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Geographical Maldistribution of Pediatric Medical Resources in Seattle-King County

Published online by Cambridge University Press:  28 June 2012

Mary A. King ,
Kathryn Koelemay ,
Jerry Zimmerman  and
Lewis Rubinson
Mary A. King*
Affiliation:
Seattle Children's, Pediatric Critical Care Medicine, Harborview Medical Center, Seattle, Washington USA; University of Washington, Seattle, Washington, USA
Kathryn Koelemay
Affiliation:
Public Health-Seattle and King County, Communicable Disease Epidemiology, University of Washington, Department of Health Sciences, Seattle, Washington, USA
Jerry Zimmerman
Affiliation:
Seattle Children's, Pediatric Critical Care Medicine University of Washington, Seattle, Washington, USA
Lewis Rubinson
Affiliation:
University of Washington, Seattle, Washington, USA; Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, Washington, USA
*
M/S W-8866 PO Box 5371, Seattle, Washington 98105, USA E-mail: [email protected]
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Abstract

Objective:

Seattle-King County (SKC) Washington is at risk for regional disasters, especially earthquakes. Of 1.8 million residents, >400,000 (22%) are children, a proportion similar to that of the population of the State of Washington (24%) and of the United States (24%). The county's large area of 2,134 square miles (5,527 km2) is connected through major transportation routes that cross numerous waterways; sub-county zones may become isolated in the wake of a major earthquake. Therefore, each of SKC's three sub-county emergency response zones must have ample pediatric medical response capabilities. To date, total quantities and distribution of crucial hospital resources (available in SKC) to manage pediatric victims of a medical disaster are unknown. This study assessed whether geographical distribution of hospital pediatric resources corresponds to the pediatric population distribution in SKC.

Methods:

Surveys were delivered electronically to all eight acute care hospitals in SKC that admit pediatric patients. Quantities and categories of pediatric resources, including inpatient treatment space, staff, and equipment, were queried and verified via site visits.

Results:

Within the seven responding hospitals of eight queried, the following were identified: 477 formal pediatric bed spaces (pediatric intensive care unit, neo-natal intensive care unit, general wards, and emergency department), 43 informal pediatric bed spaces (operating room and post-anesthesia care unit), 1,217 pediatric nurses, 554 pediatric physicians, and 252 infant/pediatric-adaptable ventilators. The City of Seattle emergency response zone contains 82.1% of bed spaces, 83.5% of nurses, and 95.8% of physicians, yet only 22.8% of all SKC children live in that zone.

Conclusions:

The majority of hospital pediatric resources are located in the SKC sub-region with the fewest children. These resources are potentially inaccessible and unable to be redistributed by ground transportation in the event of a significant regional disaster. Future planning for pediatric care in the event of a medical disaster in SKC must address this vulnerability.

Keywords

disasterhospitalspediatricsSeattle-King Countyservicesstaffing
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 4 , August 2010 , pp. 326 - 332
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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References

