Section 4 - Training
- "Section 4 - Training" is also available in Portable Document Format (PDF, 131KB, 9pg.)
Purpose: The recommendations included in this section suggest training to ensure that pediatric patients receive appropriate care at all hospital facilities during a mass casualty, disaster, or terrorism related event. General medical and disaster training as well as pediatric-specific education options are included, all of which are recommended to enhance hospital response.
Section Contents
- General Guidelines
- Training Recommendations
- Primary Disaster and Emergency Courses
- Resource list of disaster and emergency training courses
- Other Disaster Courses
- Medical Society of the State of New York (MSSNY) Sponsored Course
- Sponsored by the American Academy of Pediatrics/American College of Emergency Physicians (AAP/SCEP)
- Sponsored by the New York State Department of Health and the National Association of Emergency Medical Technicians (NAEMT)
- Sponsored by the Emergency Nurses Association (ENA)
- Primary Disaster Courses
- Additional Pediatric Emergency and Disaster Courses
- Additional Trauma Courses
- Additional Critical Care and Disaster Courses
- Additional Websites for Disaster Preparedness Information
- Sources or Information for Emergency Preparedness for Childbirth
- Sources for Obstetric Simulators – Manufacturers' Websites
General Guidelines:
Disaster and emergency training includes education in both the core principles of disaster management and the emergency treatment of adult, obstetric and pediatric patients requiring basic, advanced and trauma life support.
All hospitals should address the pediatric and obstetric populations when planning training courses for staff who will likely respond during a disaster. Additionally, the hospital emergency preparedness planning committee should consider the "pediatric and obstetric surge capacity" of the current staffing, whether the hospital has these services or not.
To develop comfort in caring for pediatric and obstetric patients, staff are encouraged to enroll and/or to participate in additional pediatric and childbirth training courses, beyond that of basic proficiency.
Training Recommendations
Hospitals with Pediatric Service, but no Pediatric Intensive Care Unit
Hospitals with general pediatric in-patient services should prepare for the same possibilities listed for hospitals with a PICU. In addition, critical pediatric patients might require intensive care and subsequent monitoring when transfer is not immediately possible. Possible locations for temporary placement of critical pediatric patients include:
- Adult Medical Intensive Care Unit;
- Adult Cardiac Care Unit;
- Surgical Care Unit;
- Post-Anesthesia Care Unit; or
- Another appropriate in-patient intensive care unit.
- The staff anticipated to be responsible for the various levels of pediatric care should have the appropriate basic pediatric disaster training. Since pediatric intensivists and pediatric critical care nurses are not available at these facilities, the applicable training recommendations are recommended for Medical and Surgical ICU nurses and physicians and for nurse practitioners.
Hospitals without In-Patient Pediatric Services
These hospitals should develop disaster plans that address all of the possibilities for needed pediatric care. While pediatric specialty staff may not be available normally at these facilities, it is recommended that certain staff be pre-identified and pre-designated to staff pediatric surge capacity areas. These pre-designated individuals should receive appropriate training necessary to provide adequate care to the pediatric population during a disaster.
Hospitals without Obstetric Services
During times of disasters, pregnant women are likely to experience greater rates of complications, including premature labor and birth, low birthweight infants and neonatal and infant deaths. Stress is increased during these times, and stress combined with lack of proper nutrition and hydration can result in premature delivery. During disasters, pregnant women need access to skilled professional health assessment and methods of hydration, including intravenous hydration.
All hospitals should develop disaster plans that address the possibility for admitting pregnant women who are affected by the disaster and laboring women in need of delivery. While obstetricians and midwives may not be available normally at these facilities, it is recommended that certain staff be pre-identified and predesignated to staff obstetric areas, should the service be needed. These pre-designated individuals should receive appropriate training necessary to provide adequate care to pregnant and laboring women and their neonates during a disaster.
Primary Disaster and Emergency Courses
Staffing anticipated to be assigned to pediatric inpatient surge capacity areas in the event the usual hospital inpatient pediatric capacity is exceeded and these patients can not be transferred should receive training listed below:
| Training Recommendations for Pediatrics | |
|---|---|
| All Direct Care Providers (Nurses and Physicians) |
|
| Nurses |
|
| Physicians |
|
| Training Recommendations for Obstetrics | |
| All Direct Care Providers (Nurses and Physicians) |
|
Training Resources
American Heart Association Sponsored Courses:
Pediatric Advanced Life Support (PALS)
Course Description: The completely redesigned American Heart Association Pediatric Advanced Life Support course is based on new scientific evidence from the 2005 AHA Guidelines for CPR and ECC and new teaching methodology. The goal of the PALS course is to aid the pediatric healthcareprovider in developing the knowledge and skills necessary to efficiently and effectively manage critically ill infants and children, resulting in improved outcomes. Skills taught include recognition and treatment of infants and children at risk for cardiopulmonary arrest; the systematic approach to pediatric assessment; effective respiratory management; defibrillation and synchronized cardioversion; intraosseous access and fluid bolus administration; and effective resuscitation team dynamics.
