A Timely Assessment of Pediatric Surge Capacity and Capability

The study “Are We Ready? A Statewide Assessment of Pediatric Emergency Care Capabilities” by Li et al¹  provides a statewide assessment of Massachusetts hospitals’ ability to care for children during normal and surge operations, and draws attention to key concepts and deficiencies in pediatric emergency preparedness. By partnering with the state health department and leveraging emergency preparedness experts within hospital systems, these investigators developed an approach to efficiently assess the state’s pediatric emergency care resources. This is especially relevant given the recent surge of pediatric respiratory illness.² 

The investigators identify key deficiencies in pediatric preparedness by differentiating the concepts of capacity and capability. These concepts are crucial to consider when planning a pediatric surge response. Framing it within “the 4S’s of preparedness” (staff, space, stuff, and systems) can distinguish these 2 distinct but interconnected concepts.³  Capacity, the ability to receive many patients, relies on having appropriate staffing and physical space. Capability, the ability to offer more specific types of care, relies predominantly on subspecialty staffing and supplies. As many have experienced in this recent respiratory syncytial virus-predominant respiratory illness surge, space and supplies can be adapted but the true limitation is staffing. Increasing retirement of health care personnel since the coronavirus disease 2019 pandemic and lower than expected nursing school enrollment has created a nursing shortage.⁴ 

The article by Li et al also draws attention to pediatric surgical subspecialists who are typically scarce outside of major metropolitan areas. This is a problem that nearly all hospitals face now.⁵  Although the solutions are complex, there are resources to aid staff in caring for pediatric patients during a major surge event. Some professional organizations produce “just-in-time” training materials in response to major events or perceived threats. For example, in the setting of the recent respiratory illness surge, facilities with capacity and capability limitations can use the Basic Clinical Guidance for Pediatric Respiratory Illness released by the Western Regional Alliance for Pediatric Emergency Management.⁶ 

Li et al also identified specific limitations in their state’s ability to respond to a pediatric surge. For Massachusetts, this relates to the concentration of pediatric resources within urban areas, with many of the rural areas being underserved. A disaster that occurs in a more rural area and hinders transportation into the metropolitan area or a disaster that renders some or all the metropolitan area hospitals unusable could drastically limit the immediate availability of pediatric surge capacity.⁷  The establishment of interstate agreements can expedite transfer when the closest available facility providing specialty care is across state lines. Such agreements facilitated transfer of pediatric patients from New Orleans after Hurricane Katrina.⁸  Telehealth can also expand the number of pediatric subspecialists available for consultation and improve triage of resources and patient transfer if necessary.⁹ 

These findings in Massachusetts are likely emblematic of readiness issues in other states. The American Academy of Pediatrics has recently revised its guidelines for surge management.¹⁰  These guidelines address specific considerations for inpatient and outpatient settings when expanding capacity and capability during a surge event. The Emergency Medical Services for Children Innovation and Improvement Center also maintains a toolkit for incorporating pediatric considerations into hospital disaster plans with a domain specifically addressing surge capacity.¹¹  The Pediatric Pandemic Network released “Surge Recommendations and Resources” for acute response to infectious disease events.¹²  The Emergency Medical Services for Children Innovation and Improvement Center, the Western Regional Alliance for Pediatric Emergency Management, the Federal Emergency Management System Region V for Kids, and the Pediatric Pandemic Network are grant-funded collaboratives in pediatric disaster preparedness focused on everyday readiness, improvement of emergency care for children, and pediatric considerations during disasters. Although the recent respiratory illness surge feels unique, it is important to recognize that disasters occur regularly and unpredictably. Continued federal funding focused on improvement of pediatric readiness and expansion of surge capacity will allow experts to develop, appraise, and maintain resources for mitigating stresses to the health care system and optimizing emergency medical services for children.