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

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• National Council on Radiation Protection and Measurements. NCRP Report No. 138, Management of Terrorist Events Involving Radioactive Material. Bethesda, MD: National Council on Radiation Protection and Measurements; 2001. • Sullivan JP, Bunker RJ, Lorelli, EJ, et al, eds. Jane’s Unconventional Weapons Response Handbook, 1 st ed. Alexandria, VA: Jane’s Information Group; 2002. • United States Army Center for Health Promotion and Preventive Medicine. The Medical NBC Battlebook, USACHPPM Tech Guide 244. Aberdeen Proving Ground, MD: United States Army Center for Health Promotion and Preventive Medicine; August 2002. Historical Overview • Adams RE, Bromet EJ, Panina N, Golovakha D, Goldgaber D, Gluzman S. Stress and well-being in mothers of young children 11 years after the Chornobyl nuclear power plant accident. Psychol Med. 2002; 32:143-156. • American Academy of Pediatrics Committee on Environmental Health. Policy statement: radiation disasters and children. Pediatrics. (6)111;1455-1466.* • Armed Forces Radiobiology Research Institute. Medical Management of Radiological Casualties, Handbook, 2 nd ed. Bethesda, MD: Armed Forces Radiobiology Research Institute. April 2003. Available at: http://www.ntis.gov/products/mmrc.asp. Accessed August 18, 2006. • Centers for Disease Control and Prevention. Emergency Preparedness and Response. Frequently Asked Questions (FAQs) About Dirty Bombs. Available at: http://www.bt.cdc.gov/radiation/dirtybombs.asp. Accessed August 1, 2006. • Collins DL, de Carvalho A. Chronic stress from the Goiania 137Cs radiation accident. Behav Med. 1993;18:149–157. • Radiation Effects Research Foundation. Acute death due to radiation. Hiroshima and Nagasaki, Japan: Radiation Effects Research Foundation. Available at: http://www.rerf.or.jp/eigo/radefx/early/death.htm. Accessed August 1, 2006. • Hall, Eric. Radiobiology for the Radiologist, 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2000. • International Atomic Energy Agency. The Radiological Accident in Goiania. Vienna, Austria: International Atomic Energy Agency. 1988. Available at http://www-pub.iaea.org/MTCD/publications/PDF/Pub815_web.pdf. Accessed August 2, 2006. • Larin V. Mayak’s walking wounded. Bull Atomic Scientists. 1999;55(5):20–27. Available at: http://www.thebulletin.org/article.php?art_ofn=so99larin. Accessed August 18, 2006. • Likhtarev IA, Kovgan LN, Jacob P, Anspaugh LR. Chernobyl accident: retrospective and prospective estimates of external dose of the population of Ukraine. Health Phys. 2002;82:290–303. • Medical Research Council. The Hazards to Man of Nuclear and Allied Radiations. London: His Majesty’s Stationery Office; 1956. • Merke DP, Miller RW. Age differences in the effects of ionizing radiation. In: Guzelian PS, Henry CJ, Olin SS, eds. Similarities and Differences Between 205
Children and Adults: Implications for Risk Assessment. Washington, DC: International Life Sciences Institute; 1992:139–149. • Miller RW. Delayed effects of external radiation exposure: A brief history. Radiation Res. 1995;144:160–195. • Muirhead CR. Cancer after nuclear incidents. Occup Environ Med. 2001;58:482– 487. • National Academy of Sciences. The Biological Effects of Atomic Radiation, Summary Reports. Washington, DC: National Academy of Sciences-National Research Council;1956. • National Council on Radiation Protection and Measurements. Management of Terrorist Events Involving Radioactive Material. NCRP Report No. 138. Bethesda, MD: National Council on Radiation Protection and Measurements; 2001. • Niefert A. Case Study: Accidental Leakage of Cesium-137 in Goiania, Brazil, in 1987. Huntsville, AL: Camber Corporation; 1999. Available at http://www.nbcmed.org/SiteContent/MedRef/OnlineRef/CaseStudies/csgoiania.html. Accessed August 18, 2006. • NOVA. Dirty Bomb, Chronology of Events. Public Broadcasting Service; February, 2003. • O’Neill K. The Nuclear Terrorist Threat. Washington, DC: Institute for Science and International Security;1997. Available at http://www.isisonline.org/publications/terrorism/threat.pdf. Accessed August 18, 2006. • Public Health Strategies for Protecting the Thyroid with Potassium Iodide in the Event of a Nuclear Incident. A symposium of the American Thyroid Association, Feb 28, 2003, Washington, DC, sponsored by the Johns Hopkins University School of Medicine in conjunction with the ATA. • Talbott EO, Youk AO, McHugh KP, et al. Mortality among the residents of the Three Mile Island accident area: 1979-1992. Environ Health Perspect. 2000;108:545–552. • Manhattan Engineer District of the United States Army. Chapter 10, Total Casualties. In: The Atomic Bombings of Hiroshima and Nagasaki by the Manhatten Engineer District of the United States Army June 29, 1946. New Haven, CT: The Avalon Project at Yale Law School: Documents in Law, History, and Diplomacy; 2003. • U.S. Department of Energy. Advisory Committee on Human Radiation Experiments - Final Report. Washington, DC: U.S. Department of Energy; October, 1995. Available at: http://www.eh.doe.gov/ohre/roadmap/achre/report.html. Accessed August 18, 2006. • U.S. Food and Drug Administration, Center for Drug evaluation and Research. Guidance Document: Potassium Iodide as a Thyroid Blocking Agent in Radiation Emergencies. Available at http://www.fda.gov/cder/guidance/4825fnl.htm. Accessed Nov 9, 2003. • U.S. Nuclear Regulatory Commission. Fact Sheet on Dirty Bombs, March 2003. Available at http://www.nrc.gov/reading-rm/doc-collections/fact-sheets/dirtybombs.html. Accessed Dec 9, 2003. 206
Page 1 and 2:
Bioterrorism and Other Public Healt
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Contents Chapter 1. Introduction ..
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Q Fever............................
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Basic Principles...................
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Chapter 9. Integrating Terrorism an
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Table 5.4 Nerve agent triage and do
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There are many gaps in knowledge, e
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injured or killed (see also Chapter
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Head injury is common in children.
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In situations of disaster, caregive
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maintaining and securing the airway
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• Schonfeld DJ. In times of crisi
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Types of Disasters Chapter 2. Syste
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problems noted above for flooding,
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Federal Response The United States
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The scope of ESF #8 is broad and in
