The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) collaborate to ensure that available resources support pediatric-focused exercises and integration of pediatric topics and injects into all exercises.
The AAP and CDC have collaborated to conduct two exercises to date. The 2016 Pediatric and Public Health Tabletop Exercise brought together state teams in five states within federal Region VI (Arkansas, Louisiana, Oklahoma, New Mexico, and Texas). This was an in-person meeting. In 2017, the AAP/CDC conducted a similar tabletop exercise in four states within federal Region VII (Missouri, Iowa, Kansas, and Nebraska). The 2017 Pediatric and Public Health Virtual Tabletop Exercise (VTTX) connected exercise facilitators (at CDC offices in Atlanta) with state teams who met in state-specific locations using virtual meeting technology. For more information see a list of Exercise Planning Team members or click here to see the video that highlights the exercise.
Purpose of Exercises
The purpose of the tabletop exercises was to improve pediatric preparedness through increased communications and decision-making among pediatricians and public health professionals relevant to a public health emergency related to an infectious disease threat. This exercise used a smallpox scenario to establish a learning environment for participants to exercise/discuss communication strategies and emergency response plans, policies, and procedures that could be applicable in most situations involving an infectious disease outbreak. Each state team included at least two pediatric and two public health representatives. The public health representatives were designated by the state CDC Public Health Emergency Preparedness (PHEP) grantees, and the pediatricians were appointed by the AAP Chapter. Evaluation occurred after each tabletop exercise to determine the extent to which these activities led to improvements in participant and state preparedness. The results of the surveys showed improvements in all areas. Participants also mentioned interest in replicating or expanding this type of exercise within their own states.
The AAP conducted follow-up with participants at selected intervals after the exercise. An AAP News Article titled “Pediatricians, Public Health Professionals Take Part in Preparedness Exercise” was released in August 2016 that provides an overview of the 2016 tabletop exercise. The Disaster Medicine and Public Health Preparedness Journal recently published an article titled “Addressing Children’s Needs in Disasters: A Regional Pediatric Tabletop Exercise” that describes the activities and outcomes specific to the 2016 tabletop exercise. The article summarizes the results that took place during and after the exercise. The AAP conducted follow-up at selected intervals after the exercise. Results of the 2016 tabletop exercise were summarized in an article. The AAP developed a Pediatric and Public Health Preparedness Exercise Resource Kit to assist coalitions, hospitals, and other entities with these efforts. Please email DisasterReady@aap.org if interested in receiving a word document version.
Outcomes of Exercises
Those interested in utilizing resources from the 2016 and 2017 tabletop exercises are welcome to do so. Linked here are the exercise schedule (2016 and 2017), meeting proceedings and executive summary, and a list of strategies for future use. During both exercises, many suggestions came up that could improve preparedness plans and capabilities for an infectious disease threat that impacts children. Some ideas are highlighted below:
Collaborative strategies that AAP chapters, pediatric clinicians, and public health leaders can implement to advance pediatric preparedness at the state and local level:
- Conduct joint public health/pediatric training events.
- Implement a plan to determine vaccination coverage of first responders and emergency volunteers.
- Facilitate opportunities for public health preparedness staff and Emergency Medical Services for Children (EMSC) coordinators to build and sustain strong collaborative relationships over time.
- Include pediatric providers in planning/implementation of public health preparedness drills and exercises (all states have AAP Disaster Preparedness Chapter Contacts).
- Establish formal arrangements, ie Memorandum of Understanding (MOU)/Memorandum of Agreement (MOA) in advance to enable pediatric providers to prescribe medical countermeasures for children across state lines during an emergency involving children.
- Public health can work with schools to leverage existing efforts in children's preparedness, such as school-based influenza vaccination campaigns, to improve pediatric planning and readiness.
- Convene pre-planning and preparedness meetings to clearly define the roles and responsibilities of specific groups during an event (eg, health departments, AAP chapters, epidemiologic and infection control staff, hospital associations, behavioral health experts).
- Develop a plan to direct patients with symptoms that indicate they have been exposed to a particular infectious disease threat to an alternate care site to protect emergency department patients from exposure.
- Use health care coalitions to establish and maintain linkages to pediatric preparedness efforts.
- Conduct an assessment to determine needs, identify gaps, and evaluate the current level of capacity in children's preparedness at state, local, and regional levels.
Communication steps that states could take to improve communication, specific to children's issues:
- Invite pediatricians to serve on public health planning or communication teams.
- Increase the reach of the Health Alert Network (HAN) messages.
- Designate a children's preparedness Web page to offer details on the current event in real time.
- Publicize specific messages in an emergency: "If you believe you were exposed, call (toll-free hotline) or seek care at (name of alternate care facility)."
- Identify questions and develop responses to frequently asked questions, in anticipation of particular emergencies.
- Utilizing connections to organizations that already have the capacity to disseminate information quickly in an emergency.
- Plan ahead for emergency communications to be circulated by the AAP chapter, state health department, governor's office, hospital leadership, and media spokespersons.