Needs assessment of current pediatric guidelines for use by disaster medical assistance teams members in response to disasters and shelter care

Abstract

Study objectives: We evaluate the needs of disaster medical assistance teams (DMAT) about personnel recruitment/retention/training, curriculum, and equipment with regard to pediatric patients. Methods: A written survey was mailed to all DMAT teams in the United States in July 2003, with a follow-up mailing in November 2003. Responses were entered into a computerized database and analyzed by SPSS software. Results: Responses were obtained from 38 DMAT team leaders (88.3%, 38/43). Team levels were 1 (77.8%), 2 (11.1%), and 3 (11.1%); 28.9% were members of DMAT specialty teams, including pediatric, burn, cold weather, International Medical Surgical Response Team (IMSuRT), National Medical Response Team (NMRT), NMRT-Hazmat, surgical, and surgical pediatric burn. Responses (mean±SEM) are listed according to a Likert scale of 1 to 6 (1=not at all to 6=a great degree). Responses were as follows. Use Web-based National Disaster Medical Systems (NDMS) curriculum: 4.44 (±0.24). NDMS curriculum meets needs of pediatric patients: 4.71 (±0.30). Team uses standardized curriculum: yes 57.9%. Standardized curriculum meets needs of pediatric patients: 3.33 (±0.25). Include pediatric patients in disaster drill scenarios: 68.6%. Team's preparedness for pediatric patients: 3.91 (±0.22). Medical providers work with pediatric patients daily: 86.1%. How well team responds to a disaster with pediatric patients: 3.94 (±0.31). How well equipped to respond to a disaster with pediatric patients: 3.22 (±0.24). How well is pediatric equipment organized: 3.08 (±0.29). Agree that system needs more pediatric specialty teams: 3.37 (±0.31). Agree that current teams need more pediatric training: 3.68 (±0.34). Pediatric protocols in addition to Jump START (simple triage and rapid treatment): yes 36.1%. How well are pediatric guidelines developed: 3.69 (±0.33). Percentage of providers working with children daily: physicians 44.1% (±6.4), nurses 40.0% (±4.7), midlevel providers (nurse practitioners, physician assistants) 44.1% (±6.4), paramedics 59.2% (±6.1), respiratory therapists 51.9% (±7.3). Additional responses are listed in Tables 1 through 5. Conclusion: Emergency physicians compose about three quarters of all the DMAT physicians. Most DMAT team leaders and DMAT teams use the NDMS curriculum but believe that the curriculum in regard to pediatrics could be improved. Recruitment of medical personnel at all levels is difficult, although once they are involved, retention is still a concern but somewhat less of a problem. Although most DMAT providers work with pediatric patients daily (86.1%) and include pediatric patients in disaster drill scenarios (68.6%), some pediatric topics are missing from the curriculum (are included only 27.8% to 41.7% of the time), and there are needs for various pediatric equipment with some equipment (eg, pediatric backboards) only available 37.8% of the time.Table 1, abstract 112.Difficulty in recruitment of DMAT team membersMedical Staff in General, Mean (±SEM)Medical Staff With Pediatric Experience, Mean (±SEM)Physicians4.31 (±0.28)4.29 (±0.30)Nurses3.53 (±0.24)3.74 (±0.25)Midlevel providers3.77 (±0.26)4.15 (±0.23)Paramedics2.72 (±0.27)3.85 (±0.27)Respiratory therapists3.75 (±0.24)4.00 (±0.30) Table 2, abstract 112.Difficulty in retention of DMAT team members.Medical Staff in General, Mean (±SEM)Medical Staff With Pediatric Experience, Mean (±SEM)Physicians3.94 (±0.31)3.94 (±0.31)Nurses3.29 (±0.27)4.00 (±0.30)Midlevel providers3.41 (±0.28)3.50 (±0.30)Paramedics3.10 (±0.29)3.10 (±0.29)Respiratory therapists3.63 (±0.31)3.63 (±0.31) Table 3, abstract 112.Physician specialization of DMAT physicians.Field% of Physicians Specialized in the Following Fields, Mean (±SEM)RangeEmergency medicine74.2 (±3.9)(0–100)Pediatric emergency medicine35.1 (±7.3)(0–100)Pediatrics25.5 (±9.8)(0–100)Family medicine19.5 (±5.1)(0–100)General surgery26.9 (±7.4)(0–100)Pediatric surgery30.7 (±8.6)(0–100)Orthopedics15.4 (±7.1)(0–100)Pediatric psychiatry22.2 (±7.6)(0–100)Anesthesiology with pediatric experience20.8 (±8.6)(0–100)Pediatric intensivist14.4 (±7.7)(0–100) Table 4, abstract 112.Pediatric equipment that the DMAT team has.EquipmentYes, %No, %Airway/intubation83.816.2Backboard37.862.2Cervical collars62.237.8Pediatric IV73.027.0Interosseous devices73.027.0Pediatric medications62.237.8Broslow tape54.145.9 Table 5, abstract 112.Pediatric topics missing from the DMAT team's curriculum.^∗TopicYes, %No, %Pediatric airway and respiratory issues27.882.2Pediatric trauma and shock33.366.7Disaster triage for pediatrics36.173.9Pediatric burn management41.768.3Pediatric pain management41.768.3Psychosocial/mental health issues41.768.3Pediatric mock code practice41.768.3∗Other: General pediatric medicine, developmental milestones.