Pediatric-specific Hazard Vulnerability Analysis: The Missing Component of Regional and Hospital-based Preparedness

Background: Though children comprise a large percentage of the population and are uniquely vulnerable to disasters, they are often omitted from regional and hospital-based emergency preparedness, specifically hazard vulnerability analysis (HVA) tools. HVAs are an essential modality used by emergency managers to conduct a threat, hazard identification, and risk assessment (THIRA) as part of the stakeholder preparedness process. Specific hazards and their impacts, including probability of occurrence, are assessed along with previous mitigation endeavors. A review of the most commonly used HVA templates found that essential pediatric considerations were excluded from this process.

To address this gap, we sought to develop a novel pediatric-specific HVA template that provides regional and hospital emergency managers with a flexible way to include children in their disaster preparedness efforts.

Methods: Available HVA frameworks (e.g., Kaiser Permanente) were analyzed for overall template usefulness, pediatric inclusions, hazard impact categories, and scoring features. To create a HVA template that addressed children’s vulnerabilities and roles during hazards, we reviewed the disaster literature, prior case reports, and national recommendations. These resources were used to craft pediatric-specific hazard impact and preparedness categories. Category scoring designs and formulas were iteratively improved upon, resulting in a template that allowed managers to consider children in different types of disasters across multiple quantitative and qualitative dimensions.

Results: We created a pediatric-specific, workbook-based HVA template that informs emergency managers about their institution’s pediatric risk and resiliency, as well as how prepared their regions and/or hospitals are for the pediatric consequences of those disasters (Figure 1).

The HVA template distills a given hazard into scorable impact / severity measures that characterize a disaster’s effects on children. To assist with scoring determinations, the template includes a detailed key with descriptions of each impact / severity measure (Figure 2). The template similarly includes a key to assist managers in scoring their institution’s preparedness for a given hazard. Hazard impact and preparedness categories incorporate age-based equipment and care needs, long-term developmental and mental health consequences, and the hospital and community functions most necessary for supporting children during disasters.

After assigning scores to impact and preparedness categories, the template provides managers with the hazard’s impact on children (impact score), overall pediatric vulnerability to the hazard (vulnerability score), and the region’s and/or hospital’s hazard risk based on prior preparedness efforts (overall risk score).

Conclusion: To address the absence of children and relevant pediatric categories in commonly used HVAs, we constructed a pediatric-specific HVA template that supplies emergency managers with a comprehensive assessment of their pediatric populations and preparatory requirements. The template is designed to be used on its own or alongside existing HVA frameworks. Further work is needed to determine the overall effectiveness of the template, and it is currently being disseminated for broader use.