Management of Prevalent Infections in Children Following a Disaster

During the pre-pandemic intervals, healthcare providers and healthcare facilities play an essential role in surveillance for suspected cases of infection with novel strains of influenza and should be on the alert for such cases. Novel strains may include avian or animal influenza strains that can infect humans such as avian influenza A H5N1 or novel influenza A H1N1 and new or re-emergent human viruses that cause cases or clusters of human disease. For detection of cases during the Pre-Pandemic and Pandemic Intervals, hospitals should have predetermined thresholds for activating pandemic influenza surveillance plans.

Influenza pandemics are different from many of the threats for which public health and the healthcare system are currently planning. The pandemic will last much longer than most other emergency events and may include “waves” of influenza activity separated by months (in 20th century pandemics, a second wave of influenza activity occurred 3 to 12 months after the first wave). The numbers of healthcare workers and first responders available to work can be expected to be reduced; they will be at high risk of illness through exposure in the community and in healthcare settings, and some may have to miss work to care for ill family members. It is reasonable to assume that absenteeism may exceed 25%. Resources in many locations could be limited because of how widespread an influenza pandemic would be.

The goal of a pandemic surge plan for an emergency department or other outpatient setting is to provide safe and effective care in the event of an influenza pandemic or similar event, and to optimize resources and mitigate throughput issues in order to provide for maximum surge capacity for pediatric patients presenting to the emergency department for care. Utilizing the all-hazards approach to develop plans for epidemic and pandemic respiratory illness is based on the concept that most disaster-response functions are common to all disaster types, and unified planning provides the strongest basis for effective response.

Critical components of comprehensive plans must address the following: 1) Screening, surveillance, and tracking of exposed individuals; 2) controlled access to the healthcare facility; 3) prevention strategies (isolation and cohorting, PPE use, vaccination, antiviral prophylaxis, modification of environmental controls (i.e., separate areas for ill and non-ill patients)); 4) disease-specific admission criteria, treatment, and triage algorithms; and 5) enabling the continuity of limited clinical operations.

In all healthcare settings, patients with symptoms of influenza or influenza-like illness (ILI) should be segregated from non-influenza patients as rapidly as possible, especially in a triage setting. When possible, consider having different teams of staff care for influenza and non-influenza patients. In acute care settings, triage non-ILI patients promptly to specific non-ILI waiting and examining areas, physically separate from the ILI assessment area to prevent their exposure to ILI if possible. Additionally, separate entrances and exits should be established for those who believe they may have been exposed to ILI or those that are in need of other types of medical attention if feasible.

Admission policies and testing and treatment algorithms should also be created for determining if a patient needs to be admitted to the hospital or if an alternate care facility may be more appropriate if altered standards of care are being used. If possible, hospital triage protocols for phone triage may help to educate patients and families and provide help with illness management without accessing the clinic, emergency department, or hospital setting. The diagnosis and treatment algorithms used at the Children’s Hospital Colorado can be found in this module appendix.