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City Pediatric Emergency Drill Takes on Grim Urgency in Wake of UK Bombing

By Amy Zimmer | May 26, 2017 10:24am
 Dr. George Foltin (second from left) and his team at Maimonides test their communications systems and coordination efforts during the pediatric disaster preparedness drill run by the city's Health Department, FDNY, and Emergency Management.
Dr. George Foltin (second from left) and his team at Maimonides test their communications systems and coordination efforts during the pediatric disaster preparedness drill run by the city's Health Department, FDNY, and Emergency Management.
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DNAInfo/Amy Zimmer

BOROUGH PARK — Hope for the best, but prepare for the worst.

City officials staged a grim emergency exercise at Maimonides Medical Center and 27 other hospitals in the city on Thursday — drilling their response to a hypothetical bombing that would send hundreds of children to the emergency room.

The NYC Pediatric Disaster Coalition, based at Maimonides, had been planning for this exercise with the Health Department, Fire Department and Emergency Management for nearly a year. But the training took on a heightened emotional tenor in light of the recent Manchester bombing at the Ariana Grande concert.

“It’s like insurance: You don’t ever want to use it,” said Dr. George Foltin, Maimonides’ vice chair of pediatrics, who spearheaded his staff’s efforts in the exercise. “But the events of this week remind us very clearly that children can be targets.”

Under the simulation’s scenario, multiple bombs were placed on school buses in Queens. Roughly 300 children, including many in critical condition, needed to be transported to hospitals across the city.

No fake patients participated in the training; rather staffers gathered around tables discussing the hypothetical scenario as they were tested on their ability to triage patients requiring transfers to other facilities, assess available beds and coordinate transportation of severely injured patients between hospitals.

Maimonides — which is an accredited children’s hospital and has Brooklyn’s only pediatric trauma unit — got 69 patients under the drill, the vast majority of whom were under the age of 18. The staff had to decide whether it could take more children from elsewhere even though it might strain the facility.

Under typical disaster plans for New York City, patients are supposed to stay put for 24 to 48 hours, Foltin explained to his colleagues, but when dealing with children, things are different.

“The resources for them are much fewer,” he said. “There are fewer beds, fewer pediatric neurosurgeons.”

A child with blood in his head, for instance, would only have four hours to survive, he noted.

Because Maimonides has the expertise on working with children, the hospital would take in more, Foltin said.

There were other issues that needed attention in the scenario, like making sure there was enough equipment.

Staffers discussed, for example, running across the street to a nursing home to borrow their ventilators so existing adult hospital patients could be switched to those devices and free up Maimonides' special ventilators that can be used for both adult and pediatric patients to ensure incoming children can be treated.

In the tabletop scenario, the hospital also had to deal with news media attempting to enter its facilities as well as maintain focus on getting the right information out on Twitter while staying on top of inaccurate reports on social media.

They had to troubleshoot the best department to handle the needs of an incoming group of kindergartners who had no physical trauma but significant emotional trauma.

Staffers also came up with best practices for handling family members contacting the hospital to look for patients, particularly those who need translators who may not speak English.

The hospital has had unfortunate experience dealing with real-life versions of the hypothetical attack, as they ran a mental health hotline after the Sept. 11, 2001 attacks, operated by the hospital's psychiatric specialists.

Dr. Michael Frogel, co-principal investigator along with Foltin of the NYC Pediatric Disaster Coalition, advised the Maimonides staff to be mindful of mental health issues during a crisis.

“If you have 10 patients, you probably have 100 people with mental health issues,” he said, noting an estimated 500,000 people suffered from mental health issues after 9/11, including people who watched events unfold on the news.

The Pediatric Disaster Coalition worked with the health department on a similar exercise a year ago with 13 hospitals before expanding it this year, explained Dr. Celia Quinn, a Centers for Disease Control and Prevention epidemiologist who works for the city's health department.

Quinn highlighted the critical need to put a lot of effort into the planning and coordination of an event that disproportionately affects children.

“Although almost a quarter of New York’s residents are under the age of 18, children are, luckily, not sick that often. So there’s not an overwhelming capacity for critical care within our system to take care of them,” she said. “We need to make sure we can surge the ability very quickly and build it up if we needed to.”