Pediatric disaster preparedness in the medical setting: Integrating mental health

The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.

BackgroundDisasters, whether natural or man-made, pose significant challenges to healthcare systems, with children being among the most vulnerable populations. Pediatric Emergency Departments (PEDs) require specialized protocols to address children’s distinct physiological, psychological, and developmental needs in other to respond adequately to disasters. While international guidelines for disaster preparedness exist, significant disparities persist across different healthcare settings, particularly in low-resource regions where preparedness measures remain inadequate. This review examines the current state of pediatric disaster preparedness, analyzing insights from past disasters to highlight key challenges, gaps, and opportunities for improvement. Special attention is given to global frameworks, existing protocols, and how lessons from successful disaster responses can inform future strategies, particularly in resource-limited settings.AimsThis review aims to assess the readiness of PEDs for disaster scenarios by identifying deficiencies and proposing strategies to enhance preparedness. It explores infrastructure requirements, workforce training, triage protocols, and mental health considerations specific to pediatric populations. Additionally, it assesses international frameworks and best practices to inform policy recommendations for strengthening pediatric-focused disaster response globally.ConclusionPediatric disaster preparedness remains inadequate across global healthcare systems, particularly in resource-limited settings. While international protocols exist, their implementation varies widely, leaving gaps in staff training, resource allocation, and mental health support. Addressing these gaps requires a multi-faceted approach that includes enhanced training programs, improved resource allocation, and integration of mental health services into disaster protocols. By adopting evidence-based strategies and fostering interdisciplinary collaborations, healthcare systems can develop more resilient and child-focused emergency response frameworks. Strengthening disaster preparedness in PEDs is essential to ensuring equal opportunities for care and effective treatment for children in times of crisis.

Introduction:The Illinois EMSC Pediatric Facility Recognition Program was implemented in 1998. The objective was to identify the capability of a hospital to provide optimal pediatric emergency and critical care. Beginning in 2004, steps were taken to integrate pediatric disaster preparedness into the facility recognition process.Aim:The goal of this study was to identify strengths and areas for improvement in pediatric disaster preparedness in participating Chicago hospitals.Methods:The impact of the EMSC Pediatric Preparedness Checklist was assessed during the 2016 Pediatric Facility Recognition hospital site surveys. The following components were surveyed as they relate to pediatrics: Overall Emergency Operations Plan (EOP), Surge Capacity, Decontamination, Reunification/Patient Tracking, Security, Evacuation, Mass Casualty Triage/JumpSTART, Children with Special Health Care Needs/Children with Functional Access Needs, Pharmaceutical Preparedness, Recovery, Exercise/Drills/Trainings. All survey items were extracted, collated, and reviewed.Results:Fourteen Chicago hospitals participated in the survey. Almost all hospitals (93%) surveyed indicated that they consult staff with pediatric expertise when updating their EOP, incorporate pediatric trained mental health professionals into their disaster call lists (93%), and integrate staff with pediatric focus into their incident command system/emergency operation center during a disaster (79%). Almost all of the hospitals (93%) had an infant/child abduction plan and all hospitals (100%) were testing the process at least once per year. Finally, almost all of the hospitals (93%) had incorporated a patient connection program into their tracking and reunification plan. However, not all hospitals included drills for pediatric surge, decontamination, and evacuation. Less than one-third of the hospitals had pediatric components in their alternate treatment site plans. Half of the hospitals did not have pediatric components incorporated into their decontamination plans.Discussion:Integrating the EMSC Pediatric Preparedness Checklist surveys into the recognition process is an innovative approach to improve pediatric disaster planning and preparedness in hospitals.

