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AMERICAN ACADEMY OF PEDIATRICS
Disaster Preparedness Advisory Council Meeting Minutes
Washington, DC
April 16-17, 2014
MEMBERS PRESENT:
Steven E. Krug, MD, FAAP, Chairperson
Sarita Chung, MD, FAAP
MAJ Daniel B. Fagbuyi, MD, FAAP
Margaret Fisher, MD, FAAP
Scott Needle, MD, FAAP
David J. Schonfeld, MD, FAAP
LIAISON MEMBERS PRESENT:
John Alexander MD, FAAP, US Food and Drug Administration
Daniel Dodgen, PhD, Office of the Assistant Secretary for Preparedness and Response (part-time)
Georgina Peacock, MD, MPH, FAAP, Centers for Disease Control and Prevention
Sally Phillips, PhD, RN, US Department of Homeland Security (part-time)
Erica Radden, MD, US Food and Drug Administration (part-time)
David Siegel, MD, FAAP, National Institute of Child Health and Human Development (part-time)
GUESTS:
Michael Anderson, MD, FAAP, Children’s Hospital Association (part-time)
Elizabeth Edgerton, MD, Maternal and Child Health Bureau (part-time)
Richard Gorman, MD, FAAP, National Institutes of Health (part-time)
Joseph Wright, MD, FAAP, Emergency Medical Services for Children National Resource Center (part-time)
Cynthia Hansen, PhD, Office of the Assistant Secretary for Preparedness and Response (part-time)
Andrew Rucks, PhD, University of Alabama at Birmingham (part-time)
Jeffrey Stiefel, PhD, US Department of Homeland Security (part-time)
LT Allen Applegate, Office of Human Services Emergency Preparedness and Response (part-time)
Jennifer Hannah, Office of the Assistant Secretary for Preparedness and Response (part-time)
LT Tala Hooban, Office of Human Services Emergency Preparedness and Response (part-time)
Lauralee Koziol, Federal Emergency Management Agency (part-time)
Regina Moran, Federal Emergency Management Agency (part-time)
Ellen Schenk, Emergency Medical Services for Children National Resource Center (part-time)
CDR Jonathan White, Office of Human Services Emergency Preparedness and Response (part-time)
LCDR Jonathan Whiteheart, Office of Human Services Emergency Preparedness and Response (part-time)
STAFF:
Laura Aird, MS, Manager, Disaster Preparedness and Response, Department of Child Health & Wellness
Aaron Emmel, Manager, Global Health Advocacy Initiatives, Department of Federal Affairs (part-time)
Tamar Haro, Assistant Director, Department of Federal Affairs
Alyssa Mezzoni, Legislative Assistant, Department of Federal Affairs
Edgar Vesga, Director, Office of International Affairs (part-time via video-conference)
AAP Disaster Preparedness Advisory Council Meeting Minutes
April 16-17, 2014
CALL TO ORDER
Steven E. Krug, MD, FAAP, Chairperson, called the American Academy of Pediatrics (AAP)
Disaster Preparedness Advisory Council (DPAC) meeting to order on April 16, 2014, at 8:45 am
(EDST). Attendees introduced themselves. Dr Krug welcomed members, liaisons, and guests and
offered introductory comments.
CONFLICT OF INTEREST
Through an AAP electronic conflict of interest system and in-person at the meeting, participants
were given an opportunity to disclose any direct or indirect financial interests, or any personal,
family, or other relationships that conflict (or have the appearance of conflicting) with their
duties, responsibilities, or exercise of independent judgment with respect to the meeting agenda.
No conflicts were identified.
REVIEW/APPROVAL OF MEETING MINUTES
A motion was made, seconded, and approved that the minutes from the October 2013 DPAC
meeting be accepted as submitted.
DISASTER PREPAREDNESS ADVISORY COUNCIL UPDATE
Dr Krug referred members to the DPAC strategic plan, vision/mission, and balanced score card
materials. The new DPAC balanced score card identifies 5 objectives for the year that covers
July 2013 through June 2014. Progress on select objectives was reviewed. Dr Krug emphasized
DPAC priorities for the year, which include advocacy efforts, funded project deliverables, policy
development, and educational efforts. Progress on select action items related to the October 2013
DPAC meeting and February 2014 conference call were reviewed.
Dr Krug mentioned that it was time to begin to review and update the strategic plan. Members
emphasized the need to focus on improving state and local readiness by strengthening and
mobilizing the efforts of the AAP Disaster Preparedness Chapter Contacts. Staff agreed to devote
time to this over the summer. It was emphasized that a job description was still needed to
identify the minimal expectations for the Chapter Contacts. It was suggested that the Early
Hearing Detection and Intervention Chapter Champions job description could be referred to.
Other ideas were discussed including: sharing the job description at the AAP Annual Leadership
Forum, seeking funding to convene a meeting of the Chapter Contacts, and scheduling calls with
individual chapters, perhaps grouped by Districts. Dr Krug discussed the need to be responsive to
(and integrate efforts with) the federal National Advisory Committee on Children and Disasters
(NACCD), once members are appointed.
Ms Aird reported that there were several new newsletters that focus on children and disasters.
