health security.
This Veteran’s Day, as we honor service to our nation, we encourage you to think about ways that you can increase social connectedness as a way to serve your community. In particular, try to think about how community leaders and diverse stakeholders can join traditional disaster planning partners to work together to make their communities more prepared and resilient. Get involved and share your ideas on our IdeaScale collaboration community, Increasing Social Connectedness to Improve Community Resilience .