The purpose of this study was to understand the relationship among counselors' self reported multicultural counseling competence and their attitudes of the geriatric population. A statistically significant negative correlation was found between participants' attitudes of the geriatric population and their self-reported multicultural counseling competence. Implications for training and practice are provided. ********** Approximately 75 million individuals who were born between 1946 and 1964 encompass the Baby Boom population (Goldstein & Damon, 1993). In the year 2011, these individuals began entering the geriatric population. As the Baby Boom population ages, the geriatric population, which includes those 65 years and older, will grow to be the largest cohort in history. By 2000, 35 million individuals composed the geriatric population (Gist & Hetzel, 2004), and researchers expect this cohort to continue to grow to include 21% of the U.S. population--or 76.4 million individuals--by 2030 (Van Gerpen, Johnson, & Winstead, 1999). With the rapid increase of the geriatric population, greater attention to mental illness, elder abuse, and other psychosocial factors (e.g., ageism) within the population is likely, as counselors may be treating more of these individuals. The purpose of this article is to review these salient characteristics for working with this population and to explore the relationship between two constructs indicating counselor competency in multicultural counseling and attitudes toward the geriatric population. MENTAL HEALTH AND PSYCHOSOCIAL CONSIDERATIONS Mental Health Considerations There are many mental health considerations counselors must be aware of when counseling individuals of the geriatric population. Dementia, depression, and suicide are prevalent within this population. Dementia such as Alzheimer's disease is extremely prevalent during older adulthood and may be the most prevalent mental illness in older adults (Zank, 1998). Overall, 5% of adults over the age of 65 years are diagnosed with dementia and 10% are diagnosed with Alzheimer's disease (Spira & Edelstein, 2007; Zank, 1998). In addition, individuals over the age of 80 years are diagnosed with dementia at a rate of 20%, and more than half of individuals over the age of 85 years are diagnosed with Alzheimer's disease. Currently, in the United States, 4 million people are living with Alzheimer's disease (Spira & Edelstein, 2007). These individuals often have progressive memory loss; language disruption; agitation; and personality, emotional, and behavior changes (Abraham, 2005). Depression can lead to impairments in mental, physical, and social functioning for this population (Centers for Disease Control and Prevention [CDC] & National Association of Chronic Disease Directors [NACDD], 2009). Overall, 2.5% of older adults meet the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) criteria for depression or dysthymic disorder. However, 27% of older adults have symptoms of depression but do not meet the full criteria for the disorder. Older adults must often face the death of friends as well as partners, and, therefore, bereavement becomes a focus of older adulthood. Because of this, elders may experience increased depression. In addition, depression may also be exacerbated by illness and accidents, such as hip fractures or heart disease (U.S. Department of Health and Human Services [USDHHS], 2000). For instance, 12% of older individuals who are hospitalized for illness and accidents such as these develop depression. In addition, elders in nursing homes are particularly inclined to develop depression because 15% to 25% of these individuals develop symptoms of the mental health illness (USDHHS, 2000). Suicide also greatly affects individuals of the geriatric population. Overall, 13 individuals 65 years and older commit suicide each day in the United States (Walsh, Currier, Shah, Lyness, & Friedman, 2008). …

Children account for 30 percent of the US population; as a result, many victims of disaster events are children. The most critically injured pediatric victims would be best cared for in a tertiary care pediatric hospital. The Children's Hospital Association (CHA) undertook a survey of its members to determine their level of readiness to respond to a mass casualty disaster. The Disaster Response Task Force constructed survey questions in October 2011. The survey was distributed via e-mail to the person listed as an "emergency manager/disaster contact" at each association member hospital and was designed to take less than 15 minutes to complete. The survey sought to determine how children's hospitals address disaster preparedness, how prepared they feel for disaster events, and how CHA could support their efforts in preparedness. One hundred seventy-nine surveys were distributed with a 36 percent return rate. Seventy percent of respondent hospitals have a structure in place to plan for disaster response. There was a stronger level of confidence for hospitals in responding to local casualty events than for those responding to large-scale regional, national, and international events. Few hospitals appear to interact with nonmedical facilities with a high concentration of children such as schools or daycares. Little commonality exists among children's hospitals in approaches to disaster preparedness and response. Universally, respondents can identify a disaster response plan and routinely participate in drills, but the scale and scope of these plans and drills vary substantially.

Children are particularly vulnerable during disasters and mass-casualty incidents. Coordinated multi-hospital training exercises may help health care facilities prepare for pediatric disaster victims. The purpose of this study was to use mixed methods to assess the disaster response of three hospitals, focusing on pediatric disaster victims. A full-functional disaster exercise involving a simulated 7.8-magnitude earthquake was conducted at three Los Angeles (California USA) hospitals, one of which is a freestanding designated Level I Pediatric Trauma Center. Exercise participants provided quantitative and qualitative feedback regarding their perceptions of pediatric disaster response during the exercise in the form of surveys and interviews. Additionally, trained observers provided qualitative feedback and recommendations regarding aspects of emergency response during the exercise, including communication, equipment and supplies, pediatric safety, security, and training. According to quantitative participant feedback, the disaster exercise enhanced respondents' perceived preparedness to care for the pediatric population during a mass-casualty event. Further, qualitative feedback from exercise participants and observers revealed opportunities to improve multiple aspects of emergency response, such as communication, equipment availability, and physician participation. Additionally, participants and observers reported opportunities to improve safety and security of children, understanding of staff roles and responsibilities, and implementation of disaster triage exercises. Consistent with previous investigations of pediatric disaster preparedness, evaluation of the exercise revealed several opportunities for all hospitals to improve their ability to respond to the needs of pediatric victims. Quantitative and qualitative feedback from both participants and observers was useful for comprehensively assessing the exercise's successes and obstacles. The present study has identified several opportunities to improve the current state of all hospitals' pediatric disaster preparedness, through increased training on pediatric disaster triage methods and additional training on the safety and security of children. Regular assessment and evaluation of supplies, equipment, leadership assignments, and inter-hospital communication is also suggested to optimize the effectiveness and efficiency of response to pediatric victims in a disaster.