Further, she indicated that the AAP was making an effort to include relevant updates when
possible in these and other organizational newsletters.
AAP GLOBAL HEALTH INITIATIVES
Dr Krug reported that he and Ms Aird had recently met with other AAP staff and leaders of the
AAP Section on International Child Health (SOICH) to discuss AAP priorities and collaborative
approaches to plan for international disasters. Edgar Vesga, Director, AAP Office of
International Affairs, joined the meeting and briefly discussed international activities. There are
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three areas of focus for the Office: professional relationships (ie, connections to pediatric
societies or the minister of health, program implementation (ie, grants), and business
development, which includes maintaining relationships with professionals outside of the health
arena. Mr Vesga emphasized that the recent meeting with the SOICH leaders was an important
step, and that next steps would include development of an inventory of AAP international
disaster collaborations and efforts. The challenge of having a Web site only in English was
recognized. Aaron Emmel, Manager, Global Health Advocacy Initiatives, introduced himself and
shared information about AAP global health priorities and initiatives. He discussed efforts
related to newborn survival, early childhood development, and the importance of maintaining
connections with the United States Agency for International Development offices. He relayed
that it was clear that guidance was needed for non-US countries about emergency preparedness
and children. Gaps also exist in approaches to address the needs of victims of violence.
Members identified some pressing needs such as developing a written plan to guide the response
of the AAP in an international disaster, especially during power outages when internet access
was not available. Mr Vesga pointed out that sometimes the challenges are country-specific or
cultural in nature. Some countries require certain paperwork while others might restrict the
number of agencies or teams that can come into the country to offer help after a disaster. Mr
Vesga reported that an internal meeting was held where it was agreed that he would serve as the
AAP point of contact in regards to international disasters.
Mr Vesga also reported that the AAP was about to sign a Memorandum of Understanding with
the pediatric society in Argentina. The pediatric leaders are hoping to develop a sustainable
process that will be helpful in a disaster. The partnership will include an effort to update the
Pediatric Education in Disasters (PEDs) training in Spanish. Training needs in the country are in
the process of being identified.
Members discussed how the AAP could help to improve responsiveness in future international
disasters. Options range from having AAP leaders contact pediatric society leaders after a
disaster to leveraging technology to offer resources, consultation, or training on pediatric topics.
It was recognized that the needs will differ in various disaster situations and that there might be
an opportunity to track priority needs about what is most needed after certain disasters. Members
emphasized that there was an opportunity to meet with select pediatric leaders in advance of a
disaster in conjunction with AAP National Conference. Other efforts could include identifying
members who frequently volunteer to offer medical relief or services in international arenas and
asking for their input. It was noted that the new AAP Provisional Section on Non-US Medical
Graduates might be a good group to reach out to.
Dr Krug noted that the DPAC does not have the bandwidth or expertise to support all of these
efforts and that developing a comprehensive AAP response to international disasters will require
the assistance of and collaboration with AAP groups and perhaps external organizations (along
with funding) to move forward. The AAP Section on Emergency Medicine and the SOICH are
groups that would likely be most interested. Ms Aird mentioned that it has been suggested that
the AAP reach out to the Pan American Health Organization (PAHO) and the United Nations
Disaster Assessment and Coordination (UNDAC) group, which is part of the international
emergency response system. Liaison representatives indicated a willingness to help connect AAP
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leaders with other agencies and representatives who might be able to help in this area. Mr Vesga
reported that some AAP internationally-focused educational sessions will be translated into
Spanish and other languages in the future. Members suggested that perhaps a disaster-related
session could be one of the first sessions to be translated.
It was suggested that the newly formed NACCD could be asked to consider children’s
preparedness needs in regards to international disasters. Dr Krug indicated that he had spoken
with Linda Arnold, MD, FAAP, Chairperson for the SOICH yesterday and that he would be in
touch with members and staff to discuss a plan to identify useful objectives to guide next steps.
NATIONAL PREPAREDNESS AND RESPONSE SCIENCE BOARD
MAJ Daniel B. Fagbuyi, MD, FAAP, and Dr Krug provided an update on recent activities of the
National Preparedness and Response Science Board (NPRSB), formerly the National Biodefense
Science Board. The NPRSB will hold a public meeting on April 23, 2014. This public meeting
will focus on the consideration of the findings from the Community Health Resilience Working
Group. The NPRSB will also hold a public meeting on April 29, 2014, where it is hoped that
new members will be sworn in. The NPRSB will also deliberate and vote on a new task for the
long term strategy that supports the US Department of Health and Human Services (HHS) and
the Office of the Assistant Secretary for Preparedness and Response (ASPR) in the context of
preparedness and response. It was noted that the NPRSB and the NACCD are coordinated by the
office within ASPR that CAPT Charlotte Spires, DVM, MPH, DACVPM, oversees.
OFFICE OF THE ASSISTANT SECRETARY FOR PREPAREDNESS AND RESPONSE
Daniel Dodgen, PhD, reported on recent activities of the ASPR. In regards to the NPRSB, new
members will be announced shortly. Dr Dodgen stated that the Children’s HHS Interagency
Leadership on Disasters (CHILD) Working Group has completed a comprehensive report of the
2012-2013 activities with 3 main focus areas. The report will be made public as soon as it is
approved through the clearance process. Once the document is released, efforts will focus on
monitoring implementation of the report recommendations.
