title: Outside the box and into thick air: implementation of an exterior mobile pediatric emergency response team for North American H1N1 (swine) influenza virus in Houston, Texas.
abstract: OBJECTIVE
  We describe the implementation of a mobile pediatric emergency response team for mildly ill children with influenza-like illnesses during the H1N1 swine influenza outbreak.
  
  
  METHODS
  This was a descriptive quality improvement study conducted in the Texas Children's Hospital (Houston, TX) pediatric emergency department (ED), covered, open-air parking lot from May 1, 2009, to May 7, 2009. Children aged 18 years or younger were screened for viral respiratory symptoms and sent to designated areas of the ED according to level of acuity, possibility of influenza-like illness, and the anticipated need for laboratory evaluation.
  
  
  RESULTS
  The mobile pediatric emergency response team experienced 18% of the total ED volume, or a median of 48 patients daily, peaking at 83 patients treated on May 3, 2009. Although few children had positive rapid influenza assay results and the morbidity of disease in the community appeared to be minimal for the majority of children, anxiety about pandemic influenza drove a large number of ED visits, necessitating an increase in surge capacity. Surge capacity was augmented both through utilization of existing institutional resources and by creating a novel area in which to treat patients with potential airborne pathogens. Infection control procedures and patient safety were also maximized through patient cohorting and adaptation of social distancing measures to the ED setting.
  
  
  CONCLUSIONS
  The mobile pediatric emergency response team and screening and triage algorithms were able to safely and effectively identify a group of low-acuity patients who could be rapidly evaluated and discharged, alleviating ED volume and potentially preventing transmission of H1N1 influenza.
authors.affiliation: Section of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA. acruz@bcm.edu
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Cruz
authors.forename: Binita
authors.initials: B
authors.lastname: Patel
authors.forename: Michael C
authors.initials: MC
authors.lastname: DiStefano
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Codispoti
authors.forename: Joan E
authors.initials: JE
authors.lastname: Shook
authors.forename: Gail J
authors.initials: GJ
authors.lastname: Demmler-Harrison
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sirbaugh
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D004189:Disaster Planning; D004196:Disease Outbreaks / Q000517:prevention & control*; D006284:Health Plan Implementation; D006776:Hospitals, Pediatric; D006801:Humans; D017053:Infection Control; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000175:diagnosis / Q000517:prevention & control*; D008952:Mobile Health Units / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D013781:Texas / Q000453:epidemiology; D014218:Triage / Q000458:organization & administration*