PDLS 2.0 Outline
Draft 12 March 2016
Course Introduction
• Pediatric Disaster Life Support is designed to
give emergency personnel a foundation of
knowledge and skills to allow them to more
effectively respond to a disaster involving
children
• The structure and timeline of the course can
fit in as little as 1 day or be expanded to 2
days for those requesting additional practice
Prerequisite Training
• This course builds on the fundamental
pediatric assessment and resuscitation skills
that are the backbone of courses such as:
– Pediatric Advanced Life Support (PALS)
– Advanced Pediatric Life Support (APLS)
– Pediatric Emergency for the Prehospital Provider
(PEPP)
• One of these courses is prerequisite
– Or equivalent professional experience
Concurrent PALS Training
• It is the goal that the PDLS training course
described here will be paired with an
opportunity to obtain PALS certification as
well
• The day prior to PDLS training would be the
“skills and examination day” for PALS
– Attendees wishing to obtain PALS certification will
have completed the new on-line PALS course to
prepare for the “skills and examination day”
On-line PALS
Day 1:
Pediatric Skills
(PALS Testing)
Day 2:
Pediatric Disaster
Life Support course
Day 3:
Optional Additional
Modules for PDLS
PDLS Syllabus
• Registration
• Introduction
• Fundamental Concepts in Pediatric Disaster
Medicine (didactic)
• Case Study Exercise
• Practical Issues in Pediatric Disaster
Medicine (didactic)
• Field Training Practical Exercise
• Debriefing and Test
PDLS Syllabus
• Optional Additional Modules:
– Practical Disaster Scenarios
– Expanded WMD/biohazard didactic training
Introduction
• Beginning Lecture
– “Children as victims of disasters and terrorism”
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Introduce statistics
Examples of disasters affecting children
Establish that children have unique needs
Concept of children “not fitting the mold” for standard
preparedness dogma
• Caring for children more difficult for providers
• Introduce new paradigm
– Children as intentional victims of terrorism
• Purpose of PDLS
– Teach basic concepts to allow for children to have to same
chance as adults to to survive disaster
Fundamental Concepts
• Purpose
– Establish a framework of pediatric-specific
knowledge pertinent to disaster medicine
– Build on general concepts in pediatric
assessment and resuscitation such as
those taught in Pediatric Advanced Life
Support (PALS)
Fundamental Concepts
• “Children don’t fit the mold”
– Most disaster medicine concepts have
grown from adult and military model
– Specific needs demand specific planning
– Focus on vulnerabilities of children to tailor
disaster response options already in place
Fundamental Concepts
• A “Bio-Psycho-Social” approach
• Recognizes that effective preparedness and
response requires integration of three realms
Biological
Psychological
Social
Fundamental Concepts
• BIOLOGICAL
– Anatomy and Physiology unique to children
– Focus on vulnerabilities of children, not on
resuscitation
– Discuss relationship to:
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Environmental exposure (heat, cold, entrapment)
Decontamination
Susceptibility to Chemicals, Toxins
Behaviors that increase risk
Biological
Immature immune systems
Lack of verbal skills
Lack of self-preservation skills
Fundamental Concepts
• PSYCHOLOGICAL
– Emotional Response to Disaster
– Focus on general concepts, not by age group
– What to expect & scope of problem
• Behavior changes, aggression, regression
• Post traumatic stress and anxiety
– Latest research from disaster setting
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How to anticipate and recognize problems
How to help
How long do these disorders last?
Where is help available?
Integrating these concepts into disaster preparedness and response plans
Psychological
Fundamental Concepts
• SOCIAL
– Kids are irreversibly integrated into our society
• If children are not accounted for, parents will not comply with
officials
– Adapting to the concept that children may be intentional
targets of terrorism
– Role of parents in disaster
– Role of media in disaster, a double edged sword
– Role of schools, where children spend the bulk of their time
away from home
– Children routinely cause increased stress in emergency
providers
Social
Case Study
• Hypothetical Hurricane Fiona (2010)
• Same track as Hurricane Katrina 2005
• Role play from 3 perspectives/phases:
– Planning
– Response
– Recovery
• Students will assume leadership roles and open
forum discussion will occur
– Goal is to apply material from Fundamental Concepts
session and discuss how children will be accounted for in all
three phases of a major event
Practical Issues
• Goal of this section:
– To apply the vulnerability concepts learned
in the Fundamental Concepts session
– Teach specific information which will
enhance the application of this information
in pediatric disaster planning, response,
and recovery
– Further develop the Bio-Psycho-Social
model’s applicability to disaster medicine
Practical Issues
• Pediatric Triage: JumpSTART tool
– What exactly is triage, how and where is it
used?
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Why develop triage tools in the first place?
Mass casualty incident
Mass casualty receiving
Re-evaluation
– Review adult START triage
– Why modify adult triage?
• Review anatomy/phys
– Handout protocol
Practical Issues
• Focus on integration, rather than separation,
of pediatric triage concepts
• Mini simulated drill with poll-the-audience
response
– Show video/slides of 10 adults and children
requiring triage at both MCI scene and a casualty
receiving point
Practical Issues
• Children with Special Health Care Needs:
– Introduce scope of issue with statistics
– Examples from Indonesia and Katrina
• What may be affected?
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Mobility
Communication (Visual/Verbal/Hearing)
May be technology-dependent (examples)
Resources required
Emphasize the integration, rather than separation of CSHCN
How will this affect the following two topics
• Sheltering
• Decontamination
Practical Issues
• Sheltering
– What aspects of shelter management may not work well for
children as they exist now?
– Identify and plan for specific needs in advance:
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Security
Safety (childproofing, etc.)
Hygiene
Nutrition
Health Screening
Sleep schedule
CSHCN
Recreation
– Should CSHCN be sheltered separately or integrated?
Practical Issues
• Decontamination
– What aspects of on scene and hospital decon need to be
addressed for children?
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Patient flow (need to keep with parents) and timing
Prevention of heat and cold injuries
Chemical decontamination dangerous to kids (e.g. bleach)
Clothing for children after decon
CSHCN durable medical equipment/hardware
Responding to surge capacity
Ensuring responder safety
Tracking non-verbal naked children
– What do you do with exposed children before decon occurs?
– Utilize concepts from BCH Pediatric Decon DVD
Practical Issues
• Chem/Bio/Rad
– Issues facing children during these incidents
– Review why children may be at higher risk during an
exposure based on behavior and biology
– Utilize Cieslak/Henretig material
• Specific topics:
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Personal Protection
Diagnosing exposures in children
Role of Primary Care
Immunization
Prophylaxis challenges
Treatment challenges
Field Exercise
• Purpose
– Give students a focused, practical experience to apply the
skills learned in PDLS
– Review key concepts:
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JumpSTART Triage
Resource Allocation
Need for proper decontamination
Recognizing suspicious pattern of illnesses
– Same scenario approached from two angles
• “secure” mass casualty incident requiring triage
• Mass casualty receiving and decon at the closest emergency
department
• Course director will choose scenario based on audience
Field Exercise 1
Triage
on scene
Schoolbus
Triage at
hospital
1 driver
Decon
1 escort
14 children
Hospital
1 child in wheelchair
1 deaf child
Chemical Tanker
Field Exercise 2
1 teacher
School Shooting
1 principal
20 children
Triage at
hospital
Hospital
Triage
on scene
1 child in
wheelchair
1 visually
impaired child
Field Exercise 3
2 pilots
20 children
Triage at
hospital
Hospital
1 child in
wheelchair
1 visually
impaired child
Triage
on scene
Debriefing and Test
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Discussion of scenarios
Short examination
Evaluation
Train the trainer comments