Pediatric Insight to Humanitarian and Trauma Crisis Response: Operation Allies Refuge and Operation Allies Welcome at Landstuhl Regional Medical Center
Caitlin McSorley, Margaret Shields, Melinda Funk, Aaron Dahlin, Jeramy Mahoney, Emily ParsonsAbstract
Introduction
Pediatric patients account for disproportionate medical resource utilization in times of disaster and war. This was demonstrated in 2021 during Operation Allies Refuge/Operation Allies Welcome (OAR/OAW) following withdrawal of U.S. troops from Afghanistan. Landstuhl Regional Medical Center (LRMC), a U.S. military hospital in Germany, played a pivotal role in medical support for evacuees from Afghanistan, including critically injured children. The objective of this study is to define the injury and disease patterns of pediatric patients admitted to LRMC during OAR/OAW.
Materials and Methods
A retrospective chart review of pediatric patients was performed to extract data elements including demographic variables, mechanism of injury, primary and secondary diagnoses, length of stay (LOS), LOS in the intensive care unit (ICU), number of days requiring mechanical ventilation, procedures, and final disposition. Injury patterns were determined based on diagnosis codes and procedures performed.
Results
A total of 82 pediatric patients ≤17 years of age were identified. Of these, 37.8% (N = 31) were infants born at LRMC to families who had evacuated. Infants had a median LOS of 3 days (range 1–14 days), with 3 infants requiring neonatal ICU care. Outside of births, the most common reason for admission was infection (39.2%, N = 20), followed by those injured in the Hamid Karzai International Airport (HKIA) bomb attack in Kabul, Afghanistan (25.5%, N = 13), chronic medical conditions (19.6%, N = 10), and acute medical/surgical needs (15.7% N = 7). HKIA blast victims had longer lengths of stay, were more likely to require ICU admission, and underwent more procedures.
Conclusions
This study provides a snapshot of pediatric care needs at one institution in the setting of a complex disaster that was affected by both mass population evacuation and a bombing event. Although patients with infections constituted the majority of non-birth pediatric admissions, HKIA blast victims required the most resource utilization. The need for pediatric-trained medical providers and pediatric equipment is crucial in upholding a high standard of care in military support hospitals during disaster relief operations.