Dr Dodgen mentioned that Andrew Garrett, MD, MPH, FAAP, is conducting a survey of
pediatric providers. Dr Dodgen indicated that a 10-page report on community health resilience is
being developed. The report complements the National Health Security Strategy and includes
steps that the government can take to improve resilience and specific recommendations on
engaging local, state, and other non-federal partners. Although the report does not focus on
children, it does include recommendations to address the needs of vulnerable populations. The
ASPR will coordinate the implementation of the recommendations. A teleconference is being
scheduled to raise awareness of these efforts. David Schonfeld, MD, FAAP, mentioned that the
recommendations or model strategies included in the report might require new models of health
care delivery, and therefore, it might be beneficial for the AAP to discuss the recommendations
in more detail once the report is released. Attendees reflected on how to demonstrate the
community benefits of resilience. It was suggested that Gregg S. Margolis, PhD, NREMT-P,
who oversees the ASPR Emergency Care Coordination Center, be included in future discussions
about emergencies and waivers that allow health care to be offered and reimbursed in a disaster.
Dr Schonfeld suggested that there might be opportunities to explore public private partnerships
in the future. One example might be to discuss psychological self-care, and how AAP efforts
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might be expanded to improve activities in other (non-pediatric) disciplines or associations. A
collaborative discussion with organizations such as the American Hospital Association (AHA),
the Association of American Medical Colleges, the Association of State and Territorial Health
Officials, and the National Association of County & City Health Officials might be productive.
Tamar Haro, Assistant Director, Department of Federal Affairs (DOFA), indicated that the AAP
had provided comments on the proposed rule to establish national emergency preparedness
requirements for Medicare- and Medicaid-participating providers and suppliers. Members agreed
that there are many opportunities for follow-up.
Activities of the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE)
Pediatric and Obstetric Integrated Program Team (PedsOB IPT) were discussed. Dr Dodgen
indicated that Olivia Sparer was leaving the ASPR for another position. Members acknowledged
Ms Sparer’s contributions.
NATIONAL INSTITUTE FOR CHILD HEALTH & HUMAN DEVELOPMENT
David Siegel, MD, FAAP, reported on recent activities of the National Institute for Child Health
and Human Development (NICHD). Dr Siegel stated that in regards to pralidoxime or 2-PAM,
multiple studies demonstrate the lack of efficacy when this substance is used to treat
organophosphate (OP) toxicity. The National Institutes of Health sponsored a study that is almost
complete that compares the efficacy of 2-PAM with other oximes that are utilized in Canada,
Israel, and Europe. Production of 5mg and 10mg auto injectors are still being discussed. These
discussions will effect what dose is determined to be safe for children, as well as what should be
included in the chemical hazards emergency medical management (CHEMM) packs within the
Strategic National Stockpile (SNS).
Dr Siegel explained that the dosing recommendations for the treatment of nerve agent exposure
with midazolam is based on studies of intramuscular injections in non-human primates. In certain
scenarios, the child may have an intravenous (IV) line in place. The plan is to model IV
midazolam kinetics to address this clinical need.
Dr Siegel indicated that the best clinical outcomes regarding the use of IV atropine for the
treatment of OP toxicity have been obtained by doubling the dose of atropine every 5 minutes
until a good clinical response is obtained. There are questions about the best way to achieve a
good clinical response utilizing the auto injector delivery mode in the field, and modeling will be
utilized to attempt to answer that question. Dr Siegel also noted that information on the CHEMM
Web site has been updated. See http://www.chemm.nlm.nih.gov/.
In regards to the use of hydroxocobalamin in children, there is a study assessing treatment of
cyanide toxicity from smoke inhalation. Dosing in obese patients can be challenging, and new
modeling is being considered. A comprehensive new Web site for clinicians and researchers will
be available soon and will provide known dosing information for obese members of the
population as well as identify which molecules require additional study.
Dr Siegel stated that the US Department of Homeland Security (DHS) has produced draft
guidance “Patient Decontamination in a Mass Chemical Exposure Incident: National Planning
Guidance for Communities” that is available for public comment. Dr Krug mentioned the need to
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disseminate the final document to those interested in decontamination. Sarita Chung, MD,
FAAP, encouraged the AAP to not only circulate these recommendations to hospitals but also to
encourage hospitals to include relevant steps or recommendations in preparedness plans.
ACTION:
Staff will circulate the draft decontamination guidance to DPAC members for
feedback. Once the guidance is finalized, staff will circulate the guidance broadly
with ideas on how this information can be used to improve preparedness for
children.
