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Utilizing a Pediatric Disaster Coalition Model to Increase Pediatric Critical Care Surge Capacity in New York City
- Michael Frogel, Avram Flamm, Mayer Sagy, Katharine Uraneck, Edward Conway, Michael Ushay, Bruce M. Greenwald, Louisdon Pierre, Vikas Shah, Mohamed Gaffoor, Arthur Cooper, George Foltin
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 11 / Issue 4 / August 2017
- Published online by Cambridge University Press:
- 13 June 2017, pp. 473-478
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- Article
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A mass casualty event can result in an overwhelming number of critically injured pediatric victims that exceeds the available capacity of pediatric critical care (PCC) units, both locally and regionally. To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) was established. The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from 18 of 25 major NYC PCC-capable hospitals. A PCC surge committee created recommendations for making additional PCC beds available with an emphasis on space, staff, stuff (equipment), and systems. The PDC assisted 15 hospitals in creating PCC surge plans by utilizing template plans and site visits. These plans created an additional 153 potential PCC surge beds. Seven hospitals tested their plans through drills. The purpose of this article was to demonstrate the need for planning for disasters involving children and to provide a stepwise, replicable model for establishing a PDC, with one of its primary goals focused on facilitating PCC surge planning. The process we describe for developing a PDC can be replicated to communities of any size, setting, or location. We offer our model as an example for other cities. (Disaster Med Public Health Preparedness. 2017;11:473–478)
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. 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Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. 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- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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108 - Protein C
- from PART II - ENDOTHELIAL CELL AS INPUT-OUTPUT DEVICE
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- By Marlies Van de Wouwer, Department for Transgene Technology and Gene Therapy, VIB, and the Center for Transgene Technology and Gene Therapy (CTG), K.U. Leuven, Belgium, Edward M. Conway, Department for Transgene Technology and Gene Therapy, VIB, and the Center for Transgene Technology and Gene Therapy (CTG), K.U. Leuven, Belgium
- Edited by William C. Aird, Harvard University, Massachusetts
-
- Book:
- Endothelial Biomedicine
- Published online:
- 04 May 2010
- Print publication:
- 03 September 2007, pp 973-981
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Summary
Protein C (PC) is a key component in a multiprotein, physiologically relevant pathway that regulates thrombin's procoagulant activity, but which also limits inflammatory responses and provides the vascular endothelium with protection against an array of insults. Delineation of the biochemistry and molecular biology underlying regulation of the PC pathway, complemented by preclinical and clinical studies, has led to major new insights bridging the gap between inflammation and coagulation and resulting in innovative approaches to treat thrombotic disease and sepsis.
DISCOVERY OF PROTEIN C AND A NOVEL NATURAL ANTICOAGULANT PATHWAY
In 1975, Johan Stenflo reported the discovery of a novel vitamin K–dependent factor that revolutionized our view of the molecular mechanisms by which the coagulation system is regulated and provided insights into how coagulation interfaces with other biological systems, including inflammation and cell survival. In the final steps of his strategy to isolate new vitamin K–dependent plasma proteins, Stenflo identified four peaks from a chromatography column, the third of which – “pool C” – was subsequently referred to as protein C (1). Shortly thereafter, Esmon and colleagues (2) recognized that PChas lipid-binding properties and is a zymogen precursor for a serine protease – so-called activated PC (APC). The importance of PC in coagulation rapidly became evidentwhen it was determined that APC is derived from the thrombin-mediated cleavage of PC, that APC proteolytically destroys procoagulant cofactors V/Va and VIII/VIIIa, and finally that familial deficiency of PC in humans results in a hypercoagulable disorder (3–5).
STRUCTURAL FEATURES OF PROTEIN C
PC is synthesized predominantly in the liver as a 461-amino acid, long single-chain precursor, approximately75% of which is subsequently processed prior to and during secretion to yield a two-chain species.
105 - Thrombomodulin
- from PART II - ENDOTHELIAL CELL AS INPUT-OUTPUT DEVICE
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- By Marlies Van de Wouwer, Department for Transgene Technology and Gene Therapy, VIB, and the Center for Transgene Technology and Gene Therapy (CTG), K.U. Leuven, Belgium, Edward M. Conway, Department for Transgene Technology and Gene Therapy, VIB, and the Center for Transgene Technology and Gene Therapy (CTG), K.U. Leuven, Belgium
- Edited by William C. Aird, Harvard University, Massachusetts
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- Book:
- Endothelial Biomedicine
- Published online:
- 04 May 2010
- Print publication:
- 03 September 2007, pp 939-946
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Summary
Thrombin has far-reaching effects in a variety of biological systems, including coagulation, inflammation, cell survival, and cell proliferation. Modulation of the dynamic production of this key protease is essential to maintain homeostasis during development and, in adults, under a variety of pathophysiological conditions. The crucial importance of thrombin has prompted intense studies over the past few decades to characterize the molecular pathways that regulate its functional expression. The remarkable insight of several scientists led to the discovery of thrombomodulin (TM) (1), a key regulator of thrombin's activities, a predominantly vascular endothelial cell (EC) cofactor in a physiologically relevant natural anticoagulant system, and a modulator of inflammation and cell proliferation, with links to innate immunity.
THROMBOMODULIN IS A MASTER SWITCH THAT PREVENTS BLOOD CLOTTING
The discovery of TM (1,2), elegantly recounted by Esmon and Owen (1), emanated from evidence in the 1960s of the existence of a circulating thrombin-activated protein – now referred to as activated protein C (APC) – and the identification and isolation of its precursor, protein C (PC) (3). PC is a vitamin-K–dependent plasma protein, synthesized in the liver and circulating as a biologically inactive species. Activation of PC by thrombin requires TM as a cofactor (4) (Figure 105.1), which accelerates the reaction over 1,000-fold. APC, in turn, suppresses further thrombin generation through the proteolysis of coagulation factors Va and VIIIa, facilitated by the cofactor, protein S (PS). Not only does TM affect the generation of APC but, when complexed with TM, thrombin's entire substrate specificity is changed such that it no longer functions as a procoagulant molecule. For example, thrombin-TM is not able to activate platelets or factor V, or to cleave fibrinogen.