title: Going viral: adapting to pediatric surge during the H1N1 pandemic.
abstract: OBJECTIVE
  The objective of this study was to assess hospital and emergency department (ED) pediatric surge strategies utilized during the 2009 H1N1 influenza pandemic as well as compliance with national guidelines.
  
  
  METHODS
  Electronic survey was sent to a convenience sample of emergency physicians and nurses from US EDs with a pediatric volume of more than 10,000 annually. Survey questions assessed the participant's hospital baseline pandemic and surge preparedness, as well as strategies for ED surge and compliance with Centers for Disease Control and Prevention (CDC) guidelines for health care personal protection, patient testing, and treatment.
  
  
  RESULTS
  The response rate was 54% (53/99). Preexisting pandemic influenza plans were absent in 44% of hospitals; however, 91% developed an influenza plan as a result of the pandemic. Twenty-four percent reported having a preexisting ED pandemic staffing model, and 36% had a preexisting alternate care site plan. Creation and/or modifications of existing plans for ED pandemic staffing (82%) and alternate care site plan (68%) were reported. Seventy-nine percent of institutions initially followed CDC guidelines for personal protection (use of N95 masks), of which 82% later revised their practices. Complete compliance with CDC guidelines was 60% for patient testing and 68% for patient treatment.
  
  
  CONCLUSIONS
  Before the H1N1 pandemic, greater than 40% of the hospitals in our study did not have an influenza pandemic preparedness plan. Many had to modify their existing plans during the surge. Not all institutions fully complied with CDC guidelines. Data from this multicenter survey should assist clinical leaders to create more robust surge plans for children.
authors.affiliation: From the *Division of Emergency Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA; †Division of Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC; ‡Children's Emergency Services, University of Michigan Health System, Ann Arbor, MI; §Department of Pediatrics, Division of Emergency Medicine, Department of Medicine, Division of General Internal Medicine University of Pittsburgh, Pittsburgh, PA; ∥Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; ¶Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT; #Division of Pediatric Emergency Medicine, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland OH; **Pediatrics and Emergency Medicine at Emory University School of Medicine, Atlanta, GA; ††Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Sarita
authors.initials: S
authors.lastname: Chung
authors.forename: Daniel
authors.initials: D
authors.lastname: Fagbuyi
authors.forename: Marie M
authors.initials: MM
authors.lastname: Lozon
authors.forename: Tiffani
authors.initials: T
authors.lastname: Johnson
authors.forename: Alan L
authors.initials: AL
authors.lastname: Nager
authors.forename: Mark X
authors.initials: MX
authors.lastname: Cicero
authors.forename: Deanna
authors.initials: D
authors.lastname: Dahl-Grove
authors.forename: Brian E
authors.initials: BE
authors.lastname: Costello
authors.forename: Steven E
authors.initials: SE
authors.lastname: Krug
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D004189:Disaster Planning; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D019983:Guideline Adherence; D019538:Health Care Surveys; D006274:Health Facility Moving / Q000458:organization & administration; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration / Q000706:statistics & numerical data; D008397:Masks / Q000706:statistics & numerical data / Q000600:supply & distribution; D058873:Pandemics; D010561:Personnel Staffing and Scheduling; D017410:Practice Guidelines as Topic; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States