The American Academy of Pediatrics (AAP) strongly supports the uninterrupted care of children during surges in patient volume and acuity created by infectious disease outbreaks, including COVID-19, influenza, and respiratory syncytial virus (RSV) as well as the continued crisis in mental health to ensure timely access to care and optimal care outcomes. Enhancing both capabilities and capacity for emergency readiness on a day-to-day basis in all settings is the first step toward operational preparedness and resiliency to accommodate for daily, weekly and seasonal variations in patient volumes. Readiness preparations must consider the physical and mental health care needs of children of all ages, including children with special health care needs. The AAP recognizes that many areas of the United States have experienced and continue to experience surge episodes attributable to infectious disease outbreaks and local large-scale crises. It is also well understood that existing health disparities are often further magnified during surge events. This document provides a framework of prevention strategies as well as proactive planning to guide efforts for continued surge response and additional preparedness, focusing primarily on responses that can be readily implemented.
Patient volume or disease prevalence surges are common occurrences in pediatric care. Seasonal viral outbreaks, such as those attributable to influenza or RSV, typically occur annually, and pediatricians and children’s hospitals are generally able to anticipate and respond to these events when they occur. The COVID-19 pandemic, the increase in other pediatric respiratory disease, and the continued pediatric mental health crisis have resulted in an extraordinary surge in health care demand of unpredictable severity and duration. There have been substantial increases in morbidity and mortality seen across multiple “waves” of illness, as well as unprecedented stresses on health care workers and support structures. This stress on health care systems and providers, patients and families can be overwhelming when simultaneous outbreaks of multiple diseases occur, with the potential for impact on access to both routine and acute care.
Surge capacity refers to the ability to evaluate and care for a markedly increased volume of patients—one that challenges or exceeds normal variations in operating capacity. Surge capability refers to the ability to add specialized medical services for unique patient populations, such as children, that may not be routinely available in all facilities under normal operating conditions. Surges may require alternate care processes and additional resources to meet the demand for services. Critical surges may require consideration of contingency plans, which typically require activation of incident command systems and alternate care standards. Surges that exceed the additional capacity of contingency planning may require implementation of crisis standards of care. During a public health emergency, surge requirements may extend beyond direct patient care to include access to medications and vaccines, availability of pediatric equipment, as well as laboratory screening or epidemiologic investigations.
Planning should include readiness for increased numbers of patients seeking care, whether caused by COVID-19, other communicable diseases, mental and behavioral health challenges, local large-scale crises or the many other concerns prompting patients to seek care. As seen during the COVID-19 pandemic, active response must address ongoing shortages of health care staff, financial stresses on health care systems and pediatricians and supply chain issues affecting needed medications, equipment and supplies. Ongoing collaboration among community and regional partners is necessary to address the current surge of patients requiring care, as well as consideration of situations that could lead to further increases in patient volume or acuity.