Clarifying needs of the pediatric disaster patient: A descriptive analysis of pediatric patient encounters from four disaster medical assistance team deployments

Abstract

Study objectives: Disaster preparedness enhanced to meet children's needs has become a growing priority, especially in light of recent world events. In the wake of a catastrophic disaster, children can be a significant part of the surviving population in need of disaster medical assistance teams (DMAT) aid. Pediatric patients represented approximately a third of all patients treated in New Mexico DMAT (NMDMAT) field clinics in the days and weeks after 4 recent natural disasters. We have no information on the specific needs of pediatric patients who present to DMAT field clinics. The purpose of this study is to describe pediatric patient encounters in 4 natural disaster DMAT deployments. Methods: We conducted a retrospective cohort review of pediatric patient encounter forms from NMDMAT field clinics during deployments to hurricanes Andrew (Florida, August 1991) and Iniki (Hawaii, September 1991), the Northridge earthquake (California, January 1994) and the Houston flood caused by Tropical Storm Allison (Texas, June 2001). All patients 18 years and younger were included. Data abstracted included age, sex, triage level, chief complaint, diagnosis, treatment, and disposition. For analysis, patients were placed by age into 5 groups: 2 months and younger; 3 months to 1 year; 1 to 5 years; 5 to 12 years; and 12 to 18 years. Simple descriptive statistics were used to describe patient variables. Results: Six hundred sixty-one patients were 18 years or younger, ranging from 0 to 18 years. The median age was 4 years. Children aged 1 year to 5 years represented the largest patient group ( Conclusion: DMATs should be prepared to treat pediatric patients of all ages, particularly young children and infants, and anticipate medical and minor injury complaints. Field teams must be prepared to care for the infrequent pediatric patient in yellow and red triage categories who may need stabilization and hospital transfer. This unique study yields several interesting trends. First, minor trauma complaints and diagnoses (wounds and msk) increase in frequency as the children get older, whereas the medical complaints are more common in younger children. Next, the youngest children (0 to 2 months) were sent to hospitals more frequently than the other age groups. Finally, triage category was missing more often in the younger age groups. These latter 2 observations may indicate a lack of provider comfort in evaluating and treating young children. Further work is indicated: to improve field documentation, especially of younger children; to plan and implement postdisaster parent and pediatric injury prevention interventions; and to enhance the pediatric capability of DMATs. This first report of DMAT deployments specifically focused on children clarifies the specific needs of pediatric disaster victims and can serve as an important guide to future DMAT deployments.