Children’s Health Care in Mass-Casualty Incidents: A Systematic Literature Review

Objectives: Considering the pediatric peculiarities and the difficulty of assisting this population in mass-casualty situations, this study aims to identify the main topics regarding children’s health care in mass-casualty incidents (MCIs) that are discussed in the Emergency Medicine area. Methods: This systematic review was performed according to the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered with the PROSPERO database of systematic reviews with the number CRD42021229552. The last update of the search in the databases was on May 27, 2021 and resulted in 45 documents to be analyzed. The inclusion criteria included the peer-reviewed academic papers in English, Portuguese, Spanish, and Italian languages; the databases used were PubMed, Scopus, MEDLINE/Bireme (Virtual Library of Health - VLH), and Web of Science, which execute the query on the topic, keywords, or abstracts. Also, to be included, documents that were available with full-text access through CAPES, Google, or Google Scholar. Books, non-academic research, and content in languages other than the presented ones were represented as exclusion criteria. Results: From the resulting papers, 21 articles served as the basis for this analysis. Revealed were the year of publication, the first author’s institution nationality, topic, and disaster management phase for each study, which allow other researchers to understand the main topics regarding children’s health care in MCIs. Conclusions: The topics regarding child’s health care in MCIs found in the primary studies of this review, in order of frequency, were: Disaster Response (including the following sub-topics: simulation, education, quality of care, use of technological tools, and damage analysis); Triage; and Disaster Planning. The Emergency Medicine operation was focused on harm reduction after the occurrence of an MCI. Further studies focusing on the pre-disaster and post-disaster phases are needed.

Residential Segregation, Neighborhood Health Care Organizations, and Children's Health Care Utilization in the Phoenix Urbanized Area

Research has demonstrated health care consequences of racial/ethnic residential segregation. Here, I test one possible mechanism—the distribution of community health care organizations and service providers across urban communities. Using data from a 2013 survey on children's health care utilization in the Phoenix urbanized area combined with data on a 2013 census of health care organizations, I estimate a series of statistical models in order to test this relationship. I find that Latino and Native American segregation is related to a lower density of health care organizations. Furthermore, the lack of these resources increases the odds of a family using a clinic, versus a physician's office, which is a more ideal source of care. Finally, a higher rate of racial/ethnic clustering is also related to greater utilization of a clinic, as opposed to a physician's office, and this association is partially mitigated by distribution of health care organizations.