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<td height="30px"><span class="title"><a name="h1" id="h1"></a>Pediatric Terrorism and Disaster Preparedness </span></td>
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<td><div id="centerContent"><p><strong>Public Health Emergency Preparedness</strong></p> <div class="headnote">
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<h3>Table 5.1. Pediatric Vulnerabilities To Chemical Terrorism</h3>
<table border="1" cellspacing="0" cellpadding="3" width="80%">
<tr valign="top">
<th scope="row" width="33%">Realm</th>
<th scope="row" width="39%">Potential Vulnerability</th>
<th scope="row" width="28%">Potential Response</th>
</tr>
<tr valign="top">
<td width="33%" rowspan="5" scope="row">Physiologic</td>
<td width="39%">Increased respiratory exposure (higher minute ventilation, live closer to the ground)</td>
<td width="28%">Early warning, sheltering<sup><a href="#notea">a</a></sup> (gas masks not advised because of risk of poor fit, suffocation)</td>
</tr>
<tr valign="top">
<td width="39%">Increased dermal exposure (thinner, more permeable skin; larger body surface area/mass ratio)</td>
<td width="28%">Protective clothing, early decontamination<sup><a href="#note1">1</a></sup></td>
</tr>
<tr valign="top">
<td width="39%">Increased risk of dehydration, shock with illness-induced vomiting, diarrhea (decreased fluid reserves, larger body surface area/mass ratio)</td>
<td width="28%">Recognition, aggressive fluid therapy</td>
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<td>Increased risk of hypothermia during decontamination (larger body surface area/mass ratio)</td>
<td>Warm water decontamination</td>
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<td>More fulminant disease; (possible) physiologic detoxification immaturity; more permeable blood-brain barrier</td>
<td>Pediatric-specific research for early diagnosis and treatment of chemical weapons victims<sup><a href="#note1">1</a></sup></td>
</tr>
<tr valign="top">
<td scope="row">Developmental</td>
<td>Less ability to escape attack site, take appropriate evasive actions (developmental immaturity, normal dependence on adult caregivers who might be injured or dead)</td>
<td align="center">?</td>
</tr>
<tr valign="top">
<td rowspan="2" scope="row">Psychological</td>
<td>Less coping skill of children who suffer injury or witness parental, sibling death (psychological immaturity)</td>
<td>Child psychiatry involvement, research for preventing pediatric post-traumatic stress disorder<sup><a href="#note1">1</a></sup></td>
</tr>
<tr valign="top">
<td>Greater anxiety over reported incidents, hoaxes, media coverage, etc</td>
<td>Pediatric counseling of parents and children<sup><a href="#noteb">b</a></sup></td>
</tr>
<tr valign="top">
<td rowspan="3" scope="row">EMS</td>
<td>Less capacity to cope with influx of critical pediatric patients</td>
<td>Community and regional planning with significant pediatric input</td>
</tr>
<tr valign="top">
<td>Loss of routine hospital transfer protocols</td>
<td>&nbsp;</td>
</tr>
<tr valign="top">
<td>Limited ability to expand pediatric hospital bed capacity through NDMS</td>
<td>&nbsp;</td>
</tr>
</table>
<p class="size2"><a id="notea" name="notea"></a><sup>a</sup> Plausible, but unproved or unstudied, and/or not intuitively obvious.<br />
<a id="noteb" name="noteb"></a><sup>b</sup> For American Academy of Pediatrics (AAP) and American Academy of Child and Adolescent Psychiatrists (AACAP) resources for parents and pediatricians, go to <a href="http://www.aap.org/advocacy/releases/disastercomm.htm">http://www.aap.org/advocacy/releases/disastercomm.htm</a> and <a href="http://www.aacap.org/publications/factsfam/disaster.htm">http://www.aacap.org/publications/factsfam/disaster.htm</a>. <a href="/exitdisclaimer.htm"><img src="/images/exitdisclaimer.gif" alt="Exit Disclaimer" border="0" align="middle" /></a></p><p class="size2"><a id="note1" name="note1"></a><sup>1</sup> Adapted from Rotenberg JS, Newmark J. Nerve agent attacks on children: diagnosis and management. <em>Pediatrics</em> 2003; 112:648-58.</p>
<p class="size2"><strong>Note:</strong> EMS = emergency medical services; NDMS = National Disaster Medical System.</p>
<p class="size2"><strong>Source:</strong> Adapted from Henretig FM, Cieslak TJ, Eitzen EM Jr. Biological and chemical terrorism. <em>J Pediatr</em> 141:311-326, &copy;2002, with permission from Elsevier. </p>
<p class="size2"><a href="pedchap5.htm#Tab5.1">Return to Document</a></p>
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