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Determine the severity of the burn Adjuncts Imaging and laboratory studies Scald How did the burn occur? What was the temperature of the liquid? What was the liquid? How much liquid was involved? What was the temperature setting of the water heater? Was the patient wearing clothes? How quickly were the patient’s clothes removed? Was the burned area cooled? Who was with the patient when the burn took place? How quickly was care sought? Where did the burn occur? Are the purported circumstances of the injury consistent with the burn characteristics? Chemical What was the agent? How did the exposure occur? What was the duration of contact? What decontamination occurred? Was there an explosion? Electrical What kind of electricity was involved? What was the duration of contact? Did the patient fall? What was the estimated voltage? Was there loss of consciousness? Was cardiopulmonary resuscitation administered at the scene? Extent of burn Rule of nines for adolescents Lund-Browder chart for children and infants (Table 6.5) Depth of burn Carboxyhemoglobin Reevaluation Continued assessment of ventilatory effort Continued assessment of extremity perfusion Pain management Psychosocial assessment Burn Wound Care Thermal burns Chemical burns Cover the area with a clean, dry sheet Ice applications are appropriate only in small burns Flush the chemical agent from the body surface with copious amounts of water Powdered chemicals should be brushed from the skin prior to flushing the involved area 263
Electrical burns Remove all contaminated clothing Chemical eye injuries require continuous irrigation until otherwise instructed by an expert Continuous cardiac monitoring may be necessary during the first 24 hr after injury Maintain urine output at twice normal target volumes if myoglobinuria Burn Center Referral Partial thickness burns >10% total BSA Burns that involve face, hands, feet, genitalia, perineum, or major joints Full-thickness burns Chemical burns Electrical burns, including lightning injury Inhalation injury Burn injury in patients with significant comorbidities; concomitant trauma; or who require special social, emotional, or rehabilitative intervention Burned children in hospitals without qualified personnel or equipment for care of children Note: The principles of Advanced Burn Life Support are identical to the principles of Advanced Trauma Life Support ® (Table 7.3), with additional caveats pertinent to Advanced Burn Life Support. Source: Courtesy American Burn Association. Used with permission. Note: The principles of Advanced Burn Life Support are identical to the principles of Advanced Trauma Life Support ® (Table 7.3), with additional caveats pertinent to Advanced Burn Life Support. Source: Courtesy American Burn Association. Used with permission. 264
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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
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• Geiger-Mueller or G-M counters
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• Protective clothing— Disposab
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Decontamination priorities are as f
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These effects can occur anywhere fr
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manifestations of ARS may range fro
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Neutropenia: Viral and Fungal Infec
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The main reason for targeting pregn
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No significant side effects from it
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axilla, groin, and skin folds. Radi
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Followup Care, Including Risk of Ca
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artificial because followup in almo
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adioactive material in an accident.
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131, canned milk or other milk prod
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home immediately after the incident
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• National Council on Radiation P
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• U.S. Nuclear Regulatory Commiss
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Radiation Detection, PPE, Monitorin
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• 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
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 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
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Page 288 and 289: was mean to my father yesterday and
Page 290 and 291: these roles, they should work close
Page 292 and 293: • Lack of availability of trauma-
Page 294 and 295: The structure provided by a preexis
Page 296 and 297: necessarily meet the children’s n
Page 298 and 299: Make Psychological Contact Tune in
Page 300 and 301: A communications goal of “educati
Page 302 and 303: • Schonfeld D. Crisis interventio
Page 304 and 305: Chapter 9. Integrating Terrorism an
Page 306 and 307: Chain of command. A chain of comman
Page 308 and 309: The chain of command established by
Page 310 and 311: Advice for families of children wit
Page 312 and 313: Quarantine procedures. Quarantine p
Page 314 and 315: Chapter 10. Working with Government
Page 316 and 317: need under the 12 Emergency Service
Page 318 and 319: ecognizes that community clinicians
Page 320 and 321: Chapter 11. Conclusion This report
Page 322 and 323: 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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