Pediatric-medical Operations Coordinating Cells (MOCC): A Telehealth Alternative to Deployable Pediatric Disaster Medical Assistance Teams (DMATs)

Background: The United States continues to struggle with pediatric disaster preparedness. Previously identified challenges persist and the recent pandemic has elevated the needs of other vulnerable groups. One solution frequently advocated to augment local pediatric response capabilities is the use of pediatric disaster medical assistant teams (DMAT).
During the recent pandemic, the USDHHS recommended the development of local, state, and regional Medical Operations Coordinating Cells (MOCC) to better match healthcare resources with demand. MOCCs are healthcare providers working within existing Emergency Operation Center (EOC) structure that are tasked with equitably facilitating patient movement, health care staffing and resource allocation. Adapting this idea and developing pediatric specific MOCCs, offers an alternative to deployable pediatric teams that can more effectively and efficiently increase pediatric disaster response capabilities.

Methods: Informal, non-structured interviews were conducted with state NDMS DMAT team leaders regarding the utility of pediatric specific disaster response teams. To verify and contextualize the information gathered, a literature review was conducted. Peer review publications were identified in PubMed, using the search term “disaster medical assistance teams”. The list of included publications was augmented by articles references and in subsequent citation listings. To develop a comprehensive understanding of how deployable disaster medical assistance teams were utilized articles were screened for those identifying details regarding patients age, types of injuries, duration of deployment and nature of the disaster.

Results: Informal interview: general themes.
1. Most deployments involved providing general medical and minor surgical care to vulnerable displaced populations.
2. Pediatric patients were frequently encountered but usually with minor problems well within the scope of general emergency medicine or family practice providers.
3. Pediatric specific teams would not meet the needs of adult patients and would be a limited utility.

Literature review: conclusions
1. DMAT deployments occur most commonly with natural disasters that disrupt existing health care systems.
2. DMAT teams provide general medical care for minor illnesses and injuries. Medication refill requests are common. Children are frequently seen but rarely required transfer to regional centers.
3. Earthquakes or similar events that result in crush or blast injuries require specialty surgical long term wound care and rehabilitation services.
4. Disruption of medical supply chain and limited access to primary care result in increased demand for chronic disease management.

Conclusion: DMATs provide general medical and minor surgical care within the scope of practice of emergency medicine and family practice providers.
Complex healthcare services need to be provided at regional centers. This will require intact patient transportation and regional health systems.
Pediatric MOCC's can utilize telehealth and expert consultation to build bridges between frontline DMAT healthcare providers and regional specialty pediatric medical centers.
Pediatric MOCC’s can coordinate pediatric patient transport and ensure equitable access to specialty pediatric centers.