American Journal of Emergency Medicine 91 (2025) 25–28

Contents lists available at ScienceDirect

American Journal of Emergency Medicine

journal homepage: www.elsevier.com/locate/ajem

Are we prepared to care for the children? An assessment

of pediatric-specific pre-deployment training provided
by non-governmental organizations operating in disaster zones
Lea Ohana Sarna Cahan, MD a,b,1,⁎, Derrick Tin, MBBS a,1, Jamla Rizek, RN a,
Debra L. Weiner, MD, PhD a,c, Gregory R. Ciottone, MD a
a
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, MA, USA
b
Department of Pediatric Emergency Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
c
Pediatric Emergency Medicine, Boston Children's Hospital, MA, USA

a r t i c l e i n f o a b s t r a c t

Article history: Introduction: Children have specific vulnerabilities during crises that necessitate specialized care. This study
Received 9 September 2024 assessed the adequacy of pediatric-specific pre-deployment training provided by Non-Governmental Organiza-
Received in revised form 15 January 2025 tions (NGOs) operating in crisis zones.
Accepted 12 February 2025 Method: To identify NGOs active in disaster response, a list of organizations that responded to the 2023 Turkey-
Available online xxxx
Syria earthquake were selected from Charity Watch's top-rated NGOs in the International Relief & Development
category. A comprehensive analysis of their public websites was performed, and the NGOs were contacted for in-
Keywords:
Disaster training
formation on their pediatric-specific training. NGO response rates and the content of the programs were analyzed
Disaster medicine education to evaluate the current state of pediatric pre-deployment training.
EMT emergency medical team Findings: Twelve of the 23 (52.1 %) NGOs responded to inquiries. Of the responding NGOs, only one required any
pediatric-specific training: a baseline minimum requirement for both pediatric and neonatal life support certifi-
cates (or the equivalent) for all clinical staff. The NGO stipulated that its staff also receive mandatory training on
safeguarding child welfare, as well as Integrated Management of Neonatal and Childhood Illness training. The
non-pediatric specific courses offered by this specific NGO include Personal Safety and Security, Psychological
First Aid and Hostile Environment Awareness Training.
Conclusion: There is a critical lack of pediatric training provided by NGOs. This underscores the crucial need for
standardized and comprehensive pre-deployment training for healthcare personnel in disaster zones, with a par-
ticular focus on pediatric care. The analysis of NGO responses and practices revealed inconsistencies in training
content, strategies and programs. Establishing best practices and collaboration between NGOs, healthcare ex-
perts, and authorities is vital to ensuring the proper care of pediatric patients in disaster zones.
© 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar tech-
nologies.

1. Introduction management. From the initial traumatic exposure to post-disaster

stressors, children are at heightened risk of adverse psychological, de-
Informed, adapted care of children in disaster zones is crucial [1,2], velopmental, and social outcomes, thus underscoring the need for com-
in particular since children comprise 26 % of the world's population. prehensive, sustained interventions [4-7].
Depending on the area and type of disaster, children may constitute The 7.7 magnitude earthquake in Turkey on February 6, 2023, was
30 % or more of the casualties [3]. This stark reality underscores the ur- one of three earthquakes that struck the country [8]. The extent of the
gency of prioritizing pediatric concerns in all areas of disaster damage from the disaster was further impacted by the extreme winter
weather conditions, supply chain issues including personnel, and the in-
stability of the infrastructure that impeded the overall response.
⁎ Corresponding author at: Department of Pediatric Emergency Medicine, Hadassah Coordination efforts were hindered by the densely populated area af-
Medical Center, Ein Kerem, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel. fected which resulted in over 45,000 deaths and 100,000+ injuries. [9]
E-mail addresses: [email protected] (L. Ohana Sarna Cahan),
[email protected] (D. Tin), [email protected] (D.L. Weiner),
The pediatric population has specific vulnerabilities and needs dur-
[email protected] (G.R. Ciottone). ing times of disaster. Anatomical and physiological differences make
1
Both authors equal contribution children more susceptible to physical and psychological trauma. [2,10]

https://doi.org/10.1016/j.ajem.2025.02.018
0735-6757/© 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
L. Ohana Sarna Cahan, D. Tin, J. Rizek et al. American Journal of Emergency Medicine 91 (2025) 25–28

