Would Triage Predictors Perform Better than First-Come-First-Served in Pandemic Ventilator Allocation?

In a pandemic, needs for ventilators might overwhelm the limited supply. Outcome predictors have been proposed to guide ventilator triage allocation decisions. However, pandemic triage predictors have not been validated. This quantitative simulation study evaluated outcomes resulting from allocation strategies varying in their performance for selecting short stay survivors as favorable candidates for ventilators. A …

Disaster Planning for Vulnerable Populations: Leveraging Community Human Service Organizations Direct Service Delivery Personnel

Given the variability, complexities, and available resources for local vulnerable populations, it is clear that preparing effectively for catastrophic events cannot be accomplished with a single, simple template. Inclusion of Community Human Service Organizations’ (CHSO’s) direct service delivery personnel ensures that emergency disaster planning efforts for vulnerable populations are effective and responsive to unique needs …

Children’s Health after the Oil Spill: A Four-State Study Findings from the Gulf Coast Population Impact (GCPI) Project

In 2012, with funding from the Baton Rouge Area Foundation, the National Center for Disaster Preparedness (NCDP) at Columbia University, in partnership with the Children’s Health Fund, launched a four-state study in order (1) to identify communities of children in the coastal areas of Louisiana, Mississippi, Alabama and Florida who were adversely impacted by the …

Measuring the Impact of Hurricane Katrina on Access to a Personal Healthcare Provider: The Use of the National Survey of Children's Health for an External Comparison Group

This paper examined the effect of Hurricane Katrina on children’s access to personal healthcare providers and evaluated the use of propensity score methods to compare a nationally representative sample of children, as a proxy for an unexposed group, with a smaller exposed sample. 2007 data from the Gulf Coast Child and Family Health (G-CAFH) Study, …

The 2011 Tuscaloosa Tornado: Integration of Pediatric Disaster Services into Regional Systems of Care

Objective: To empirically describe the integration of pediatric disaster services into regional systems of care after the April 27, 2011, tornado in Tuscaloosa, Alabama, a community with no pediatric emergency department or pediatric intensive care unit and few pediatric subspecialists. Study design: Data were obtained in interviews with key informants including professional staff and managers …

Children as Bellwethers of Recovery: Dysfunctional Systems and the Effects of Parents, Households, and Neighborhoods on Serious Emotional Disturbance in Children After Hurricane Katrina

Background: Over 160 000 children were displaced from their homes after Hurricane Katrina. Tens of thousands of these children experienced the ongoing chaos and uncertainty of displacement and transiency, as well as significant social disruptions in their lives. The objectives of this study were to estimate the long-term mental health effects of such exposure among …

Impact on Children and Families of the Deepwater Horizon Oil Spill: Preliminary Findings of the Coastal Population Impact Study

Although the ruptured Deepwater Horizon oil well was capped on July 15, 2010, an estimated 3 to 5 million barrels of oil spilled in to the Gulf of Mexico over a three-month period. Several surveys prior to the capping of the well documented the concerns and immediate effects of the oil spill on coastal residents. …

Second Wind: The Impact of Hurricane Gustav on Children and Families Who Survived Katrina

The category 2 Hurricane Gustav made landfall on the Louisiana Coast on Sept. 1, 2008, nearly three years to the day after Hurricane Katrina, resulting in an evacuation of approximately 2 million people and considerable property damage. Although it did not match the intensity or consequence of Hurricane Katrina, the experience of anticipating and responding …

Broadcasting Flu Messages – Citywide Transmission and Community Reception: An Evaluation of Ready New York’s pandemic influenza outreach campaign

Public health risk communication is a central feature of New York City’s pandemic flu preparedness plan. Particularly in the early stages of a pandemic, before effective therapeutic measures are available, non-pharmaceutical interventions such as social distancing, personal protective hygiene, and voluntary isolation are critical strategies for suppressing the spread of a novel viral strain. New …

Building Integrated Mental Health and Medical Programs for Vulnerable Populations Post-Disaster: Connecting Children and Families to a Medical Home

Introduction: Hurricane Katrina, a Category 3 hurricane, made landfall in August 2005. Approximately 1,500 deaths have been directly attributed to the hurricane, primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and >200,000 residents became homeless. Many of these internally displaced persons received transitional housing in …

