Southeastern Regional Pediatric Disaster Surge Network: a public health partnership.

During the past five years, the South Central Center for Public Health Preparedness (SCCPHP) has worked in conjunction with the Alabama Department of Public Health (ADPH), the Mississippi State Department of Health (MSDH), and more than 40 agencies and institutions to improve the pediatric preparedness response strategies of public health, emergency responders, and pediatric providers in the Southeastern United States. Disasters such as Hurricane Katrina, the earthquakes in Haiti and Chile, and other emergencies have illustrated the need for a coordinated and collective response to the needs of children, as children are among the most vulnerable to injury, disease, and exploitation in any emergency.1 Immediate response is needed not only to ensure child survival and protection, but also to restore some sense of normalcy to the lives of children. The Southeastern U.S. lacks pediatric surge capacity because of the relatively small number of pediatric facilities, limited public health resources, high rates of poverty, and other adverse factors specifically related to children. As a result, the ability to respond effectively to large-scale pediatric emergencies and disasters is often beyond the capacity and capability of a single organization, institution, or health department. The challenge of accommodating pediatric surge becomes more daunting given the increased number and consequences of large-scale disasters, and the number of agencies and organizations that must be organized, coordinated, and managed during a disaster response.2,3 Through their emergency and disaster experiences, ADPH, MSDH, and pediatric providers learned that traditional approaches and local health systems, by themselves, were not always effective in addressing the complex, multi-institutional, and multijurisdictional nature of regional pediatric surge.4–8 Further, they realized that the continuing challenges of limited pediatric resources and the unique physiological, mental, and social issues of children would require a focus on leading, organizing, and managing numerous government and private sector organizations to eliminate multiple chains of command, reduce duplicative efforts, and prevent agencies from working at cross purposes. Effective pediatric emergency and disaster response in the Southeast would require a collaborative network of agencies and organizations—a new type of organization called a high-reliability network (HRN).9 This article chronicles the efforts of more than 40 organizations to develop an HRN, specifically the Southeastern Regional Pediatric Disaster Surge Network (the Network), a voluntary network of health-care providers, public health departments, volunteers, and emergency responders from Alabama, Florida, Louisiana, Mississippi, and Tennessee. The purpose of the Network is to provide pediatric care and mutual aid at the time of an emergency or disaster. Previous efforts by national and regional groups have illustrated methods for addressing surge capacity through general mutual aid agreements and limited emergency-response resources related to children.10 These efforts, however, are generally clinically focused, intrastate, and not specific to the Southeastern U.S. In contrast, Network organizers envisioned the solution to limited pediatric surge capacity as regional in nature and as a managerial and organizational issue rather than strictly clinical. Therefore, drawing upon the high-reliability organization (HRO) literature, Network partners attempted to create, maintain, and operate a collaborative, pediatric-surge HRN. The aim was to create a network that would (1) be highly reliable and (2) exhibit an extremely high degree of inter-organizational/agency collaboration. Additionally, this first-of-its-kind regional network would have to operate in cooperation with existing response systems as described in the National Response Framework.11