are unlikely to be able to absorb the influx of patients from such an incident (Shute and Marcus, 2001). Emergency medical services (EMS) systems lacking sufficient resources even for day-to-day operations are overwhelmed in the event of a large-scale disaster. Deficiencies in the emergency care system for children that are evident during normal operations in the areas of pediatric equipment, medication and supplies, and pediatric training are greatly exacerbated during a disaster. The available evidence reveals that the nation’s emergency care system is poorly prepared for disasters (Schur et al., 2004):

  • Surge capacity. Surge capacity refers to a hospital’s ability to manage a sudden, unexpected increase in patient volume that would otherwise severely challenge or exceed its normal capacity (Hick et al., 2004). Few American hospitals have the capacity to handle the increased volume of patients likely to result from a large-scale disaster or an epidemic, particularly if the patients are infants or small children (Kaji and Lweis, 2004; Oster and Chaffee, 2004).

  • Surveillance. In public health parlance, surveillance refers to the ability to collect and analyze morbidity, mortality, and other relevant ED data in order to identify and control health threats. Few automatic, real-time surveillance systems are in operation across the United States that can accurately alert public health officials to an impending crisis (GAO, 2003a).

  • Coordination/communication. In the event of a disaster or public health emergency, emergency care personnel may have to coordinate their efforts with personnel from other hospitals; EMS agencies; and public safety agencies, such as fire and police. A high level of coordination is required. However, communications systems are often not secure or reliable during such an event. Many communications systems are incompatible across regions or even across agencies within the same community (GAO, 2001).

  • Training. The medical and nonmedical needs of victims of a disaster or public health emergency may vary from the type of care normally delivered by emergency care providers. Emergency personnel must be able to recognize and meet these needs. Overwhelmingly, research indicates that academic, on-the-job, and continuing education training in disaster response for emergency care personnel is insufficient, particularly when it comes to treating victims of chemical, biological, and nuclear events (Treat et al., 2001; GAO, 2003a; Rivera and Char, 2004).

  • Protective equipment. Protective equipment refers to clothing and garments, respiratory equipment, and other barriers designed to shield emergency care personnel from chemical, biological, or other physical hazards. Evidence suggests that many emergency care providers are inadequately equipped for routine practice, and disasters make it difficult or impos-



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