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Table 6.2. Biodosimetry based on acute photon-equivalent exposures Dose estimate Time to onset of vomiting Gy % a Time (hr) Absolute lymphocyte count (× 10 9 /L) b (day) Lymphocyte depletion rate c 0.5 1 2 4 6 8 Rate constant Number of dicentrics d Per 50 cells Per 1000 cells 0 — — 2.45 2.45 2.45 2.45 2.45 2.45 — 0.05-0.1 1-2 1 19 2.30 2.16 1.90 1.48 1.15 0.89 0.126 4 88 2 35 4.63 2.16 1.90 1.48 0.89 0.54 0.33 0.252 12 234 3 54 2.62 2.03 1.68 1.15 0.54 0.25 0.12 0.378 22 439 4 72 1.74 1.90 1.48 0.89 0.33 0.12 0.044 0.504 35 703 5 86 1.27 1.79 1.31 0.69 0.20 0.06 0.020 0.63 51 1024 6 94 0.99 1.68 1.15 0.54 0.12 0.03 0.006 0.756 7 98 0.79 1.58 1.01 0.42 0.072 0.012 0.002 0.881 8 99 0.66 1.48 0.89 0.33 0.044 0.006
Table 6.3. Initial or prodromal phase, whole body irradiation from external radiation or internal absorption (gamma radiation) Vomiting (onset and percentage) Nausea duration Diarrhea (severity, onset, and percentage) Lymphocyte count (× 10 6 /L)* Headache, (severity, onset, and percentage) CNS function Body temperature (severity, onset, and percentage) Subclinical range (cGy Sublethal range(cGy Lethal range(cGy [rad]) [rad]) [rad]) 0–100 100–200 200–600 600–800 800–3000 >3000 None 3–6 hr 2–4 hr 1–2 hr
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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
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need to be shielded, although the a
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adioactive isotope of potassium. Ba
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An integrated, interactive human bo
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Biodosimetry and Radiological Terro
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primitive/progenitor cells and othe
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permits bacterial translocation and
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To assess radiation dose, a researc
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status? 4. Conduct an initial surve
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explosion, when it is concentrated
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Skin pathway. Although intact skin
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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
Page 208 and 209: artificial because followup in almo
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 216 and 217: • National Council on Radiation P
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 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
Page 266 and 267: Bibliography Explosives, Incendiary
Page 268 and 269: Trauma Systems and Planning/Mitigat
Page 270 and 271: Table 7.2 Spectrum of primary blast
Page 272 and 273: Table 7.3 Principles of Advanced Tr
Page 274 and 275: Determine the severity of the burn
Page 276 and 277: Chapter 8. Mental Health Issues Men
Page 278 and 279: • Amnesia for important parts of
Page 280 and 281: Treatment. Treatment should be guid
Page 282 and 283: • Before notifying the family, br
Page 284 and 285: • Be conscious of nonverbal commu
Page 286 and 287: 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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