title: Meeting children's needs: a mixed-methods approach to a regionalized pediatric surge plan-the Los Angeles County experience.
abstract: BACKGROUND
  Children are one of the most vulnerable populations during mass casualty incidents because of their unique physiological, developmental, and psychological attributes. The objective of this project was to enhance Los Angeles County's (LAC) pediatric surge capabilities. The purpose of this study was threefold: (1) determine gaps in pediatric surge capacity and capabilities; (2) double pediatric inpatient capacity; and (3) document a plan to address gaps and meet pediatric inpatient surge. We hypothesized that LAC would be able to meet the identified pediatric surge target by leveraging resources of hospitals within the region. Deliverables included a pediatric surge plan for LAC, pediatric surge training resources, and pediatric supplies for hospitals participating in LAC's Hospital Preparedness Program (HPP).
  
  
  METHODS
  After Institutional Review Board approval, the authors used a mixed-methods approach to explore gaps in hospital capacity and capabilities in a large urban county. Hospitals were surveyed via Qualtrics® on 38 questions regarding capacity, staffing, availability of pediatric supplies, and existing pediatric surge plans. Publicly available inpatient bed data were collected from the Office of Statewide Health Planning and Development for the year ending June 2010 and supplemented by hospital survey responses. Population data was used from US Census 2010. This combined dataset was analyzed for capacity, pediatric designations, and capabilities. To supplement this data, three focus groups were conducted between April 2011 and May 2012. Focus group topics included: supplies and training needed for pediatric surge, surge targets, and plan development and functionality.
  
  
  RESULTS
  Hospitals varied in pediatric capacity and capability. Forty-six percent of facilities provide inpatient pediatric services. Forty-one hospitals are designated as an Emergency Department Approved for Pediatrics. Identified gaps included: limited pediatric bed capacity, geographic variability, limited pediatric intensive care unit capacity, limited pediatric specialty physician resources, varying availability of pediatric trained staff, less availability of pediatric critical care supplies, and limited ability to accept and receive children. Focus group stakeholders requested advance and just-in-time training and reference guides to supplement the plan.
  
  
  CONCLUSIONS
  LAC was able to create a pediatric surge plan that doubles pediatric acute and pediatric intensive care bed capacity by using participating HPP hospitals. A tiered system was created based on capacity and capability with varying surge targets and guidance on types of patients that could be cared for at each tier. This plan will assist the LAC Emergency Medical Services Agency distribute pediatric patients during a surge event that disproportionately impacts children.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Berg
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Valerie M
authors.initials: VM
authors.lastname: Muller
authors.affiliation: Los Angeles County Emergency Medical Services Agency, Los Angeles, California.
authors.forename: Millicent
authors.initials: M
authors.lastname: Wilson
authors.affiliation: Los Angeles County Emergency Medical Services Agency, Los Angeles, California.
authors.forename: Roel
authors.initials: R
authors.lastname: Amara
authors.affiliation: Los Angeles County Emergency Medical Services Agency, Los Angeles, California.
authors.forename: Kay
authors.initials: K
authors.lastname: Fruhwirth
authors.affiliation: Patient Care Services, Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Stevenson
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Rita V
authors.initials: RV
authors.lastname: Burke
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Upperman
mesh_terms: D002648:Child; D003422:Critical Care / Q000458:organization & administration; D004632:Emergency Medical Services / Q000458:organization & administration; D017144:Focus Groups; D006742:Hospital Bed Capacity; D006801:Humans; D015141:Los Angeles; D054527:Mass Casualty Incidents; D010372:Pediatrics; D012040:Regional Health Planning; D055872:Surge Capacity; D019037:Urban Health Services / Q000458:organization & administration*