Climate change represents a complex and multifaceted challenge for health systems, particularly in the African region, where the research has predominantly focused on physical health impacts while overlooking critical mental health dimensions. Our central hypothesis is that integrating culturally adapted mental health and psychosocial support (MHPSS) into climate resilience frameworks and disaster response planning will significantly reduce psychological distress (e.g., anxiety, depression, and trauma) and enhance adaptive capacities among both mainstream and migrant communities in disaster-prone African regions. This rapid review methodology systematically explores the intricate relationships between climate change, mental health, and migration by examining the existing literature and identifying significant information gaps. The key findings underscore the urgent need for targeted research and strategic interventions that specifically address mental health vulnerabilities in the context of climate change. This review highlights how extreme weather events, environmental disruptions, and forced migration create profound psychological stressors that extend beyond immediate physical health concerns. This research emphasizes the importance of developing comprehensive adaptation strategies integrating mental health considerations into broader climate response frameworks. Recommendations emerging from this assessment call for immediate and focused attention on developing specialized research, policies, and interventions that recognize the unique mental health challenges posed by climate change in African contexts. We also note the current limitations in the existing national adaptation plans, which frequently overlook mental health dimensions, thereby underscoring the necessity of a more holistic and nuanced approach to understanding climate change’s psychological impacts. In this exploratory study, we intended to provide a crucial preliminary assessment of the complex intersections between climate change, mental health, and migration, offering valuable insights for policymakers, researchers, and healthcare professionals seeking to develop more comprehensive and responsive strategies in an increasingly challenging environmental landscape.

The COVID-19 pandemic exacerbated the child mental health crisis and existing disparities. Child anxiety, depression, suicide attempts and completions, and mental-health-related emergency department visits significantly increased. In response to this crisis, the Administration for Strategic Preparedness and Response (ASPR) developed behavioral health task forces associated with funded pediatric centers of disaster excellence. The Health Resources and Services Administration (HRSA) funded the Pediatric Pandemic Network (PPN) to prepare for future endemics and pandemics, with behavioral health identified as a priority in mitigation, preparedness, response, and recovery. This commentary provides insights from pediatric disaster preparedness and response behavioral health subject matter experts. Our roles have been to identify how to build behavioral health professional competencies across disciplines and various medical settings and to strengthen emergency interdisciplinary behavioral health care capability regionally and at the national level. Specific examples of interdisciplinary training and demonstration projects are included as models for enhancing behavioral health situational awareness and developing curricula to support preparedness and response for the current ongoing pandemic and future natural and biological disasters. This commentary also includes a call to action for workforce development to move beyond a boots-on-the-ground mentality for pediatric behavioral health disaster preparedness and response toward a more inclusive role for behavioral health providers of varied specialties. This means that behavioral health providers should become more informed of federal programs in this area, seek further training, and find innovative ways to collaborate with their medical colleagues and community partners.

Disaster Management in the Era of Lean Healthcare

Factors associated with increased preparedness for future bushfires after exposure to a severe bushfire in Australia

1. To conduct a review of the role of informatics in pediatric disaster preparedness using all medical databases. 2. To provide recommendations to improve pediatric disaster preparedness by the application of informatics. A literature search was conducted using MEDLINE, CINHL and the Cochrane Library using the key words "children" AND "disaster preparedness and disaster" AND "informatics". A total of 314 papers were initially produced by the search and eight that met the selection criteria were included in the review. Four themes emerged: tools for disaster preparedness, education, reunification and planning and response. The literature pertaining to informatics and pediatric disaster preparedness is sparse and many gaps still persist. Current disaster preparedness tools focus on the general population and do not specifically address children. The most progress has been achieved in family reunification; however, the recommendations delineated are yet to be completed.

