ners to address all the social service needs associated with a disaster of that magnitude. However, the development of evacuation plans should take into account how children can attend schools in different areas, the availability of health care services for children, pediatric capacity in the SNS, ways to expedite Medicaid enrollment for pediatric disaster victims, and long-term sheltering options available for children. Although difficult for disaster planners to address, these issues must be considered.

Conducting Pediatric Disaster Drills

It is widely believed that medical professionals do not receive as much disaster preparedness training as they should (AAMC, 2003; NASEMSD, 2005). The American College of Emergency Physicians (ACEP) has reported that the lack of bioterrorism training for medical responders is so severe that patient treatment could be seriously compromised (Maniece-Harrison, 2005). It is perhaps not surprising that pediatric training is particularly lacking. Most bioterrorism training initiatives, for example, make no reference to the needs of children (Maniece-Harrison, 2005).

Disaster drills have long been central to disaster preparedness efforts for all types of emergency responders. Such drills have proven to be effective in training hospital providers to respond to mass casualty incidents (Hsu et al., 2004) and indeed are required of most hospitals. The Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO) 2006 accreditation standards require hospitals to conduct two disaster drills per year, 4 to 8 months apart, one of which must include an influx of volunteers or simulated patients. Hospitals must also participate in at least one communitywide drill per year to assess the communications, coordination, and effectiveness of hospital and community command structures (JCAHO, 2005).

However, the JCAHO requirements do not specifically address conducting disaster drills with children, and in fact, many disaster drills do not include pediatric patients. For example, one hospital held a disaster drill for a mock earthquake, in which a pediatric patient was simulated by a 5-gallon water bottle on which was taped a list of symptoms (Fields, 2003). Obviously, this is a poor means of simulating a pediatric patient. Some disaster drills do not consider children at all. Most (68 percent) of DMATs include pediatric patients in disaster drill scenarios (Mace and Bern, 2004), but it is significant that 32 percent do not. An assessment of EMS agencies in Arkansas found that few had participated in school disaster drills or planned for school responses (Dick et al., 2004).

The exception is, of course, children’s hospitals, where all drills involve an influx of critical pediatric patients. In September 2003, for example, Children’s Hospital of Atlanta held a drill during which it received 20 critically injured pediatric patients. Yet while children’s hospitals are among the

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