Course Length: 14 hours
Intended Audience: For pediatricians, emergency physicians, family physicians, physician assistants, nurses, nurse practitioners, paramedics, respiratory therapists, and other healthcare providers who initiate and direct advanced life support in pediatric emergencies.
Advanced Cardiac Life Support
Course Description: This course is designed to teach providers the knowledge and skills to manage the first ten minutes of an adult VF/VT arrest. Students manage ten core ACLS cases: respiratory emergency, stroke, simple and complex VF/VT, PEA, asystole, bradycardia, stable and unstable tachycardia, and acute coronary syndrome.
Course Length: 8 to 16 hours
Intended Audience: Emergency ICU or cardiac care personnel, emergency medical providers such as physicians, paramedics, respiratory therapists, and other health care providers who may need to respond to a cardiovascular emergency.
Emergency Nurses Association Sponsored Courses
Emergency Nursing Pediatric Course (ENPC)
Course Description: ENPC is a course designed to provide core-level pediatric knowledge and psychomotor skills needed to care for pediatric patients in the emergency setting. The course presents a systematic assessment model, integrates the associated anatomy, physiology and pathophysiology and identifies appropriate interventions. Triage categorization and prevention strategies are included in the course content. ENPC is taught using a variety of formats, including lectures, videotapes and includes skill stations that encourage participants to integrate their psychomotor abilities into a patient situation in a risk-free setting.
Course Length: 16-hours
Intended Audience: For nurses expected to care for pediatric patients following a disaster. Although the course is geared towards nurses in an emergency setting, the content can easily be utilized by nurses who will need to provide care to pediatric patients who may require in-patient hospital services.
American College of Surgeons Sponsored Courses
Advanced Trauma Life Support (ATLS)
Course Description: The doctor who first attends to the injured patient has the greatest opportunity to impact outcome . This course provides an organized approach for evaluation and management of seriously injured as well as a foundation of common knowledge for all members of the trauma team. The objectives for the course include: (1) Assess the patient's condition rapidly and accurately; (2) Resuscitate and stabilize the patient according to priority ; (3) Determine if the patient's needs exceed a facility's capabilities ; (4) Arrange appropriately for the patient's definitive care ; and, (5) Ensure that optimum care is provided.
Course Length: 2 or 2.5 days
Intended Audience: Designed for physicians, physician extenders and nurse practitioners.
American Burn Association Sponsored Courses
Advanced Burn Life Support (ABLS)
Course Description: The course provides guidelines in the assessment and management of the burn patient during the first 24 hours post injury. Following a series of lectures, case studies are presented for group discussions. An opportunity to work with a simulated burn patient to reinforce the assessment, stabilization, and the American Burn Association transfer criteria to a Burn Center will be given. Final testing consists of a written exam and a practical assessment return demonstration.
Course Length: Eight-hours.
Intended Audience: For physicians, nurses, physician assistants, nurse practitioners, therapists, and paramedics.
Other Disaster Courses
American Medical Association/National Disaster
Life Support Foundation (AMA/NDLSF)
Sponsored Courses:
Core Disaster Life Support (CDLS)
Course Description: The course is presented in a four-hour didactic format, and provides an overview of disasters including events such as natural and manmade, traumatic and explosive, nuclear and radiological, biological and chemical. The overall goal is to introduce participants to basic concepts and terms reinforced in greater detail in the BDLS and ADLS courses.
Course Length: Four-hours.
Intended Audience: For basic EMTs, allied health workers and technicians, law enforcement officials, administrators and planners, entry-level Medical Reserve Corps, dentists, pharmacists, office-based physicians and nurses and anyone needing and introductory program.
Decon Disaster Life Support
Course Description: The ability to decontaminate a large number of victims from a chemical or radiological event will require large numbers of personnel trained and equipped to provide decontamination. Although healthcare providers in PPE will be needed to render immediate care and triage victims, the majority of the workforce to provide decontamination in a disaster of this nature should be non-medical provider, hospital based personnel. This program is designed to meet this need.