1.King County census data. King County Website. Available at http://www.metrokc.gov/about.htm Accessed 11 October 2007.Google Scholar
2.Committee on Pediatric Emergency Medicine, Committee on Medical Liability and the Task Force on Terrorism: The pediatrician and disaster preparedness. Pediatrics 2006;117(2);560–565.CrossRefGoogle Scholar
3.US Census Bureau (2000); State by Place: King County, WA. Available at http://www.census.gov/census2000/states/wa.html.Google Scholar
4.Jeff Duchin, MD. Public Health—Seattle & King County, 29 March 2007.Google Scholar
5.Kanter, RK, Moran, JR: Pediatric hospital and intensive care unit capacity in regional disasters: Expanding capacity by altering standards of care. Pediatrics 2007;119(1):94–100.CrossRefGoogle ScholarPubMed
6.Washington State Department of Transportation: SR 520—Bridge Replacement and HOV Project website. Available at http://www.wsdot.wa.gov/projects/SR520Bridge/. Accessed 17 June 2008.Google Scholar
7.Potoka, DA, Schall, LC, Ford, HR: Improved functional outcome for severely injured children treated at pediatric trauma centers. J Trauma 2001;51(5):824–832.CrossRefGoogle ScholarPubMed
8.Stylianos, S, Nathens, AB: Comparing processes of pediatric trauma care at children's hospitals versus adult hospitals. J Trauma 2007;63(6 Suppl):s96–s100.Google ScholarPubMed
9.Mackenzie, EJ, Rivara, FP, Jurkovich, GJ, Nathens, AB, Frey, KP, Egleston, BL, Salkever, DS, Weir, S, Scharfstein, DO: The National Study on Costs and Outcomes of Trauma. J Trauma 2007;63(6 Suppl):s54–s67.Google Scholar
10.Nathens, AB, Rivara, FP, MacKenzie, EJ, Maier, RV, Wang, J, Egleston, B, Scharfstein, DO, Jurkovish, GJ: The impact of an intensivist-model ICU on trauma-related mortality. Ann Surg 2006;244(4):545–554.Google ScholarPubMed
11.Thompson, DR, Clemmer, TP, Applefeld, JJ, et al: Regionalization of critical care medicine: Task force report of the American College of Critical Care Medicine. Crit Care Med 1994;22(8):1306–1313.CrossRefGoogle ScholarPubMed
12.Tilford, JM, Simpson, PM, Green, JW, Lensing, S, Fiser, DH: Volume-outcome relationships in pediatric intensive care units. Pediatrics 2000;106(2 Pt 1):289–294.CrossRefGoogle ScholarPubMed
13.Watson, RS: Location, location, location: Regionalization and outcome in pediatric critical care. Curr Opin Crit Care 2002;8(4):344–348.CrossRefGoogle ScholarPubMed
14.Bode, MM, O'Shea, TM, Metzguer, KR, Stiles, AD: Perinatal regionalization and neonatal mortality in North Carolina, 1968-1994. Am J Obstet Gynecol 2001;184(6):1302–1307.CrossRefGoogle ScholarPubMed
15.Sacchetti, A, Brennan, J, Kelly-Goldstein, N, Graff, D: Should pediatric emergency care be decentralized? An out of hospital destination model for critically ill children. Acad Emerg Med 2000;7(7):787–791.CrossRefGoogle ScholarPubMed
16.Hick, JL, O'Laughlin, DT: Concept of operations for triage of mechanical ventilation in an epidemic. Acad Emerg Med 2006;13(2):223–229. Epub 2006 Jan 6.CrossRefGoogle Scholar
17.Rubinson, L, Hick, JL, Hanfling, DG, et al: Definitive care for the critically ill during a disaster: A framework for optimizing critical care surge capacity: From a Task Force for Mass Critical Care summit meeting, 26-27 January 2007, Chicago, IL. Chest 2008;133(5 Suppl):s18–s31.CrossRefGoogle ScholarPubMed
18.Christian, MD, Devereaux, AV, Dichter, JR, et al: Definitive care for the critically ill during a disaster: Current capabilities and limitations: From a Task Force for Mass Critical Care summit meeting, 26-27 January 2007, Chicago, IL. Chest 2008;133(5 Suppl):s8–s17.CrossRefGoogle ScholarPubMed
19.Hick, JL, Hanfling, D, Burstein, JL, et al: Health care facility and community strategies for patient care surge capacity. Ann Emerg Med 2004;44(3):253–261.CrossRefGoogle ScholarPubMed
20.Thomas, DE, Gordon, ST, Melton, JA, et al: Pediatricians' experience 80 miles up the river: Baton Rouge pediatricians' experiences meeting the health needs of evacuated children. Pediatrics 2006;117(5):s396–s401.CrossRefGoogle Scholar
21.Sirbaugh, PE, Gurwitch, KD, Macias, CG, et al: Caring for evacuated children housed in the Astrodome: Creation and implementation of a mobile pediatric emergency response team: Regionalized caring for displaced children after a disaster. Pediatrics 2006;117(5):s428–s438.CrossRefGoogle Scholar
22.Rubinson, L, Hick, JL, Curtis, JR, et al: Definitive care for the critically ill during a disaster: Medical resources for surge capacity: From a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest 2008;133(5 Suppl):s32–s50.CrossRefGoogle ScholarPubMed
23.Kozar, RA, Schackford, SR, Cocanour, CS: Challenges to the care of the critically ill: novel staffing paradigms. J Trauma 2008;64(2):366–370.Google Scholar
24.Duchesne, JC, Kyle, A, Simmons, J, et al: Impact of telemedicine upon rural trauma care. J Trauma 2008;64(1):92–97.Google ScholarPubMed
25.Marcin, JP, Schepps, DE, Page, KA, et al: The use of telemedicine to provide pediatric critical care consultations to pediatric trauma patients admitted to a remote trauma intensive care unit: A preliminary report. Pediatr Crit Care Med 2004;5(3):251–256.CrossRefGoogle ScholarPubMed