Focus Area: Pediatric Surge Capacity

Consider this scenario: A school bus carrying 100 children has crashed and you are the only hospital nearby. Does your current surge plan guide your next steps? Are you able to quickly mobilize the staff, supplies, identify space, and access components within your hospital systems required to respond?

Surge planning refers to the systematic process of preparing healthcare facilities and systems to effectively manage and respond to a sudden increase in the number of patients requiring medical care during emergencies or disasters. Focusing on the unique needs of pediatrics related to surge requires a detailed view from the lens of this patient population and their families when considering staffing, stuff, space, and systems strategies.  This planning involves assessing existing resources, developing plans for expanding pediatric healthcare capacity, training healthcare staff to care for children in emergency situations, coordinating with external agencies and organizations, and establishing protocols for triage, treatment, and patient transportation. The goal of pediatric surge planning is to ensure that healthcare systems can maintain quality care for children even under extreme circumstances, thereby reducing morbidity and mortality among pediatric populations during crises.

Pediatric surge planning is a critical component of emergency preparedness within healthcare systems, aimed at ensuring the timely and effective response to large-scale disasters or public health emergencies that disproportionately affect children. These plans are essential because children have unique medical needs and vulnerabilities that must be addressed in crisis situations. From pandemics to natural disasters, such as hurricanes or earthquakes, the ability to rapidly expand pediatric healthcare capacity and adapt resources to meet the specific needs of children can mean the difference between life and death. By conducting pediatric surge planning, healthcare facilities can minimize disruptions in care, optimize resource allocation, and ultimately save more young lives during times of crisis.

Meeting Schedule

All meetings are held the first Tuesday of each month from 1:00 – 2:15 pm CT.

Planning

For pediatric surge capacity, having a plan in place to establish ways to adapt care plans for sick/more complex pediatric patients is essential, as is determining options to expand pediatric capacity/capability and convert space and non-pediatric services for pediatric use.

All four DRC intervention bundle guides are based on information and recommended strategies within the Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Policies (also known as “The Disaster Checklist”). Pediatric Surge Capacity, domain 3, includes recommended activities at foundational, intermediate, and advanced levels and can be found on pages 13-15.

Key considerations for your facility’s pediatric surge capacity disaster plan:

• Understand your facility’s unique services and capacity (ED, surgical, extended care, etc.)
• Determine how to prioritize which patients would most benefit from transfer to your facility (if regional pediatric resources are limited)
• Identify patients to discharge early
• Consider staff processes needed to address surge
• Identify staff credentials and abilities in your facility that might be used during an event, including subspecialties
• Determine your facility’s spaces that could be shared or used as alternatives during a surge event
• Form existing and needed relationships with local primary care pediatricians, community hospitals, and other partners who might be involved in a surge event.
• Determine supplies needed based on your patients’ demographics in a surge event

Tabletop Exercises and Drills

The DRC teams will be offered an opportunity to review/test their disaster plans during a 3-hour virtual tabletop exercise (VTTX) in 2025. An After-action report completed by exercise participants will help identify gaps and steps for improvement that the facility can consider and follow up on. The gaps and process measures can be tested in two follow-up drills to be conducted in 2026. See the VTTX Checklist and the DRC Tabletop Exercises and Drills webpage.

Quality Improvement and Intervention Strategies

Global AIM

Support children’s hospitals to develop robust surge capacity plans in the event of diverse disaster events that recognize the unique scope of healthcare services at their individual facility.

AIM Statement

By June 2026, 50% of children’s hospitals in the DRC choosing to focus on Surge capacity will have evaluated one or more strategies to improve performance on at least one of the following process measures:

Quality Measures

Select one or more measures from the list below to test and improve upon in the two drills. The following strategies may be considered for improving surge response. The WRAP-EM Pediatric Surge Playbook, PPN Pediatric Preparedness for the Winter Viral Surge, and the PPN Hospital Surge Recommendations and Resources for Pediatric Care offer several surge improvement strategies.

• Time from notification of event to activation of incident command
  • Intervention Strategies:
    • Establish a clear notification process for the occurrence of a surge event and activation of incident command, including who will communicate, how the communication occurs, and who must receive the information
• Time to prioritization of current inpatients for decompression using systematic method (e.g. TRAIN)
  • Intervention Strategies:
    • Include in the disaster plan a systematic method for prioritization and train staff on its use
    • Include in the disaster plan the prioritization parameters of who needs/requires decompression
    • Develop a process for training staff on the use of prioritization methods
• Percentage of patients who are appropriately triaged into one or more categories of prioritization for purposes of resource allocation (MCI triage and infectious disease triage)
  • Intervention Strategies:
    • Include in the plan a systematic method for prioritization and train staff on its use
    • Include in the plan the prioritization parameters of resources and their allocation
• Time to identification of space (ED, inpatient, ICU, surgical) and staffing (physicians, nurses, technicians, etc.) needs to accommodate patients
  • Intervention Strategies:
    • Establish a systematic method to be used in your hospital for identifying additional available space for use during a surge event.
    • Develop a process to create and regularly update a list of staff to be called during a surge event, internal and external to normal hospital operations

If you have identified other objectives or measures because of an exercise after-action report or state/organizational requirements (CMS, Joint Commission, ACS Trauma Level 1, etc.), you can use those.

Resources

• WRAP-EM Pediatric Surge Playbook
• PPN Pediatric Preparedness for the Winter Viral Surge
• Hospital Surge Recommendations and Resources for Pediatric Care