Course Length: Eight-hours.
Intended Audience: For physicians, physician assistants, nurse practitioners, nurses, emergency medical technicians, paramedics, allied health professionals, medical students, law enforcement officers, fire fighters, first responders, hospital administrators, decontamination personnel, emergency managers, hospital safety/security personnel and non-clinical personnel.
Basic Disaster Life Support (BDLS)
Course Description: The curricula includes: overview and disaster paradigm; natural and manmade disasters; traumatic and explosive events; nuclear and radiological weapon attacks; biological events; chemical events; the public health system and the psychosocial aspects of disasters.
Course Length: Eight-hours.
Intended Audience: For emergency medical service (EMS) personnel, hazardous materials personnel, public health personnel, and health care providers.
Advanced Disaster Life Support (ADLS)
Course Description: ADLS is an advanced practicum of the principles introduced in Basic Disaster Life Support (BDLS). ADLS includes lectures on the following: mass triage in detail; community and hospital disaster planning; media and communications during disasters; and, mass fatality management.
Course Length: Sixteen-hours.
Intended Audience: For physicians , nurse practitioners, physician assistants, nurses, emergency medical technicians, paramedics, pharmacists, allied health professionals, medical students.
Medical Society of the State of New York (MSSNY) Sponsored Course
Biological, Chemical, and Nuclear Emergencies Course (BCNE)
Course Description: This curriculum is a sixteen module program designed to assist physicians in obtaining experience in bio-terrorism preparedness training. There are eleven Biological Agents, four Chemical Agents including a Chemical Overview and one Nuclear Radiological Emergencies modules. These modules will provide valuable information during any public health emergency involving these agents.
Course Length: 4 hour seminar; also available in extended version.
Intended Audience: For physician members; however, non-members are eligible to enroll Bioterrorism Reference Cards can be down loaded from this link or may be obtained free of charge from MSSNY.
Sponsored by the American Academy of Pediatrics/American College of Emergency Physicians (AAP/SCEP)
Advanced Pediatric Life Support (APLS)
Course Description: Covers basics of pediatric emergency medicine The course curriculum is designed to present the information physicians need to assess and care for critically ill and injured children during the first few hours in the emergency department or office-based setting.
Course Length: 2 days
Intended Audience: Physicians. Also available for nurses, paramedics.
Sponsored by the University of Kentucky Pediatric Terrorism Awareness Course
Course Description: Basic awareness course, available free and on-line. Reviews the potential terrorist weapons, including the most likely agents in each class, identify the characteristics that make children more susceptible to the various forms of terrorism, review the recognition, evaluation and management of pediatric victims of terrorist incidents, discuss the various specific agents of terrorism, including the mechanisms of injury or illness, expected signs and symptoms, and evaluation and treatment of victims.
Course Length: 4 hours (Free on-line course)
Intended Audience: For federal, state and local emergency public safety, law enforcement, emergency response, nurses, emergency medical (including hospital emergency facilities), and related personnel, agencies, and authorities.
Sponsored by the New York State Department of Health and the National Association of Emergency Medical Technicians (NAEMT)
Pre-hospital Pediatric Care Course (PPCC)
Course Description: The New York State EMSC Prehospital Pediatric Care Course (PPCC), a continuing education course for EMTs, was designed to reinforce or enhance the knowledge and skills of all prehospital providers in assessing and treating children in the field.
Course Length: One to 2 days
Intended Audience: For emergency medical technicians and paramedics
Sponsored by the Emergency Nurses Association (ENA)
Trauma Nursing Core Course (TNCC)
Course Description: ENA developed and implemented the TNCC for national and international dissemination as a means of identifying a standardized body of trauma nursing knowledge. The TNCC (Provider) is a 16 or 20-hour course designed to provide the learner with cognitive knowledge and psychomotor skills. Nurses with limited emergency nursing clinical experience, who work in a hospital with limited access to trauma patients, or who need greater time at the psychomotor skill stations are encouraged to attend courses scheduled for the 20- hour format. The course covers pediatric, pregnant and older adult trauma. Psychosocial aspects of trauma are also covered.