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• Centers for Disease Control and
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Table 2.1 Types of disasters, hazar
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Medical staffs need to know what wi
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information, health and safety educ
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y private physicians. Approximately
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even required (particularly if a pe
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ICS structure is hierarchical. For
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• Provide community education so
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• Provide for crisis counseling.
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incident command officer is most of
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Figure 3.1 National Response Plan D
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Background History of Bioterrorism
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Epidemiology of a Terrorist Attack
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and may be watery, purulent, or blo
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fluid in these vesicles. A painless
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determined to be due to an agent of
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cared for using standard precaution
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may be providing longer term and mo
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The vaccine has a number of common
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Vaccination Large-scale vaccination
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cutaneous lesions; however, previou
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common food source is identified du
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treated people experience some degr
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treatment for plague meningitis. An
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Smallpox is spread most commonly in
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focal, intensely suppurative necros
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Control measures. Some viruses that
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Control measures. Person-to-person
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Signs and symptoms. The incubation
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currently used for individuals trav
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Accessed July 12, 2006. • Centers
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• Roffey R, Tegnell A, Elg HF. Bi
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Figure 4.2. Neurological signs, bot
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Figure 4.4. Physical distribution o
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Figure 4.6. Varicella lesions Note:
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Figure 4.8a. Febrile rash illness a
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Table 4.1. Early clinical signs and
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Table 4.2. Infection control transm
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Table 4.3. Diagnostic procedures, i
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Table 4.4a. Diagnostic tests for an
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Table 4.6. Treatment recommendation
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Introduction Chapter 5. Chemical Te
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likely manifest as an acute onset o
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exposures (Table 5.3). For an in-de
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Neuromuscular effects. At the neuro
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children. Finally, routine administ
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Treatment Management of cyanide poi
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Sulfur mustard is stockpiled both i
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decontamination is therefore extrem
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Pulmonary Agents Toxic industrial c
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Type I agents, the significance of
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After dispersal of riot control age
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• Kales SN, Christiani DC. Acute
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• Gray EA, Love JW, Arnold JL. CB
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Table 5.2. Chemical weapons - Summa
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Table 5.3 Representative classes of
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Table 5.4. Nerve agent triage and d
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Table 5.5. Clinical effects from su
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Table 5.7. Medical treatment of rio
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Chapter 6. Radiological and Nuclear
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from ground zero. For weapons large
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(1000 rem), resulting in four fatal
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cooling systems at Mayak exploded,
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pediatric practices. This put infan
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energy, releasing two photons of ex
Page 166 and 167: need to be shielded, although the a
Page 168 and 169: adioactive isotope of potassium. Ba
Page 170 and 171: An integrated, interactive human bo
Page 172 and 173: Biodosimetry and Radiological Terro
Page 174 and 175: primitive/progenitor cells and othe
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Page 178 and 179: To assess radiation dose, a researc
Page 180 and 181: status? 4. Conduct an initial surve
Page 182 and 183: explosion, when it is concentrated
Page 184 and 185: Skin pathway. Although intact skin
Page 186 and 187: personnel should also take a wipe s
Page 188 and 189: • Geiger-Mueller or G-M counters
Page 190 and 191: • Protective clothing— Disposab
Page 192 and 193: Decontamination priorities are as f
Page 194 and 195: These effects can occur anywhere fr
Page 196 and 197: manifestations of ARS may range fro
Page 198 and 199: Neutropenia: Viral and Fungal Infec
Page 200 and 201: The main reason for targeting pregn
Page 202 and 203: No significant side effects from it
Page 204 and 205: axilla, groin, and skin folds. Radi
Page 206 and 207: Followup Care, Including Risk of Ca
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Page 210 and 211: adioactive material in an accident.
