By Kerri Hatt, EMS1 Senior Editor
LAS VEGAS — Just weeks after responding to the Las Vegas shooting, Clark County native Susie Kochevar, RN, MSN, spoke to a captivated crowd at EMS World Expo 2017.
After years in prehospital and hospital medicine as a nurse, flight nurse, military medic educator, fire department educator and more, Kochevar says she is “under cover” as a school nurse.
In her session, “Special Considerations for Pediatric Population During Disaster Management,” Kochevar identified the unique needs of the pediatric population, and related some advice gleaned from Las Vegas’s recent tragedy.
Quotes on pediatric disaster planning
Here are some of Kochevar’s most memorable quotes on pediatric disaster management.
“Disaster plans are usually geared toward healthy adults and the peds thing is in the back, with geriatrics and special needs.”
“I have low standards as a care provider. All I care about is, is my patient ventilated and perfused?”
“It took one assessment question: Is she spunky?”
“The adage is ‘Don’t just stand there, do something!’ But sometimes, you don’t do something. You just stand there and try to be human and meet any needs you can.”
Top takeaways on pediatric disaster management
Kochevar covered a lot of ground in the hour-long session. Here are some of the biggest takeaways.
1. Pediatrics must be considered a standalone population
While many disaster plans consider pediatrics an appendices in the back of the manual, they represent one-quarter of the overall population. “We need to think of pediatrics as a standalone population to address,” Kochevar stressed. Children are especially vulnerable in an emergency because of the following characteristics:
- Dependent physically and emotionally
- Vulnerable
- Naïve
- Lack communication skills
- Less life experience
- Less able to cope
- Education
- Decreased mobility
- Embrace routine
- Seek comfort
“They are targets of terror, decimated by disease and the wellbeing of children is a barometer of the wellbeing of our community,” Kochevar noted.
2. We are not as ready as we think for a pediatric disaster
Kochevar quoted a Conference on Child Resiliency study that found 65 percent of households have no or an inadequate disaster plan and 35 percent of households are not familiar with school emergency plans. She noted at a recent lockdown at her school, the parents swarmed the front doors for information, potentially putting themselves in harm’s way, rather than congregate at the reunification point.
We need to avoid complacency, and the first one that needs to prepare is you and your family, she stressed.
Kochevar noted a lack of planning and a failure to learn from past disaster events has had an adverse impact on pediatric populations in recent events. She asked attendees to consider the pediatric specific resources in their community hospitals, from pediatric beds and cribs, to pediatric transport equipment, diapers, formula and comfort objects.
In Las Vegas, which has a population of about 500,000 children, there are only 99 pediatric hospital beds. And in the event of an emergency, along with physicality, we need to address mental health. Are children separated from their parents? Are they terrified?
3. Lessons from the Las Vegas shooting
Kochevar was stationed at the family reunification area following the Las Vegas shooting. She reported the numerous volunteers were overwhelmed with the donations of food, beverages and comforts for the families.
She urged attendees to recognize they are not alone if and when a disaster occurs, and to preplan the resources and relationships with organizations that can and will help, down to the local Wal-Mart which will donate almost anything you need.
She also stressed how invaluable schools and school nurses and psychologists can be in a disaster. School nurses:
- Know kids
- Know the emergency and reunification plans
- Can/will have their own family emergency plan in place
- Work with at-risk populations daily
- Understand the Children with Special Health Care Needs Services Program, the Individuals with Disabilities Education Act and other programs and guidelines
- Have database information to identify local children
- Have buildings, transportation, food services, law enforcement
Kochevar takes a no-nonsense approach to disaster planning, and educating the public about disaster planning. She asked attendees to think of the first word that would spring to mind should they find themselves in an active shooter event. She then recommended attendees spread the following emergency response plan:
- Fire or flee: if unarmed, run
- Uncontrollable hemorrhage: try to control the bleeding
- Communicate
- Keep moving
Kochevar’s final point was made emphatically with a roll of electrical tape. In the aftermath of the Las Vegas shooting, an overwhelming number of police officers had used their socks, belts and whatever else was available to create tourniquets. After recruiting a volunteer, in mere seconds, she had wrapped his arm, torn the tape with her teeth and successfully controlled his imaginary bleeding.
As Scott Cravens, group publisher, EMS World, noted in the opening ceremonies, there is a good chance someone at the 2017 Expo will be at the next mass shooting or disaster. If it’s you, remember Kochevar’s acronym, and keep a roll of electrical tape on hand.
Learn more
- Systems-based prehospital pediatric care
- Broadening the approach to pediatric assessment
- How to be a disaster response volunteer
- Rapid response: Triage mass shooter patients as treatable by lay people or medical professionals
- Paramedic recalls ‘agonizing’ decisions made during Las Vegas shooting rescue
- Rapid response: EMS providers can prepare citizens to treat MCI patients
- Officials: Vegas hospitals overwhelmed after shooting