Course Length: 16 to 20 hours
Intended Audience: For nurses; other healthcare providers may attend as observers
Primary Disaster Courses
American College of Surgeons (ACS) Sponsored Course:
Disaster Management and Emergency Preparedness (DMEP)
- 1 day, physicians and physician extenders only
American Medical Association/National Disaster Life Support Foundation (AMA/NDLSF)
Sponsored Courses:
Core Disaster Life Support (CDLS)
- 1/2 day, non medical hospital staff
Core Disaster Life Support-Decontamination (CDLS-D)
- 1 day, hospital decontamination team personnel
Basic Disaster Life Support (BDLS)
- 1 day, all medical disaster providers, soon to be available in an on-line version
Advanced Disaster Life Support (ADLS)
- 2 days, all medical disaster providers
Hospital Emergency Response Training (HERT) for Mass Casualty Incidents (MCI) Train-the-Trainer Course
Sponsored by Department of Homeland Security at the Alabama Noble Training Center
- Hospital Administrators, doctors, nurses, physicians, security personnel and other hospital staff who would make up or manage their Hospital's Emergency Response Team, 2.5 to 3 day format.
Additional Pediatric Emergency and Disaster Courses
Emergency Nursing Pediatric Course (ENPC)
Sponsored by the Emergency Nurses Association (ENA)
- Modular course, self taught
Pediatric Disaster Life Support (PDLS)
Sponsored by the University of Massachusetts Medical School and Emergency Medical Services for Children (EMSC)
- 1or 2-day training course for medical, EMS, and disaster professionals
Additional Trauma Courses
Trauma Nursing Core Course (TNCC)
Sponsored by the Emergency Nurses Association (ENA)
- 2 days, nurses only
Advanced Trauma Care for Nurses (ATCN)
Sponsored by the Society of Trauma Nurses (STN)
- 2 days, nurses only, run only in conjunction with a co-located ATLS course
Pre-Hospital Trauma Life Support Course (PHTLS)
Sponsored by the National Association of Emergency Medical Technicians (NAEMT) in collaboration with the American College of Surgeons (ACS) Committee on Trauma
- 1 day, EMTs, 2 days, paramedics
Additional Critical Care and Disaster Courses
Fundamentals of Critical Care Support (FCCS)
Sponsored by the Society of Critical Care Medicine (SCCM)
- 2 days, all medical providers, includes pediatric considerations
Fundamentals of Disaster Medicine (FDM)
Sponsored by the Society of Critical Care Management (SCCM)
- 1 day, all medical providers, includes pediatric considerations
Hospital Disaster Management (HDM)
Sponsored by the Society of Critical Care Medicine (SCCM)
- 1 day, all medical providers, includes pediatric considerations
Additional Websites for Disaster Preparedness Information
Agency for Healthcare Research and Quality (AHRQ)
- Agency for Healthcare Research and Quality site with general preparedness information
American Academy of Family Physicians
- American Academy of Family Physicians website with links to emergency/disaster preparedness
Center for Trauma Response, Recovery and Preparedness for Health Care Communities
- Center for Trauma Response, Recovery and Preparedness for Health Care Communities with links to disaster and emergency preparedness
Centers for Disaster Control and Prevention
- Centers for Disease Control and Prevention site with links to Emergency Preparedness and Response
Critical Illness and Trauma Foundation Inc.
- "Bioterrorism & Trauma Training: An All Hazards Approach to Multiple Casualty Events" CD-ROM, written by Critical Illness and Trauma Foundation Inc.
Delaware Emergency Medical Services
- "Triaging Kids in Disasters" CD-ROM, developed by Delaware EMSC
Emergency Medicine Services for Children (EMSC)
- EMSC website with links to various pediatric disaster preparedness websites
Illinois Emergency Medical Services for Children
- Illinois EMS-C site with additional links to disaster and emergency preparedness websites JumpSTART Pediatric Mass Casualty Incident (MCI) Triage Tool
- Links to information about JUMPStart triage system
National Center for Disaster Preparedness
- Pediatric Preparedness for Disasters and Terrorism: A National Consensus Conference, Executive Summary 2003
Sources or Information for Emergency Preparedness for Childbirth
World Health Organization
- Birth and emergency preparedness in antenatal care: Integrated management of pregnancy and childbirth (IMPAC), Standards for Maternal and Neonatal Care, 2006
- Mangaging Complications in Pregnancy and Childbirth: A guide for midwives and doctors, 2003.
The Journal of Perinatal Education
- DeWald, L and Fountain, L. Introducing emergency preparedness into childbirth education.
American College of Nurse Midwives
- Giving birth "in place," emergency preparedness for childbirth.
Johns Hopkins University
- Emergency Obstetric Care: Quick Reference Guide for Frontline Providers, 2003