Understanding these differences is important for healthcare personnel respond. An identical follow-up was repeated a month later for agencies
working in disaster zones to provide appropriate and targeted care to that had not responded.
pediatric patients. Healthcare responders need to be equipped with
the medical knowledge and skills to address the challenges posed by 3. Results
the needs of children in disaster zones. Ensuring proper pediatric spe-
cific pre-deployment training is critical to optimizing the healthcare Twelve of the 23 (52.1 %) NGOs responded, whereas 11 did not re-
and wellbeing of children during disaster and in the long-term [11,12]. spond to the email, web contact, and/or phone appeals. Of the 12
This training should cover a wide range of medical and psychosocial NGOs that responded, 4 had not deployed healthcare providers to
topics, that include but is not limited to pediatric vulnerabilities to disas- Turkey or Syria. Of the 8 NGOs that did deploy staff, 2 did not specify
ter, pediatric-specific injuries, physical and mental health, nutrition, whether any pediatric training was provided as part of their pre-
shelter, safety, communication with children and their families, and re- deployment training, 5 did not provide any pediatric-specific training
unification. Considerations on race, ethnic and cultural issues are crucial prior to deployment, and only one provided this type of training. The
to insuring equitable, culturally sensitive care [13]. NGOs that deployed healthcare providers to the Turkey-Syria earth-
This study examined current NGO pre-deployment pediatric train- quake zone but did not provide prior pediatric specific training stated
ing practices to identify opportunities and strategies for NGOs to better that their model predominantly relied on local health staff and partner-
prepare their healthcare personnel to provide effective and compas- ships for primary and specialist clinical care. This NGO had provided ad-
sionate care to children during disasters, as well as emotional support ditional pediatric training to their healthcare providers in past
to their parents and caregivers. deployments, including Integrated Management of Childhood Illnesses
(IMCI) training modules, neonatal resuscitation training, as well as
2. Methods basic care for newborns at the time of delivery and basic post-natal
care training. No specific reason was given as to why these training
A list of the 23 top-rated NGOs that provided aid in Turkey and Syria courses were not offered before the Turkey-Syria earthquake
was obtained from CharityWatch (Table 1) [14]. These charities spend deployment.
at least 75 % of their budgets on programs, spend $25 or less to raise The sole NGO that provided training stated that it set a baseline min-
$100 in cash donations, and meet CharityWatch's governance and imum requirement for clinical staff to have both pediatric life support
transparency benchmarks. CharityWatch, founded in 1992 as the and neonatal life support certificates (or the equivalent). In addition, it
American Institute of Philanthropy, is one of America's most indepen- noted that the staff receive mandatory training on safeguarding child
dent, assertive charity watchdogs. welfare, as well as Integrated Management of Neonatal and Childhood
Once these international NGOs were identified, each page of their Illness (IMNCI) training. Other non-pediatric specific courses such as
public websites was examined by the investigators for mentions of Personal Safety and Security, Psychological First Aid and Hostile
pediatric-specific training provided to their employees and volunteers. Environment Awareness Training are also offered by this specific NGO.
All 23 were also contacted via their public email addresses or website
contact pages to inquire whether they provided any form of pediatric- 4. Discussion
specific training. While some NGOs do not primarily provide direct
healthcare services, they were still included in the analysis to assess This study explored preparedness training practices of NGOs operat-
the presence or absence of secondary medical objectives. This was ing in post-earthquake Turkey and Syria and focused specifically on
done because these organizations, despite their primary focus, may en- their pediatric training protocols and deployment strategies. Despite
counter pediatric needs in disaster settings, such as family reunification the limited response rate, the NGOS that did respond had very different
or supporting traumatized children. Including these NGOs ensured a pediatric training requirements for healthcare provider deployment.
more comprehensive view of the potential scope of pediatric-specific Deploying personnel to disaster zones who are inadequately trained
training requirements. A follow-up email, phone call and/or web con- in pediatric care carries potential risks for both the child victims and the
tact message was sent two weeks later to organizations that did not responding personnel who may unwittingly expose themselves to pedi-
atric infectious disease. [15-17] The analysis revealed a deficit of
pediatric-specific training across NGOs and the need for programs of
Table 1
this type to ensure a consistently high level of pediatric preparedness
List of NGOs. in healthcare responders.
Entities such as the World Health Organization (WHO) offer stan-
1 All Hands and Hearts
2 American Jewish Joint Distribution Committee
dardized training guidelines and certifications aimed at improving
3 CARE healthcare providers' pediatric care and preparedness [18,19]. Two of
4 Catholic Relief Services the best known are the Integrated Management of Childhood Illness
5 Church World Service (IMCI) [20] and the Integrated Management of Neonatal and Childhood
6 Direct Relief
Illness (IMNCI) training programs [21]. They focus on improving the
7 Episcopal Relief and Development
8 Doctors Without Borders quality of healthcare for children in resource-limited settings by provid-
9 HIAS ing systematic training in the diagnosis and management of common
10 International Medical Corp childhood illnesses.
11 International Rescue Committee The Centers for Disease Control and Prevention (CDC), American
12 MAP International
13 Medical Teams International
Academy of Pediatrics (AAP), and Federal Emergency Management
14 Mercy Corps Agency (FEMA), Pediatric Pandemic Network (PPN) among others,
15 Operation USA offer open-source pediatric disaster training courses and content rele-
16 Project Hope vant to disaster and pandemic deployment response [2,22,23]. These re-
17 Samaritan's Purse
sources are designed to enhance healthcare providers' knowledge and
18 Save the Children
19 Oxfam-America skills in managing pediatric patients during disaster zone responses.
20 United Methodist Committee on Relief The topics include but are not limited to different types of disasters, pan-
21 UNICEF USA demics, pediatric-specific vulnerabilities, anatomic and physiological
22 World Central Kitchen differences, triage, pediatric-specific medical care, psychological sup-
23 World Vision
port for children and families, reunification, children with special health

