Issue #24: September 1, 2015

NEWS

WORLD HEALTH ORGANIZATION CRITICIZED FOR EBOLA RESPONSE – An international panel of experts commissioned by the World Health Organization sharply criticized the WHO’s response to the Ebola crisis: a 5 month delay before declaring the emergency and the lack of operational capability or funds to respond to the crisis. The international president of Doctors Without Borders, one of the few organizations that effectively responded to the West Africa Ebola outbreak, said, “The reality today is if Ebola were to hit on the scale it did in August and September (2014), we would hardly do much better than we did the last time around.” In fact, there is no international health emergency manager. Countries lacking well developed healthcare systems cannot provide the necessary resources to control massive infectious outbreaks.

REPORT ON PEDIATRIC SURGE CAPACITY – The National Advisory Committee on Children and Disasters has published a report on the current state of readiness to transport large numbers of critically ill children and accommodate them in emergency departments, children’s hospitals, nonpediatric hospitals. The problems inherent to infectious outbreaks were the focus of particular attention. Strategies were explored to close the gaps, including the utility of healthcare coalitions, but planning is limited by lack of evidence on existing resources or how to extend them.

PEDIATRIC DISASTER RESPONSE AND EMERGENCY PREPAREDNESS COURSE – This course, sponsored by Washington, DC Emergency Medical Services for Children, prepares for a disaster incident involving children. Pediatric specific planning considerations include mass sheltering, triage, reunification, and decontamination.

NORTHWEST US EARTHQUAKE DANGER – NOT WHETHER, BUT WHEN? – A major geological fault line, the Cascadia subduction zone, lies just off the coast of Northern California, Oregon, and Washington. A tsunami following a major earthquake could reach the Pacific Northwest coast in 15 minutes. Based on the historical record, it is estimated that the Cascadia fault has a 243 year average interval between earthquakes. It is now 315 years since its last major quake. Unfortunately, the existence of the Cascadia fault was unknown 50 years ago, and the earthquake risk only has been known for about 30 years. The Pacific Northwest is entirely unprepared. See the article in the New Yorker.

REPORT FROM UPMC ON RESPONSES TO BIOTERRORISM ATTACK – The Center for Health Security at the University of Pittsburgh Medical Center reports expert consensus on improvements needed to effectively respond to a national crisis resulting from a bioterrorism attack. Key action items: governance, public health measures including restoring the declining public health workforce and budgets, medical countermeasures, healthcare system and coalitions, decontamination and remediation.

PEDIATRIC EARLY HOSPITAL DISCHARGE TO EXTEND SURGE CAPACITY – A Delphi consensus method was utilized to formulate categories estimating the risk of a serious adverse event if patients were discharged early from the hospital, classified according to the interventions they were receiving while hospitalized. Next step: to empirically determine how many beds could be freed up at an acceptable low level of risk.

PEDIATRIC PTSD AND COMORBIDITIES AFTER REPEATED TRAUMA – A study was performed to determine the extent to which mental health comorbidities complicated the diagnosis of PTSD in children exposed to repeated traumatic events compared with single events. Cumulative numbers of events were associated with PTSD symptoms, but not with greater symptom complexity.

SHELTER MENTAL HEALTH EXPERIENCE – Based on experience serving evacuees after Hurricanes Katrina, Rita, and Gustav, operational details are provided that may guide other communities. Approximately 10% of the populations served in the shelters were children or adolescents.

EBOLA VACCINE – A small Ebola vaccine trial conducted in Guinea shows potential for effective disease prevention. Patients exposed to Ebola were randomized to immediate or delayed (21 days) vaccination. In the immediate vaccination group (n=4123), no cases developed after a 10-day period following immunization (long enough for an immune response). In the delayed group (n=3528), 16 cases developed in the same time interval. For all the recent discussion of ethical issues about inclusion criteria in Ebola clinical trials, it is notable that only adults were eligible for this study, although infant and child mortality tends to be higher than that for adults. See commentary for additional perspective on Ebola clinical trials.

TRIAGE ALGORITHMS TO PREDICT NEEDS FOR CHRONIC CONDITIONS IN SHELTERS – Algorithms were evaluated for simulated patients to determine their utility in planning for services needed in disaster shelters for the care of individuals with chronic conditions. Although this study did not consider the care of children, the work should encourage pediatric services to think along the same lines.

Edited by: Dr. Bob Kanter