Population Vulnerabilities, Preconditions, and the Consequences of Disasters

In a perfect illustration of our nation’s proclivity for postevent crisis response and our resistance to longer term planning and system investment, the nation put a rush order on developing a massive bureaucracy designed to fast track new systems for preventing and responding to terrorism and large scale natural disasters. FEMA and many other agencies …

Mental Health Services in Louisiana School-Based Health Centers Post-Hurricanes Katrina and Rita

Following Hurricanes Katrina and Rita, Louisiana school-based health centers (SBHCs) were called on to respond to a sharp increase in mental health needs, especially for displaced students coping with grief, loss, trauma, and uncertainty. To assess the impact of the hurricanes on the students and the needs of SBHC mental health providers (MHPs), we surveyed …

Lessons from Katrina – What Went Wrong, What Was Learned, Who’s Most Vulnerable

If humans did not occupy the planet, disasters would never occur. Massive climatic events, earthquakes, volcanic eruptions, and tsunamis would be regular occurrences, of course, and the earth would look like a dynamic cauldron of natural activity, changing the look and the balance of nature and natural events continuously and randomly. What morphs these natural …

Mississippi Child and Family Health Study — Toplines

During the period of August 6 through August 26, 2006, the Columbia-led Mississippi Child & Family Health Study conducted an assessment among Mississippi residents displaced or heavily impacted by Hurricane Katrina. The purpose of the study was to gather information that could inform local, state, and federal policymakers about the health and social service needs …

Unanticipated Consequences of a Pandemic Flu in New York City: A Neighborhood Focus Group Study

There is fairly consistent evidence that ethnic and minority communities have historically been more vulnerable to disasters, less trusting of public authority, and often so socially marginalized that it placed them in harm’s way. In an effort to explore some of these issues we conducted a series of community-based focus groups among selected ethnic communities …

Emergency Preparedness: Addressing the Needs of Persons with Disabilities

In July 2004, President Bush signed an Executive Order explicitly stating the policy of the United States in the area of emergency preparedness for people with disabilities. The Executive Order built on The Americans with Disabilities Act (ADA), passed in 1990 “to provide a clear and comprehensive national mandate for the elimination of discrimination against …

The Recovery Divide: Poverty and the Widening Gap Among Mississippi Children and Families Affected by Hurricane Katrina

Six months after Hurricane Katrina hit the Gulf Coast, a Columbia-led research team conducted a random household survey of people who had been displaced by the disaster in Louisiana. Mental health disability and psychological strain were rampant, people’s lives were chaotic, and their futures were uncertain. The children who had been displaced were often socially …

The Legacy of Katrina's Children: Estimating the Numbers of Hurricane-Related At-Risk Children in the Gulf Coast States of Louisiana and Mississippi

The 2005 hurricane season, which included hurricanes Katrina, Rita and Wilma, exacted a monumental toll on the people and infrastructure of the Gulf Coast region in the southern United States. Disaster-related losses were estimated to have exceeded $110 billion. Much has been written about the short-term effects on the local housing stock, economy, and populations. …

Chronicles From Out-of-State Professionals: Providing Primary Care to Underserved Children After a Disaster: A National Organization Response

Hundreds of thousands of lives in the Gulf Coast region were affected by Hurricane Katrina. The Children’s Health Fund (CHF) responded rapidly to the needs of children and their families after the hurricane. CHF is a national organization that supports direct health services, education, and advocacy for medically underserved children. Although CHF’s principle mission is …

Critical Concepts for Children in Disasters Identified by Hands-on Professionals: Summary of Issues Demanding Solutions Before the Next One

This supplement contains many hands-on experiences of pediatricians and others who cared for children during the Hurricane Katrina disaster. They have all offered significant insightful suggestions to help planners better prepare for care of children during the next disaster. Pediatricians and other providers need to educate families on many aspects of disaster planning. Families should …

The Pediatrician and Disaster Preparedness

Recent natural disasters and events of terrorism and war have heightened society’s recognition of the need for emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, several additional issues related to terrorism preparedness must be considered, including the unique vulnerabilities of children to various agents as well as the limited …

On the Edge: Children and Families Displaced by Hurricanes Katrina and Rita Face a Looming Medical and Mental Health Crisis

The individuals and families who were displaced by Hurricanes Katrina and Rita and who have ended up in FEMA-subsidized community housing in Louisiana are facing a second crisis, one in which untreated and undertreated chronic medical problems and incipient mental health issues will overwhelm patients and providers. Among the displaced, children may be particularly vulnerable. …