On behalf of the National Center for Disaster Medicine and Public Health (NCDMPH), Kandra
Strauss-Riggs thanked the AAP members for offering feedback on the NCDMPH educational
modules. She specifically thanked Dr Schonfeld for authoring the module on Psychosocial
Impacts of Disasters on Children. She reported that the fourth module on pediatric cases related
to radiation emergencies would be released soon. Ms Strauss-Riggs indicated that a meeting of
federal representatives was being convened at Uniformed Services University of the Health
Sciences to focus the development of a pediatric/adult disaster education and training program. It
was noted that a Texas Engineering Extension Service (TEEX) project advisory committee has
developed a curriculum and agenda for a pediatric disaster preparedness and response training of
emergency managers and that this program was pilot-tested in several states and the final course
for would be adopted by the Federal Emergency Management Agency (FEMA). Attendees
discussed the role of the AAP in supporting the development of educational training programs. It
was agreed that the AAP can always identify pediatric subject matter experts to offer input when
the courses relate to children. A priority would be placed on offering input when the target
audience was pediatricians. The AAP might not always weigh in when a course was produced
for non-pediatrician audiences.
Dr Siegel report that the NICHD Pediatric Trauma and Critical Illness Branch has hired a
pediatric intensivist. A strategic planning meeting is scheduled for April 21-22, 2014.
CENTERS FOR DISEASE CONTROL AND PREVENTION
Georgina Peacock, MD, MPH, FAAP, asked the group to participate in an informal activity
related to state plans to dispense medications during a public health emergency, such as an
anthrax release. It was noted that Centers for Disease Control and Prevention (CDC) SNS staff
offer training to those who work within Points of Dispensing (PODs) locations during
emergencies. The activity aimed to identify opportunities to improve the staff training and
planning to meet children’s needs in an emergency. Materials developed by health departments
for use in states were shared with DPAC members, and they were asked to offered feedback on
ways to improve the planning and information sharing process. It was to be assumed that the
PODs were being asked to dispense medications to 500 to 1,000 people each hour and that the
PODs would be in various facilities (eg, airport, gymnasium, school).
Ideas for Improving the System:
- Recognize that adults will bring their children with them to the PODS, and therefore, there
should be advance planning for how to keep children safe in a situation where people are
being asked to maintain a place in line for a long while, in a room that is loud and might have
cords and poles to direct the lines.
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Planning should include ways to support adults who may be worried or may become angry
about having to wait in line.
Ensure that the facility (and lines) are accessible for those with wheel chairs or disabilities.
Have a roving mental health professional to help direct people and calm them down.
Use an automated line numbering system like what is used at a grocery store deli counter or
the local Department of Motor Vehicle’s office. Consider use of a phone app that allows
folks to “sign up” from home and come into the facility when it is their turn.
Offer training for staff on what a sick child looks like.
Offer opportunities for each person to “get the first dose here”; provide liquid formulations
for those who cannot swallow tablets or capsules.
Communicate in various languages (separate folks in line so they can understand translators).
Recognize the need for public safety personnel and health care professionals on-site.
Provide separate staging areas for different functions.
Do not separate screening/dispensing – offer one stop shop if possible.
Consider how to address situations where personnel were trained but move to a new location.
Ideas for Improving the Screening Form or Process:
- Create a universal form or set of questions that relate to children in various languages.
- Develop a special plan for certain populations (eg, Amish).
- Eliminate redundancy of information on the forms; use fewer words; do not ask questions
that do not matter (if gender is not important, don’t ask that question; if seriously ill children
will have already gone to the emergency department, do not mention them; only ask for
details on medical conditions that matter).
- Offer short handouts. The appearance of the handout and ease of reading is important. One
page for a family is good. Pictograms might be helpful.
- Ensure that scales are available so that parents can weigh children on site.
- Identify who fills out form – design a form for the person/patient to fill out (not doctors).
Ideas for Maintaining Relationships between Patients and Doctors:
- Note that the current plan positions local health departments to offer advice and care but
bypasses the person’s primary care provider or usual doctor. Determine a plan that positions
the health care providers to offer information to their clients and includes these individuals in
the planning and communication loop.
- Improve communications with local health care providers. Do not bring sick people in to
check in at a POD location only later to be referred to a health care provider. If referring to a
local health care provider, make sure that person is informed and trained.
- Consider that states and health departments will implement recommendations differently.
Determine whether there should be a single uniform process for all citizens. This will cut
down on confusion.
- If a written prescription is provided at the POD, or if primary care providers are going to be
directed to write prescriptions for medicines like doxycycline, clarify where the individual
can fill the prescription (ie, which pharmacy will have enough medication to fill
prescriptions).
- Include instructions for crushing with all pills when they are given out.
- Consider using a Voucher System rather than distributing medications onsite.
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Plan ahead to address issues with people who think they might be allergic. Have several
levels of medical professionals onsite.
Dr Peacock also reported briefly on existing activities in progress. In regards to the
Subcommittee on Children with Special Health Care Needs, it was suggested that the AAP link
with those involved in similar work within the Maternal and Child Health Bureau (MCHB) and
the Emergency Medical Services for Children (EMSC) program. Further, it was noted that
linkages to the EMSC Family Advisory Network might be useful.
AAP COMMITTEE/SECTION ON INFECTIOUS DISEASES
Margaret Fisher, MD, FAAP, provided updates on relevant activities of the AAP Committee on
Infectious Diseases (COID) and AAP Section on Infection Diseases, including policy documents
under development. Dr Fisher reported that it is anticipated that the world will be free of polio by
2018. The Section is in the process of conducting a member interest and expertise survey as part
of an overarching effort to identify a Section “go to” person in each state/chapter. This type of
approach might be useful for the AAP Disaster Preparedness and Response Contact Network. A
similar survey was conducted in 2008, and it might be time to survey members again.