Page 212 and 213: 131, canned milk or other milk prod
Page 214 and 215: home immediately after the incident
Page 218 and 219: • U.S. Nuclear Regulatory Commiss
Page 220 and 221: Radiation Detection, PPE, Monitorin
Page 222 and 223: • National Council on Radiation P
Page 224 and 225: • Peter RU, Gottlober P. Manageme
Page 226 and 227: Recommendations for State and Local
Page 228 and 229: Figure 6.2. Environmental exposure
Page 230 and 231: Figure 6.4. Bone marrow irradiated
Page 232 and 233: Figure 6.6. Classic Andrews diagram
Page 234 and 235: Figure 6.8. Examples of radiation s
Page 236 and 237: Figure 6.10. Localized radiation ef
Page 238 and 239: Table 6.2. Biodosimetry based on ac
Page 240 and 241: Table 6.4. Diagnostic steps in acut
Page 242 and 243: Table 6.6. Dose assessment summary
Page 244 and 245: Table 6.8. Antibiotics for treatmen
Page 246 and 247: Table 6.10. Radionuclide specific t
Page 248 and 249: Introduction Chapter 7. Blast Terro
Page 250 and 251: Spalling effect. When a blast wave
Page 252 and 253: Clinical findings and diagnosis. Cl
Page 254 and 255: highest position. Because of the pr
Page 256 and 257: perilymph in the membranous labyrin
Page 258 and 259: • Hemoptysis. • Subcutaneous em
Page 260 and 261: management and immediately involve
Page 262 and 263: considered (see Chapter 4, Biologic
Page 264 and 265: • Circumstances (weather conditio
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Bibliography Explosives, Incendiary
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Trauma Systems and Planning/Mitigat
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Table 7.2 Spectrum of primary blast
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Table 7.3 Principles of Advanced Tr
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Determine the severity of the burn
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Chapter 8. Mental Health Issues Men
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• Amnesia for important parts of
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Treatment. Treatment should be guid
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• Before notifying the family, br
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• Be conscious of nonverbal commu
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sadness, anger, guilt, or a sense o
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was mean to my father yesterday and
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these roles, they should work close
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• Lack of availability of trauma-
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The structure provided by a preexis
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necessarily meet the children’s n
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Make Psychological Contact Tune in
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A communications goal of “educati
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• Schonfeld D. Crisis interventio
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Chapter 9. Integrating Terrorism an
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Chain of command. A chain of comman
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The chain of command established by
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Advice for families of children wit
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Quarantine procedures. Quarantine p
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Chapter 10. Working with Government
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need under the 12 Emergency Service
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ecognizes that community clinicians
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Chapter 11. Conclusion This report
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Planning for special medical needs
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Table 11.1 Environmental constraint
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Table 11.2 Pediatric medical compla
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• The post-storm environment is h
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Acronyms AAP American Academy of Pe
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RIA RTG SCIWORA SEB SI SNS SSRI STA
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Appendix A. Pediatric Terrorism and
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1. List which biological agents (mi
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19. Identify chemical terrorism tox
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39. Provide followup care, being mi
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Learning Objectives: At the end of
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Lead Editors Appendix B. List of Co
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James Tsung, MD, FAAP Attending Phy
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Gerald S. Braley, PhD Major, United
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Kobi Peleg, PhD Michael Stein, MD J
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Lou E. Romig MD, FAAP, FACEP Childr
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Maternal & Child Health Bureau Dan
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