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

• Circumstances (weather conditions, hazardous materials, etc.).
• Protection (clothes, barriers, etc.).
• Sequelae (structural collapse, structural fire, etc.).
• Victims (ages, number, density).
In general, small, frequent blasts in open air usually result in less serious injury than
large, single blasts in closed spaces, which historically have resulted in life-threatening
injury.
Regional trauma system planning should also consider the special needs of children who
are injured due to blast terrorism and the special resources needed to care for them.
Children and young adults are at higher risk of serious injury than adults for several
reasons (see Children Are Not Small Adults in Chapter 1). Specific to blast trauma is that
while blast tolerances in children are poorly defined, there is good reason to believe that
children may absorb more blast energy per unit body mass than adults after blast trauma.
This predisposes children to morbidity and mortality rates higher than those of adults as
compressive shock waves passing through the body are compacted into a smaller total
body mass.
Mitigation
Because most blast terrorism in recent years has involved children, with the notable
exceptions of the terrorist airliner attacks on the World Trade Center in New York and
the Pentagon in Washington on September 11, 2001, significant personal experience has
been gained with pediatric disaster and emergency preparedness and management by
child health professionals. Reports in the literature (summarized below) point out the
woeful state of emergency preparedness for disasters that involve children. They also
describe the common problems in pediatric disaster planning and management such that
pediatric professionals involved in disaster planning will be knowledgeable about these
problems and thus can seek to anticipate and thereby avoid them in future disasters.
In the Avianca jetliner crash in New York in January 1990, 22 of 25 (80%) children
survived versus 70 of 132 (50%) adults, despite the fact that pediatric patients were
inadequately treated and transported (State, regional, and county disaster plans did not
address pediatrics). Only three children died, and only seven survivors sustained highrisk
injuries. The spectrum of injuries resulting from this event were as follows:
• A 3-month-old boy with intracranial bleeding and aortic rupture (died).
• A 5-year-old boy with massive hemothorax (died).
• A 7-year-old boy with severe traumatic brain injury (died).
• Six children with traumatic brain injury.
• Five children with hypotensive shock.
• Three children with femur fractures with either hypotensive shock or traumatic
brain injury.
Triage and transport of pediatric patients:
• Of seven children with a pediatric trauma score (PTS)