In regards to the labeling of vaccine vials for exposure to extreme temperatures, Dr Fisher
explained that she had been contacted by a company that produces stickers that can be added to
vaccine vials to show when they have exposed to a temperature that would be extreme enough to
render the vaccine useless. Dr Fisher noted that the World Health Organization recommends
using these heat- and cold-sensitive stickers. Richard Gorman, MD, FAAP reported that this was
briefly discussed at the recent AAP COID meeting, yet no recommendation had been agreed
upon. Staff agreed to reach out to the AAP infectious disease and immunizations staff to learn
more about the AAP stance on this topic.
ACTION:
Staff will obtain information on the stance of the Academy in regards to use of
heat-sensitive stickers on vaccine vials.
SUPERSTORM SANDY RECOVERY UPDATE
Dr Fisher provided information on the Pediatric Partnership Initiative (PPI) in New Jersey, which
provides pediatric and family practice providers with multiple learning opportunities that will
teach best practices for supporting children and families suffering toxic stress from adverse
childhood experiences as they recover post Super Storm Sandy. The PPI offers grand rounds and
business meetings, EPIC (Educating Practices in the Community) office-based training sessions,
and learning collaboratives. Steve Kairys, MD, FAAP, leads these efforts. A video has been
produced that could be circulated or shown at a future educational session.
Members agreed that mental health recovery remains a crucial issue that touches many
individuals and sectors. Dr Dodgen noted that the Administration for Children and Families has
been involved in the coordination of recovery groups focused on improve children’s mental
health services after disasters. Dr Fisher indicated that when Dr Schonfeld presented on relevant
topics at a workshop in New Jersey, a separate meeting was held to support adults providing
foster care services.
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DISASTER RECOVERY FOR PEDIATRICIANS MEETING
Dr Schonfeld provided information on the AAP Disaster Recovery for Pediatricians:
Professional Self-care meeting held in November 2013. “Dealing with Disasters”, an
informational article for members was developed and published in the March 2014 issue of AAP
News. Members discussed the possibility of convening a “Lunch and Learn” session at a future
AAP National Conference to offer members the opportunity to connect with AAP leaders and
receive support for disaster recovery efforts. The group recommended that such a session be held
in both 2014 and 2015.
ACTION:
Staff will request a Lunch and Learn session titled “Disaster Recovery for
Pediatricians: Professional Self-care” be scheduled for the AAP National
Conference in 2014 and 2015.
Dr Dodgen reported that he had shared the article with Nicole Lurie, MD, MSPH, Assistant
Secretary for Preparedness and Response, and he commended the AAP for its efforts to date on
this important topic.
PEDIATRIC BEREAVEMENT LECTURESHIP PROGRAM
Dr Schonfeld provided a final update on the results and achievements related to the AAP
Pediatric Bereavement Lectureship program. This program had resulted in positive outcomes for
more than 2,000 pediatricians and other child health advocates interested in bereavement
support. It was noted that Mary Fallat, MD, FAAP, had coordinated an EMSC project (targeted
issue grant) and had convened a focus group to identify lessons learned in supporting pediatric
bereavement services.
ACTION:
Staff will contact Dr Fallat to obtain information on lessons learned that might
strengthen the resources that the AAP offers to support its members in addressing
pediatric bereavement.
PEDIATRIC OFFICE PRACTICES CHECKLIST AND SURVEY
Scott Needle, MD, FAAP, reported that since the DPAC had last met, the AAP had produced a
final version of the Pediatric Office Practices Checklist handout. In addition, he indicated that the
DPAC had circulated an electronic survey to AAP members who reported that they had an active
clinical practice and worked in an office setting. The survey was developed to help the AAP to
gather information on steps that members have taken or tools they have used to improve office
preparedness for a disaster. Dr Needle reported that a total of 165 individuals had completed the
survey, and only 48% of the respondents indicated that their office had a written disaster plan. A
significant number of the respondents had indicated that they were not aware of resources to
support these efforts (although the AAP had produced several such resources in previous years).
Dr Needle noted that there was several opportunities for educating members, as the respondents
had expressed interest in learning more, especially if Maintenance of Certification (MOC) credit
could be offered. Because of the reported lack of awareness of available resources, Dr Needle
suggested that any new tool be publicized and marketed in as many ways as possible. It was
noted that the DPAC has not yet tapped into the resources and expertise that may be offered by
connecting with members in the military or the AAP Section on Uniformed Services (SOUS). Dr
Needle indicated that he might develop an article for publication on the survey results. Dr
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Dodgen encouraged the group to continue its efforts to support AAP members, indicating that
the ASPR would be interested in future efforts and discussions.
ACTION:
Staff will schedule a follow-up call with Dr Needle to discuss options for future
MOC projects.
US FOOD AND DRUG ADMINISTRATION
John Alexander, MD, FAAP, and Erica Radden, MD, provided updates on key activities of the
US Food and Drug Administration.
