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

Blocking norepinephrine and epinephrine may treat these symptoms. The first choices,
especially for sleep difficulties, are the α 2 -blockers clonidine and guafacine. These agents
are especially good at improving sleep and decreasing nightmares acutely and may
improve other hyperarousal symptoms such as impulsivity and hypervigilance.
Symptoms associated with dysregulation of the dopaminergic system include anxiety,
hypervigilance, aggressive impulsivity, flashbacks, and paranoia. Studies of risperidone
indicate that it may be useful for this constellation of symptoms.
There is clear evidence of dysregulation of the serotonergic system in individuals with
posttraumatic symptoms. Deficit of 5-HT is associated with depression, thoughts of
suicide, aggression, impulsivity, anxiety, and obsessive thoughts. This suggests that
increasing 5-HT availability may treat these symptoms, and studies in adults have found
selective serotonin reuptake inhibitors (SSRIs) to be the only class of drugs to decrease
all three PTSD symptom clusters. However, with acute posttraumatic symptoms, 6–8
weeks may be needed for effect, so it is better used as a first-line therapy for children
who meet the criteria for PTSD. At present, the SSRIs of choice are fluoxetine and
citalopram.
Although benzodiazepines would seem an obvious choice for acute posttraumatic
symptoms, their use is controversial. In two randomized controlled trials of
benzodiazepine use for this purpose, one demonstrated moderate positive effects, while
the other showed increased likelihood of the individual developing PTSD.
School Crisis Response
Most children benefit from receiving supportive services in the aftermath of a disaster or
terrorist attack. Pediatricians can play a vital role in advocating for, consulting for, and
actively participating in school crisis response teams to ensure that such supportive
services can be provided to children within schools and other community sites.
School administrators, teachers, and other school staff will be affected by the same crisis
event that is affecting their students. During such times, organizing and implementing an
effective crisis response can be difficult or even impossible. Therefore, it is imperative
that schools begin planning for potential crisis events before they occur, both to avert
disasters whenever possible and to decrease the negative impact on students and staff
when disasters cannot be prevented.
The school crisis response plan should include generic protocols for the following:
• Notification of team members, school staff, students, and parents of a crisis event.
• Delivery of psychoeducational services and brief crisis-oriented counseling, such
as through support rooms or short-term support groups.
• Memorialization and commemoration (see guidelines at
http://www.csee.net/pageview.aspx?id=55).
• Followup.
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