Introduction:The Illinois EMSC Pediatric Facility Recognition Program was implemented in 1998. The objective was to identify the capability of a hospital to provide optimal pediatric emergency and critical care. Beginning in 2004, steps were taken to integrate pediatric disaster preparedness into the facility recognition process.Aim:The goal of this study was to identify the impact of the EMSC Pediatric Preparedness Checklist across time in Chicago hospitals undergoing Pediatric Facility Recognition.Methods:Chicago hospitals were evaluated during the 2012 and 2016 Pediatric Facility Recognition Program. The following components were surveyed as they relate to pediatrics: Overall Emergency Operations Plan (EOP), Surge Capacity, Decontamination, Reunification/Patient Tracking, Security, Evacuation, Mass Casualty Triage/JumpSTART, Children with Special Health Care Needs/Children with Functional Access Needs, Pharmaceutical Preparedness, Recovery, Exercise/Drills/Trainings. Data from 2012 and 2014 checklist categories were compared and p-values were computed utilizing Fisher’s Exact Test. A p-value <0.05 was considered statistically significant.Results:Stockpiling of staging areas or having ready access to resuscitation supplies increased 46% (p < 0.05), testing of pediatric surge capacity in previous 24 months decreased 43% (p < 0.05), maintaining warmed water source for decontamination decreased 43% (p < 0.05), and having familiarity of evacuation procedures in ED, pediatric, and nursery personnel decreased 42% (p < 0.05). Although not statistically significant, the training of pediatric staff with JumpSTART triage increased 59%, EOP containing a pediatric reunification process increased by 36%, the presence of specific staff plans to allow care of dependents increased for children (29%), elderly (32%) and pets (35%), integration of a pediatric component into hospital EOP increased by 29%, and identification of an alternate treatment site for children decreased by 25%.Discussion:Integrating the EMSC Pediatric Preparedness Checklist surveys into the facility recognition process impacts pediatric disaster preparedness and planning, and identifies areas of improvement in hospitals.

To outline current understanding and recommended mental health and psychiatric considerations for radicalisation and violent extremism among adolescents. Overview of recent research regarding violent extremism in adolescents and relationships with mental illness and other psychosocial determinants. Relevant international and Australasian research is outlined, with an emphasis on adolescents. Psychiatric considerations, intervention and policy implications will be explored. Adolescents who become radicalised form a heterogenous group with complex, multifaceted needs from mental disorder, familial, societal and/or environmental contributions. Thus, assessment and management need to be individualised. Mental health clinicians working with at-risk and radicalised adolescents should maintain a high index of suspicion for mental illness (particularly psychosis and depressive disorder) and neurodevelopmental disorder. Identified psychiatric conditions warrant prioritised mental health treatment. There may be a relationship between specific psychopathology and certain ideological beliefs and behaviours. Radicalised adolescents pose challenges with risk of serious harm to others, presentation complexity, multifactorial contributors and associations with varied psychopathology. All adolescents at risk of radicalisation or who are radicalised, should receive comprehensive mental health assessment and prompt assertive treatment of identified psychiatric conditions.

Disasters are major events that have significant effects on individuals, communities, and health care systems. Nurses are valuable resources that have a role in disaster response. However, barriers in disaster education in nursing programs negatively affect nurses' knowledge and skills in disaster preparedness and response. A literature review was conducted to better understand the disaster response educational needs of nurses and to explore gaps in nurses' preparedness for disaster response and nursing education and training. Findings indicated disaster response education is a vital component of nursing education. When provided with effective disaster education, nurses are better equipped for disaster management and disaster response. Challenges in educational needs continue, and nurses lack specific disaster knowledge and preparedness. Further research is needed to identify effective teaching strategies for disaster response and preparedness. Emphasis should be placed on integrating disaster education into nursing education programs at all levels. [J Nurs Educ. 2025;64(4):235-238.].

Introduction:Pediatric patients represent a small (but important) subset of the patient population routinely visiting emergency departments (ED) each year. With the aim of better understanding the disaster preparedness level for pediatric-specific mass casualty and surge incidents, a survey was conducted involving all hospitals that routinely manage pediatric patients in their emergency departments, to better understand the preparedness levels for these facilities.Method:This is a retrospective analysis of data collected in 2014 and repeated in 2021. Our focus included one predominantly rural state in the United States of America (USA). We examined results from surveys conducted where facilities self-reported objective criteria that resulted in a readiness score (as it relates to pediatric readiness). Reporting stratification reflected the annual pediatric ED volume with groups of; Low (<1800/year), Medium (1800-4999 /year), Medium to High (5000-9999/year), and High (>10,000/year).Results:Low-volume hospitals scored (Mean=59/Median=56), Medium volume hospitals scored (Mean=62/Median=60), Medium to High volume hospitals (Mean=67/Median=65), and hospitals with High volumes (Mean=82/Median=83). All hospital volume ranges had outlier hospitals that scored between 82-97. The general tendency, lower volume hospitals had a lower level of readiness, and higher volume hospitals had a higher (to much higher) level of readiness.Conclusion:Pediatric disaster readiness needs to be improved at the community level. It is encouraging that pediatric disaster readiness has been addressed in the larger medical centers. Yet, it should be noted that even very low-volume hospitals (had outliers with) scores as high as 94 indicating that with ample support, and resources, pediatric disaster preparedness is achievable in every hospital regardless of size or volume. The results point to a need to develop, improve, and distribute resources and support local hospitals with pediatric disaster readiness.