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Original Research and Critical Analysis

Developing Consensus on Appropriate Standards of Disaster Care for Children

Robert K. Kanter, MD, John S. Andrake, MD, Nancy M. Boeing, RN, MS, James Callahan, MD, Arthur Cooper, MD, MS, Christine A. Lopez-Dwyer, RN, MS, James P. Marcin, MD, MPH, Folafoluwa O. Odetola, MD, MPH, Anne E. Ryan, RN, MS, Thomas E. Terndrup, MD and Joseph R. Tobin, MD

Address correspondence to Robert K. Kanter, MD, Pediatrics, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210 (e-mail: kanterr{at}upstate.edu).

Background: Neither professional consensus nor evidence exists to guide the choice of essential hospital disaster interventions. The objective of our study was to demonstrate a method for developing consensus on hospital disaster interventions that should be regarded as essential, quantitatively balancing needs and resources.

Methods: A panel of pediatric acute care practitioners developed consensus using a modified Delphi process. Interventions were chosen such that workload per staff member would not exceed the previously validated maximum according to the Therapeutic Intervention Scoring System. Based on published models, it was assumed that the usual numbers of staff would care for a disaster surge of 4 times the usual number of intensive care and non–intensive care hospital patients.

Results: Using a single set of assumptions on constrained resources and overwhelming needs, the panel ranked and agreed on essential interventions. A number of standard interventions would exceed crisis workload constraints, including detailed recording of vital signs and fluid balance, administration of vasoactive agents, invasive monitoring of pressures (central venous, intraarterial, intracranial), dialysis, and tube feedings.

Conclusions: The quantitative methodology and consensus development process described in the present report may have utility in future planning. Groups with appropriate expertise must develop action plans according to authority within each jurisdiction, addressing likely disaster scenarios, according to the needs in each medical service region, using available regional resources, and accounting for the capabilities of each institution.

Key Words: critical care • Delphi consensus process • disaster • hospital • pediatric • standards




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