AAP DEPARTMENT OF FEDERAL AFFAIRS
Ms Haro thanked the members and liaisons for their involvement in children’s preparedness
initiatives, and encouraged everyone to refer to the written report within the meeting agenda
materials. Ms Haro indicated that the AAP DOFA was expanding to address global health
initiatives as well as social media. She indicated that the President’s budget proposal had been
released and contains significant investments in poverty-reduction. The budget contains
continued funding for the Affordable Care Act, including an extension of the Medicaid payment
increase for an additional year and funding to extend the Children’s Health Insurance Program
(CHIP). The AAP is working collaboratively with other groups and organizations to ensure the
reauthorization of CHIP and the EMSC program. Ms Haro informed attendees of the Helping
Families in Mental Health Crisis Act of 2013, and indicated that while this legislation would
reauthorize several important programs, it would result in the transfer to the Community Mental
Health Services Block Grant from the Substance Abuse and Mental Health Services
Administration to the newly-created Assistant Secretary for Mental Health and Substance Use
Disorders.
The Institute of Medicine recently posted a Webcast of a conference focused on prevention of
bullying, and there were several things in this posting that DPAC members might find
interesting. Because of the increase in school shootings, there is a shift in terminology away from
mental health towards use of the term mental illness. Dr Schonfeld reported that the Sandy Hook
Advisory Commission (appointed by Governor Malloy) would release its findings soon.
US DEPARTMENT OF HOMELAND SECURITY
Sally Phillips, PhD, RN, joined the meeting to provide a brief report on relevant activities of the
US Department of Homeland Security (DHS). Dr Phillips introduced her colleague Jeffrey
Stiefel, PhD, Senior Health Threats Advisor, Health Threats Resilience Directorate. Dr Phillips
stated that the DHS Office of Health Affairs continues its work to implement a Community
Health Resilience Initiative, which includes a Pediatric Disaster Resilience Working Group and
development of a Web-based toolset. This work is supported by a broad group of stakeholders,
including pediatric experts. An initial Pediatric Disaster Resilience conference call was held in
March and a second call is scheduled for May 7, 2014. AAP member attendees were not
involved in these efforts, and it was suggested that there might be opportunities to collaborate.
ACTION:
Staff will follow-up with Drs Phillips and Stiefel to discuss future opportunities
for collaboration.
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It was noted that the HHS Children’s Environmental Task Force is forming a Climate Change
Working Group. The DHS has been asked to participate. Jerome Paulson, MD, FAAP,
Chairperson of the AAP Council on Environmental Health (COEH), may be involved.
ACTION:
Staff will contact COEH staff or Dr Paulson to learn more about the AAP
involvement in the Climate Change Working Group and disaster preparedness
efforts related to children.
HHS OFFICE OF HUMAN SERVICES EMERGENCY PREPAREDNESS
CDR Jonathan White, PhD; LCDR Jonathan Whitehart; LT Tala Hooban; and LT Allen
Applegate joined the meeting to discuss priorities of the Office of Human Services Emergency
Preparedness. Dr White reported on many key activities, highlighting efforts in regards to out-ofhome child care, children’s support services, and family violence prevention. A key issue is the
resilience of families and communities after disasters. If requested by a community, and tasked
by FEMA, the Office will help with case management services in a disaster. Accessibility of
Head Start and other child care facilities after a disaster is a crucial need. Dr White mentioned
that the Office helps to coordinate an HHS Interagency Group on Child Care and Disaster
Recovery. An HHS Disaster Human Services Concept of Operations was just released, and a
Disaster Recovery Planning Matrix for Child Care is being developed. Dr White reviewed
recommendations in the Children and Youth Task Force in Disasters Guidelines for
Development document in detail. The AAP staff and DPAC members indicated that they would
be pleased to review any draft documents where their input might be valuable.
ACTION:
Dr White will share a draft version of the Disaster Recovery Planning Matrix for
Child Care document for AAP input.
Dr White shared that the Office was working with groups, including the AAP, on improving
social services to support health in disaster recovery. A new electronic case management record
and intake form is being developed. He will keep the DPAC members informed as details
evolve.
ENGAGEMENT OF CHILDREN’S HOSPITALS
Michael Anderson, MD, FAAP, thanked members for continuing to consider children’s hospitals
in disaster response. Dr Krug indicated that organizations like the AHA and others, such as The
Joint Commission might be willing to be engaged in relevant activities. The ASPR has convened
meetings and calls to discuss pediatric transport issues, and AAP members have participated. A
new coalition for those who work in critical care is developing, and one area of focus is disaster
preparedness.
HOSPITAL, STATE, AND REGIONAL PREPAREDNESS
Andrew Rucks, PhD, reported on surveys conducted by the University of Alabama at
Birmingham in regards to collaborative regional disaster surge networks. Dr Rucks reported that
future efforts might need to be adjusted or curtailed as funding sources used to support this work
have decreased. The AAP has helped to circulate two surveys. The data from Survey One
revealed 13 new networks, with collaboration occurring mostly within the state. Very few
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agency partners were identified. The results from Survey Two will help to identify model
strategies and the extent to which networks are addressing pre-identified competency areas.
