Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

finding has relevance to children, because a direct correlation exists between a parent’s
response to a disaster and the response of the child.
Any treatment plan regarding children exposed to radiation should take these unique
vulnerabilities and parental reactions into consideration. Although many of the
psychological reactions of children involved in a radiation-related incident are to be
widely expected as an initial response, severe reactions or those persisting beyond several
weeks may prompt the need for involvement by pediatric mental health professionals.
See also Chapter 8, Mental Health.
Immediate Care
The first priority during the care of anyone exposed to radiation is to treat life-threatening
injuries before addressing radiation exposure and contamination. In general, evolving
injuries such as burns, lacerations, and fractures need to be stabilized before
decontamination and subsequent transport to facilities where radiation-specific injuries
are managed. In most instances, radiation levels will not be known, and survey
instruments may not be available. Contamination risks to medical responders will be
minimal in most cases, unlike situations involving biological and chemical exposures.
However, simple precautions such as wearing gloves and wrapping victims in sheets or
blankets to reduce the spread of contamination should be done before transport.
Medical Treatment: Acute Radiation Syndrome
Treatment of acute radiation syndrome (ARS) includes both general supportive care and
specific actions and medications. No one is known to have survived whole body doses of
radiation exceeding about 8 Gy. Therefore, those receiving doses of greater than 8 Gy can
be considered expectant, although they may survive for a few months with extensive
medical care. ARS is usually caused by direct radiation exposure, not internal
contamination.
Supportive Care
Supportive therapy is a key factor in minimizing morbidity and mortality with significant
whole body exposure, regardless of the type of radiation. A baseline history should be
obtained before or shortly after supportive therapy is initiated. The history should include
information regarding the source of radiation, the duration of exposure, the interval
between exposure and presentation, and the physical property of the radioactive
compounds (e.g., solid, liquid, particulate). The review of systems and physical
examination should be as complete as possible, particularly focused on those organ
systems that show early signs of damage, such as the skin and the hematopoietic, GI, and
neurovascular systems.
The first step is to make sure the victim has been medically stabilized and
decontaminated, and that appropriate samples have been obtained for biological
dosimetry. Next, the first symptoms likely to occur during the prodromal phase, such as
nausea, vomiting, and diarrhea, should be addressed. Treatment of these early
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