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Emergency Care for Children: Growing Pains
the first field triage model developed specifically for children was created in 1995, then revised in 2001. Triage is a primary and critical component of disaster management since resources must quickly be put to their most efficient use to do the greatest good for the greatest number of casualties. The pediatric triage model, called JumpSTART, is based on the adult triage tool START and helps prehospital providers make decisions so under- and overtriage will be minimized (Romig, 2002). JumpSTART is widely used today and allows emergency workers to triage children within 30 seconds. However, the model is the product of expert consensus; it has not been empirically validated and therefore is not evidence based (Ohio Pediatric Disaster Preparedness Committee, 2004).
Attention to the issue of pediatric disaster preparedness grew considerably after September 11, 2001. A number of initiatives to address pediatric disaster planning and preparedness began to emerge. In October 2001, the American Academy of Pediatrics (AAP) created a Task Force on Terrorism consisting of 12 pediatricians (Hicks, 2003), with the aim of ensuring that pediatricians and other providers will have the information they need as it becomes available and that children’s needs will be considered in all planning efforts. In 2006, the task force published Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians, designed to give pediatricians and other providers practical advice and information on best practices in the area of disaster preparedness.
In February 2003, a 3-day national consensus conference was held to discuss the particular vulnerabilities of children to terrorist attacks and possible responses. This represented one of the first efforts to define issues in pediatric disaster preparedness. The conference was sponsored by the Agency for Healthcare Research and Quality (AHRQ) and the Maternal and Child Health Bureau (MCHB) and was attended by nearly 70 subject matter experts, as well as representatives from government agencies and professional organizations. Conferees developed recommendations on a number of broad and specific issues and published them later that year (National Center for Disaster Preparedness, 2003). Because of a lack of evidence, however, these recommendations are largely a product of expert consensus.
At around the same time, the National Advisory Committee on Children and Terrorism (NACCT) released a report to the Secretary of Health and Human Services that contained a number of recommendations regarding areas in need of funding and program development. The NACCT was created by Congress through the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. The committee’s goal was to prepare a comprehensive public health strategy for ensuring the safety of children and meeting their needs in the face of the threat of terrorism. Unfortunately, the majority of the recommendations developed by the NACCT have not been implemented. In July 2005, an expert meeting on pediatric bioterrorism