Challenges in Meeting Immediate Emotional Needs: Short-term Impact of a Major Disaster on Children's Mental Health: Building Resiliency in the Aftermath of Huricanne Katrina

Disasters, whether resulting from terrorism or natural events, have a dramatic impact on the health and well-being of children. Studies after the terror attacks of September 11, 2001, in New York City and the 1995 Oklahoma City bombing and countless reports on the impact of natural disasters on children show that a child’s mental health …

Psychosocial Implications of Disaster or Terrorism on Children: A Guide for the Pediatrician

During and after disasters, pediatricians can assist parents and community leaders not only by accommodating the unique needs of children but also by being cognizant of the psychological responses of children to reduce the possibility of long-term psychological morbidity. The effects of disaster on children are mediated by many factors including personal experience, parental reaction, …

Uncommon Sense, Uncommon Courage: How the New York City School System, Its Teachers, Leadership and Students Responded to the Terror of September 11

Eight public schools are situated within a quarter mile of Ground Zero with 9,000 students ranging in ages from three to eighteen years – grammar, middle and high schools. On Tuesday, September 11, 2001 in the midst of chaos and a relentless unfolding of tragedy, professionals of the Board of Education safely evacuated all 9,000 …

Atropine Use in Children After Nerve Gas Exposure

Following the FDA’s approval of a pediatric dosage Atropen®, the Pediatric Expert Advisory Panel was asked to review the existing guidelines and recommendations regarding the treatment of children exposed to nerve agents and the Mark-1 Kit; review the new literature on pediatric nerve agent exposure; and to develop recommendations and guidelines for this new device …

Pediatric Preparedness for Disasters and Terrorism: A National Consensus Conference: Executive Summary

In a time of crisis, it is essential to ensure the needs of children are being met in planning and preparing for disasters and terrorist events. The current adult models and guidelines cannot be applied to the care of children. We convened experts from the multiple areas of expertise and disciplines involved in the planning …

Disaster and Terrorism Preparedness: What Pediatricians Need To Know

This chapter is designed to provide an overview of key issues for the pediatrician with respect to terrorism and disaster preparedness. It is not intended to be a complete compendium of didactic content, but it does represent an approach to understanding what needs to be learned by the pediatrician on this difficult topic and how …

The 9/11 terror attacks: Emotional consequences persist for children and their families

The terror attacks of Sept. 11, 2001, on the World Trade Center in New York City and the Pentagon in Washington, D.C., are unique in American history. The magnitude of the attack in New York, in terms of loss of life and property, was enormous. The destroyed twin towers of the World Trade Center had …

Access Denied: Taking Action for Medically Underserved Children

Advocacy centered on access to health care for children is a straightforward business. The goal is clear: children need readily available, comprehensive, continuity-based, family-friendly, and child-friendly health services to meet a range of well-accepted objectives, including preventing, screening, acute care as needed, management of chronic conditions, and anticipatory guidance. Pediatricians refer to such a health …

Constructive Conflict Management and Coping in Homeless Children Adolescents

In this largely exploratory study of the conflict management and coping behavior of homeless adolescents, the authors interviewed 176 families (mother-adolescent dyads) living in New York City welfare hotels. Results indicated that peer conflict was the “worst” problem of the previous month as reported by approximately 50% of these youth. Homeless adolescents demonstrated conflict management …

The Homeless Child Health Care Inventory: Assessing the Efficacy of Linkages to Primary Care

Each year, the New York City homeless family shelter system provides transitional housing for nearly 20,000 homeless children. While health care needs of these children are substantial, there is currently no system-wide mechanism for ensuring that they have access to appropriate medical care. This report analyzes information from the Homeless Child Health Care Inventory, a …

System-based Mobile Primary Pediatric Care for Homeless Children: The Anatomy of a Working Program

The New York Children’s Health Project (NYCHP) of the Montefiore Medical Center-Albert Einstein College of Medicine has been providing comprehensive health services to homeless and medically under served children since 1987. Fully equipped mobile child health offices have been the major mechanism for bringing pediatrician-led teams to places that are convenient for and accessible to …

Overcoming barriers to health care access for medically underserved children

Many children in the United States face serious challenges in seeking appropriate medical care, including lack of insurance coverage, linguistic and social barriers, geographic isolation, and localized shortages of health personnel. This article reviews the New York Children’s Health Project (NYCHP), outlining the planning and implementation of a mobile service delivery model for pediatric care …