Cynthia Hansen, PhD, reported on recent activities of the ASPR Hospital Preparedness Program
(HPP). Jennifer Hannah is the acting director of the program, while David Marcozzi, MD,
MSPH, is deployed out of the country. Melissa Harvey is the Acting Deputy. Dr Hansen reported
that the HPP budget was cut by 40%, and the grantees are in the process of developing
applications for future activities that reflect these funding cuts. The focus of the program has
shifted from an emphasis on hospitals towards collaborative networks and preparedness. Health
coalitions funded through this program were strongly encouraged to include pediatric expertise
and activities. Several AAP member experts presented on a conference call with grantees in
summer 2013. The ASPR is preparing for a follow-up call on June 19th to determine progress to
date in regards to pediatric preparedness.
ACTION:
Staff will follow-up to request information on the June 19, 2014, ASPR call.
Regional groupings and conference calls are being convened. Efforts are being made to review
after action reports in an effort to search for stories of hospitals that evacuated pediatric patients
in an emergency and identifying lessons learned. Dr Krug recommended an informal survey of
pediatric and neonatal intensive care units to determine categories of patients and their needs.
The AAP Section on Perinatal Pediatrics could be helpful in this effort. Or, it might be feasible
to ask the state departments of public health to seek information on the needs of pediatric
patients in hospitals and then follow-up two weeks later. This could be conducted in partnership
with the AAP Disaster Preparedness Chapter Contact. Joseph Wright, MD, FAAP, explained that
there is an electronic mechanism that allows him to look at pediatric beds for his state and
surrounding areas. States are very variable, but there are many options for future collaboration.
Elizabeth Edgerton, MD, on behalf of the MCHB, along with Ellen Schenk and Dr Wright
reported on several activities, including the National Pediatric Readiness Project. The project and
relevant survey questions are based on concepts included in the AAP joint policy statement
Guidelines for the Care of Children in the Emergency Department. Each hospital completed an
online survey that concluded with a score and ways for improvements. Having the hospital
emergency department approved for pediatrics (known as “EDAP”) is a categorization level that
is becoming more pronounced. The survey results have clarified that there are particular issues in
communities that are in rural areas, have workforce disparities, or that have a higher proportion
of tribal participants.
FEDERAL EMERGENCY MANAGEMENT AGENCY
Lauralee Koziol and Regina Moran joined the meeting to discuss FEMA activities related to
children’s preparedness issues. Dr Chung provided an update on the FEMA National Advisory
Committee (NAC). Dr Chung explained that the NAC has three standing subcommittees: the
Federal Insurance and Mitigation Subcommittee, the Preparedness and Protection Subcommittee,
and the Response and Recovery Subcommittee.
Dr Chung indicated that the FEMA NAC was emphasizing the need for review of disaster afteraction reports for identification of evidence-based-practices or lessons learned. The NAC is also
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interested in identifying ways to build on existing collaborations, particularly working with
hospitals as well as identifying strategies to mitigate barriers when health care professionals are
not allowed to serve in a disaster.
Ms Koziol mentioned that leveraging the reunification issues and protocols to discuss improved
preparedness with hospitals might be useful. Dr Chung asked for an update on how children’s
issues are addressed within FEMA, and Ms Koziol explained that these activities are now
integrated throughout the organization. AAP members and staff can communicate with Ms
Koziol and/or Ms Moran – between the two of them, all inquiries should be able to be handled.
Future efforts might include helping AAP members to access and use the Unaccompanied
Minors Registry for children separated from their parents in a disaster or highlighting how
hospitals can conduct pediatric drills or get more involved in other drills or exercises.
CHILDREN’S PREPAREDNESS CONFERENCE JUNE 2014
Dr Chung reported on the Children’s Preparedness Conference that will be taking place in
Wisconsin in June 2014. Conference objectives are to review the progress, gaps, and resources in
regards to day-to-day pediatric emergency readiness, discuss strategies that promote resilience
and recovery in children after a disaster, identify opportunities for potential collaboration
regarding disaster preparedness, and review lessons learned and best practices in regards to mass
casualty care. Drs Chung, Fagbuyi, Krug, and Garrett along with Ms Kozial are scheduled to
present.
The meeting adjourned for the day and was reconvened on April 17, 2014, at 8:45am.
POLICY DOCUMENTS
Dr Needle discussed the first draft of the Ensuring the Health of Children in Disasters policy
statement. Members were encouraged to send input and comments on the draft to Dr Needle or
Ms Aird within the next 2 weeks so that a revised version could be shared with the Committee on
Pediatric Emergency Medicine (COPEM) before its next meeting at the end of May 2014.
ACTION:
Staff will circulate the initial draft of the policy, “Ensuring the Health of Children
in Disasters” for member input and feedback.
Dr Fagbuyi indicated that he would provide the next draft of the policy statement Medical
Countermeasures for Children Exposed to Public Health Emergencies, Disasters, or Acts of
Terrorism before June 2014. Dr Schonfeld indicated that he would provide an initial draft of the
clinical report Providing Support to Children and Families in the Aftermath of Disaster and
Crisis in time for review before the next DPAC meeting in October 2014.
