PC1267: Integrating Telehealth for Pediatric Disaster Preparedness

Background: The Office of the Assistant Secretary for Preparedness and Response (ASPR) has prioritized regional coordination of disaster medical response. Three ASPR funded programs, the Western Regional Alliance for Pediatric Emergency Management (WRAP-EM), Region V for Kids, and the Region 1 Disaster Health Response System (RDHRS) are collaborating to integrate telehealth into pediatric disaster response within and across regions. We conducted assessment surveys of emergency preparedness experts, and cross-site tabletop exercises to examine how existing telehealth infrastructure can be leveraged to support disaster response. Our objective is to report the results of the surveys, tabletop exercises, and a proposed web-based application that could be integrated into emergency response plans to connect pediatricians and specialists to front-line providers, children, and families during disasters.

Methods: We surveyed pediatric emergency preparedness experts by email and asked 12 questions about the usefulness and potential of integrating telehealth services into emergency operation plans, including existing networks, inclusion of first responder access, and types of telecommunication services. In scenario-based tabletop exercises, six academic pediatric centers in two states partnered with community/critical access facilities to provide teleconsultation, facilitate triage, psychological first aid, and care coordination between the 2 state agencies charged with disaster response. A white paper was developed for ASPR describing exerciser’s experiences captured in real time.

Results: Forty-nine respondents from six WRAP-EM states and six additional western states participated in the needs assessment survey. Major themes included a positive impression on the utility of telehealth during pediatric disasters including the COVID-19 pandemic. Positive themes included enhanced safety, improved access, and increased flexibility for patients and providers. Negative themes included concerns about liability, reimbursement, and lack of in-person care. Tabletop exercises captured barriers to connectivity: firewalls, network infrastructure, and lack of interoperability of hardware and software. However, the ability to augment pediatric care at a less resourced site in a surge or disaster shows promise if these barriers are addressed. We also identified significant limitations when telecommunications and/or electrical power was interrupted and noted cybersecurity vulnerability in public networks. As a result, we created a telehealth emergency operation checklist.

Conclusion: WRAP-EM, Region V for Kids, and the RDHRS have conducted needs assessments, connectivity tests, and collaborative technology development to integrate the needs of children in regional disaster telehealth response. We identified numerous potential benefits to integrating telehealth in pediatric emergency management but highlight barriers related to interoperability of technology, connectivity, cybersecurity, regulatory and liability concerns, that should be addressed before all benefits can be realized. In addition to developing recommendations for health systems and disaster response organizations to navigate barriers, the RDHRS developed a low-bandwidth, web-based, mobile software platform that can be integrated into existing pediatric disaster management systems to facilitate new telehealth connections across health systems and state lines.