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

maintaining and securing the airway should be considered. When veins are small and/or
constricted from shock or hypothermia, the equipment for alternative methods, such as
intraosseous access, should be readily available.
Planning should consider all potential aspects of a child’s life. Therefore, it should
account for children who are at home, in school or child care, or in transit, as well as for
children who cannot be reunited with their families. School disaster plans should
coordinate with community plans and should also consider post-incident stress
management during the recovery phase. Child care centers and community youth centers
should have disaster plans that focus on ensuring safety, accessing and interacting with
community emergency responders, notifying guardians, and reuniting families.
Children are predisposed to illness and injury after a disaster for a variety of reasons.
There can be lack of adult caretaker supervision, and the usual resources of school or
child care may be unavailable. Environmental hazards can be increased from collapsed
buildings or dangerous tools or from chemicals or availability of weapons. Increased
stress on adults might lead to a higher risk of domestic violence or child abuse. Contagion
present in the community, especially infections such as respiratory syncytial virus or
influenza, may spread rapidly in group shelters. Contaminated food or water can lead to
epidemic outbreaks of infectious diseases, resulting in gastroenteritis and dehydration.
Changes in the environment can lead to heat-related illness or hypothermia. Use of
alternative sources for heating or generators can lead to carbon monoxide exposure.
Children with asthma may have acute exacerbations due to stress or environmental
contaminants. Medications may be forgotten or the supply may be exhausted, resulting in
exacerbations of chronic illnesses. Stress can produce a variety of symptoms in children
including headaches, abdominal pain, chest pain, vomiting, diarrhea, constipation,
changes in sleep, and changes in appetite.
Many considerations in planning are prompted by the possibility of children in shelters.
These include supplies and services such as diapers, infant formula, other childappropriate
food, and games and other distractions for children. Staffing is an issue with
regard to supervision. Shelters should be childproofed to promote safety for children as
well as the elderly. Sick children should be isolated. Children should be protected from
environmental hazards such as weapons, alcohol, and cigarette smoke. Children with
special health care needs, especially those that depend on technology for survival, are
particularly vulnerable and should be considered in shelter planning. Also, parents/single
parents with sick children cannot be caregivers simultaneously for both a hospitalized
child and non-hospitalized, sheltered children.
Planning should also include pregnant women, the fetus, and the newly born. The stress
of a disaster can contribute to premature labor and delivery. Infection acquired by the
fetus in utero can lead to fetal death or to devastating consequences if the fetus survives.
The risk of developing cancer is higher in children who have been exposed to radiation in
utero. Radioactive iodine is transmitted to human breast milk and threatens infants who
are breastfeeding. Cow’s milk can also be quickly contaminated if radioactive material
settles onto grazing areas, threatening alternative sources of nutrition.
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