Two additional requests for DPAC assistance with policy documents have been received.
The AAP Committee on Fetus and Newborn is interested in developing a new policy,
“Emergency Preparedness in the Neonatal Intensive Care Unit”. The DPAC members reviewed
and discussed the draft intent for this clinical report. Questions included:
- Whether this is more suited to being developed as a policy statement or a clinical report? It is
marked clinical report but could be a policy statement with recommendations.
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-
-
There was a question about whether the policy will apply only to neonatal intensive care
units or might also address pediatric intensive care units. As a facility, the neonatal intensive
care unit will overlap with the pediatric intensive care unit, especially if the policy document
addresses preparedness within the context of the neonate.
Should this policy document focus on the neonate, perhaps focusing on the child rather than
the facility?
Should surge and evacuation be addressed?
Finding evidence-based recommendations will be challenging.
The Society for Critical Care Medicine is exploring this topic too. Perhaps this should be
developed in cooperation with this group.
The DPAC agreed that it would like to assist with the development of this policy document, and
members would like to offer feedback on the draft intent. Drs Chung, Fagbuyi, and Krug
volunteered to assist with this.
ACTION:
Staff will circulate the draft intent for the Emergency Preparedness in the
Neonatal Intensive Care Unit clinical report to DPAC members for feedback.
The AAP COPEM is asking that the DPAC assume responsibility for The Injury Prevention
Program (TIPP) sheet on Four Steps to Prepare Your Family for Disasters. The DPAC members
agreed to take this on, however members wondered whether it was important to format this as a
TIPP sheet as opposed to creating a Web page or handout.
ACTION:
Staff will obtain information on the AAP use of TIPP sheets.
Dr Needle suggested the DPAC consider whether there ought to be a policy statement that covers
how to improve preparedness for a disaster in a pediatric office practice (including necessary
equipment, procedures, and training). This would not duplicate the content of other policies that
address how to prepare for pediatric emergencies in the office practice. This was deemed
important, yet was tabled until the other policies under development have been finalized.
EDUCATIONAL SESSIONS
National Conference and Exhibition 2014 (San Diego, CA)
Dr Chung discussed the schedule of educational sessions that will be presented at the 2014 AAP
National Conference, which will be taking place in San Diego, CA.
National Conference and Exhibition 2015 (Washington, DC)
Dr Chung provided information on the educational sessions submitted for the 2015 AAP
National Conference, taking place in Washington, DC. It was noted that there were several
sessions proposed by other AAP groups, and the DPAC agreed to co-sponsor these sessions if
asked to do so.
Dr Gorman provided information on the proposed program for the AAP Section on Clinical
Pharmacology and Therapeutics, which for 2015 will focus on “Preparing for the Unthinkable”
and will include presentations on medical countermeasures for children, the unique vulnerability
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of children, psychological impacts of disaster on children, and perhaps office preparedness. Dr
Gorman has identified several DPAC members to present on different topics, however, he is
encouraging each faculty member to mentor a “less-seasoned” clinician.
VISION OF PEDIATRICS 2020 MEGATRENDS
Ms Aird reported that the AAP Board of Directors would discuss the megatrends at its next
meeting in May 2014. It was suggested that continuity of operations planning might be an area of
future interest. This could be planning specific to organizations (ie AAP), pediatric practices, and
hospitals. Dr Krug will offer feedback on future sub-bullets for disaster preparedness and will
follow-up with AAP leaders about options for continuity of operations planning.
REVIEW OF VISION/MISSION, BALANCED SCORE CARD, AND STRATEGIC PLAN
Dr Krug indicated that members were welcome to offer feedback to improve the DPAC
vision/mission and the draft balanced score card. Members were asked to forward comments on
the draft DPAC vision/mission to Ms Aird.
ACTION:
Staff will circulate the draft DPAC mission/vision to DPAC members.
Dr Krug encouraged members to begin thinking about revising the strategic plan. Ideas for future
consideration include continuity of operations planning, response to international disasters, and
strengthening state emergency readiness by mobilizing the network of Disaster Preparedness
Chapter Contacts. Important next steps include developing a job description for Disaster
Preparedness Chapter Contacts and engaging these members, leveraging the AAP Annual
Leadership Forum or National Conference to talk to Chapters about preparedness, and including
a Call for Action in future newsletters.
Some discussion ensued about how to help with training of SNS and POD personnel, connecting
with hospital associations, supporting the ASPR HPP grantees, and connecting more closely with
the AAP SOUS and the AAP Section on Medical Students, Residents, and Fellowship Trainees.
Staff noted that a call would be scheduled to discuss completion of the balanced score card
(replacing the annual report), next steps with mobilizing the Chapter Contacts, updates to the
policy documents, and preparing for the National Conference and next DPAC meeting.
NEXT MEETING
The next DPAC meeting will be held on October 12-13, 2014, in San Diego, CA. Because the
2015 National Conference will be held in Washington, DC, the Spring 2015 DPAC meeting
would likely be held at CDC offices in Atlanta, GA.
The meeting was adjourned at 11:45am ET.
Respectfully Submitted,
/s/
Laura Aird, MS, Manager, Disaster Preparedness and Response
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