title: The reality of pediatric emergency mass critical care in the developing world.
abstract: BACKGROUND
  Public health emergencies resulting from major man-made crises and large-scale natural disasters severely impact developing countries, causing unprecedented rates of indirect mortality and morbidity, especially in children and women. Concomitantly, the state of children's health in the least-developed countries is the worst since the 1950s before the Declaration of Alma Ata. Worldwide decline in public health protections, infrastructures, and systems, and a health worker crisis primarily in Africa and Asia, limit the delivery of intensive and critical care services.
  
  
  METHODS
  In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations.Steering Committee members established subgroups by topic area and performed literature reviews of MEDLINE and Ovid databases. The Steering Committee produced draft outlines through consensus-based study of the literature and convened October 6-7, 2009, in New York, NY, to review and revise each outline. Eight draft documents were subsequently developed from the revised outlines as well as through searches of MEDLINE updated through March 2010.The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. Feedback on each manuscript was compiled and the Steering Committee revised each document to reflect expert input in addition to the most current medical literature.
  
  
  CONCLUSIONS
  Using pandemics as a model of public health emergencies, steps to improve care to the most vulnerable of populations are outlined, including mandates under the International Health Regulations Treaty of 2007 and World Health Organization guidelines. Recommendations include an emphasis on first improving primary care, prevention, and basic emergency care, where possible. Advances in care should move incrementally without compromising primary care resources. A first step in preparing for a pandemic in developing countries involves building capacity in public health surveillance and proven community containment and mitigation strategies. Given the severe lack of healthcare workers in at least 57 countries, the Task Force also supports World Health Organization's recommendations that planning for a public health emergency include means for health workers to collaborate with staff in the military, transport, and education sectors as well as international healthcare workers to maximize the efficiency of scarce human resources. Rapid response teams can be augmented by international subject matter experts if these do not exist at the country level.
authors: Harvard Humanitarian Initiative, Harvard School of Public Health, Cambridge, MA, USA. fburkle@hsph.harvard.edu
authors: Frederick M
authors: FM
authors: Burkle
authors: Andrew C
authors: AC
authors: Argent
authors: Niranjan
authors: N
authors: Kissoon
mesh_terms: D000293:Adolescent; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D002648:Child; D046688:Child Mortality / Q000639:trends; D002675:Child, Preschool; D003422:Critical Care / Q000592:standards*; D003906:Developing Countries / Q000191:economics; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000600:supply & distribution*; D006286:Health Planning Councils; D006287:Health Planning Guidelines; D006801:Humans; D007223:Infant; D054527:Mass Casualty Incidents; D000078329:Workforce