Toolkit paves the way for hospitals to meet children's needs during a disaster

In Brief

Due to growing concern over the specific needs of children during an emergency, public health agencies and hospitals are seeking to enhance clinical readiness for all hospitals that may see children during a mass casualty event. In response to this issue, the King County Healthcare Coalition developed a pediatric medical management toolkit and evacuation plan for regional hospitals.


The importance of caring for children plays a significant role in emergency planning; however, children's medical needs are often drastically different than the needs of adults. Children have different vital sign norms and anatomical/physiological characteristics that require a specific age-appropriate approach to emergency care. Children also have mental health and communication needs that correspond to their level of development, and they depend on adults for basic necessities.

The King County Healthcare Coalition, administered by Public Health-Seattle & King County, wanted to create a regional pediatric disaster response plan to ensure appropriate and timely medical care of children at any regional hospital during an emergency. To address this issue with thorough clinical guidance, the Coalition convened a workgroup of healthcare organizations and providers.

Specific issues

  • Uneven pediatric care capabilities. Although pediatric specialty hospitals are accustomed to seeing children and infants on a regular basis, other hospitals vary in the level of expert care they can provide to children. An assumption was that standardized training to meet the basic medical needs of children would enhance readiness and quality of care during an emergency in which children may have to be taken to the nearest hospital.
  • Hospital leadership support. Hospital leadership may be reluctant to prioritize resources for training clinical staff and for space and supplies related to pediatric disaster preparedness planning.

The practice

Based on input from local experts, the King County Healthcare Coalition developed tools to assure that children receive age-appropriate medical care during a disaster.

The toolkit consists of three parts: A set of hospital guidelines, an annex containing adaptable and interactive tools, and an evacuation plan. Details on each component are provided below:

  • "Hospital Guidelines for Management of Pediatric Patients in Disasters" includes information on a variety of topics relevant to the needs of children during a disaster. Areas of focus include:
    • Staff training
    • Appropriate equipment and supplies
    • Pharmaceutical and dietary requirements
    • Transportation
    • Inpatient bed planning
    • Security and psychosocial support
    • Decontamination
    • Surge and hospital-based triage
    • Infection control
    • Establishment of a family information and support center
  • A tools annex contains adaptable information and forms for hospitals, including Job Action Sheets for roles such as pediatric service unit leader and safe area coordinator, a pediatrics safe area checklist and registry, a sample menu, mental health information, and a patient evacuation tracking form.
  • A neonatal and pediatric evacuation plan, an annex to King County's regional evacuation plan, focuses specifically on the special transport and care required by infants and children in a rapidly changing situation. Associated tools assist users in implementing the plan and include:
    • An evacuation algorithm
    • Surge operating concepts
    • Guidelines for management of medical records and medication labeling
    • Patient tracking information
    • Charts for evaluating patient evacuation sites by capability category and surge capacity

What made this practice possible?

  • Extensive hospital collaboration and engagement in developing the toolkit, via the King County Healthcare Coalition.
  • A regional pediatric capacity and capability assessment conducted to determine planning gaps and focus for the toolkit. The Coalition conducted a regional hazard identification and vulnerability assessment; an inventory of pediatric inpatient beds, staff, and equipment; a regional evacuation planning workshop; and surge capacity evaluations.


  • The Coalition developed a standardized process for managing pediatric patients intended to allow clinicians to focus more directly on health assessment, prioritization of care, and treatment during an emergency.
  • Toolkit materials and training laid the groundwork for a pediatric medical preparedness and response network in the region.

 Note: As of January 1, 2014, the King County Healthcare Coalition has nonprofit status and has changed its name to the Northwest Healthcare Response Network.

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