Perspectives on Emergency Preparedness Emergency Department Ronald Ruffing

Perspectives on Emergency Preparedness Emergency Department Ronald Ruffing MD, MPH, MPS Chief-Division of Pediatric Emergency Medicine Children’s Hospital of Michigan Detroit, MI

“I’m an ED Doc…I got this… ” What really happens when you don’t plan!!!

Incident: School Bus Fire Background: Monday afternoon @1450 �A school bus transporting children from a single charter elementary school develops an electrical fire and the bus rapidly fills with dense smoke. �The bus pulls over to the side of the road and all children are evacuated from the bus. �Police and EMS respond. Ronald Ruffing MD, MPH.

Incident: School Bus Fire ED Notification EMS notified ED of transport of 12 patients for school bus fire. 12 children all “greens” – 2 with DIB 1 with vomiting ETA 10 minutes Emergency Department 8 OBS Beds 2 psych 15 Trauma General ED Beds X-ray 6 Pediatric beds 8 Fast track beds

Incident: School Bus Fire Over the next 30 minutes 4 ambulances arrived transporting 12 children ages 5 -12 years. – 5 children report breathing, coughing or choking problems. 2 are wheezing. – 1 children report vomiting. MEDICAL CARE • None smelled of smoke • None had soot in nose or mouth • 2 children had mild wheeze and were given a single albuterol neb each. Ronald Ruffing MD, MPH.

Incident: School Bus Fire Registration & Identification 1. 4 children can give first and last name. 9 remaining children can give first name, age, grade and teachers name. 2. No reliable medical information was available on any child.

Incident: School Bus Fire Consent for treatment 1. No adult accompanied the children from the school or the bus company. 2. When the school was contacted we got voice mail instructing us to call back during regular business hours. No emergency contact information.

Incident: School Bus Fire 2 hours later… • All 12 patients are ready for discharge but only 2 families have been reached and instructed to come to the hospital • No space • No staff • No stuff • No system

Family Reunification Hospital Family Reunification Center (HFRC) PEDIATRIC SAFE SPACE Family Reunification Site

Incident: School Bus Fire Mental health “ I couldn’t breath” “Everything was black” “I couldn’t find my brother” “I thought I was going to die” “I couldn’t see anything”

Issues of Concern for Un-accompanied Minors 1. 2. 3. 4. 5. Patient registration Consent Past medical concerns Allergies Family notification/HIPPA 6. Family re-unification 7. Security 8. Nutrition 9. Press 10. Mental Health

School Bus Fire Patients arrived in three ambulances shortly after 3 pm • 12 children ages 5 -9 all “green”. – 1 wheezing – 1 vomited • No accompanying adult Issues: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Patient registration Consent Past medical concerns Allergies Family notification/HIPPA Family re-unification Security Nutrition Press Mental Health