26
L. Ohana Sarna Cahan, D. Tin, J. Rizek et al. American Journal of Emergency Medicine 91 (2025) 25–28

care needs, and the coordination of response efforts. In addition to collaboration between NGOs, healthcare experts, and authorities is
open-source resources, there are commercially available courses that vital to ensure the effective care of children in disaster zones.
deal with pediatric disaster response and preparedness. These courses * During the preparation of this work the author used Chat GPT in
often provide comprehensive training tailored specifically to the needs order to improve the readability and language of the manuscript. The
of pediatric patients in disaster situations. They cover pediatric resusci- author then reviewed and edited the content as needed and takes full
tation, pediatric trauma care, newborn delivery and care, evacuation responsibility for the content.
procedures for pediatric patients, and communication strategies for
interacting with children during emergencies. Funding
Healthcare professionals need to stay updated on the latest guide-
lines, protocols, and best practices through regular training sessions, No external funding for this manuscript.
workshops, seminars, and online courses to ensure that they remain
proficient in their knowledge and skills and are prepared to handle CRediT authorship contribution statement
evolving healthcare challenges and emergencies effectively. By integrat-
ing these components into NGO training and preparedness efforts, Lea Ohana Sarna Cahan: Writing – original draft, Formal analysis,
healthcare providers can maintain a consistent level of readiness to re- Data curation, Conceptualization. Derrick Tin: Writing – original draft,
spond to disasters, mass casualty incidents, pandemics and humanitar- Formal analysis, Data curation, Conceptualization. Jamla Rizek: Writing
ian crises, including those involving children. – original draft, Formal analysis, Data curation. Debra L. Weiner: Writ-
When possible, training should include simulation exercises that are ing – review & editing, Supervision. Gregory R. Ciottone: Writing – re-
invaluable for enhancing the practical skills of healthcare personnel to view & editing, Supervision.
address pediatric needs during disasters [24,25]. These simulations rep-
licate real-life scenarios in a controlled environment, thus allowing Declaration of competing interest
healthcare providers to improve their knowledge, practice their clinical
skills, decision-making and teamwork in a safe setting. Engaging The authors declare that they have no known competing financial
healthcare providers in realistic simulation scenarios helps to familiar- interests or personal relationships that could have appeared to influ-
ize them with the challenges and complexities of caring for pediatric pa- ence the work reported in this paper.
tients in a range of disasters, including managing children and
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