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• Schonfeld D. Crisis intervention for bereavement support: A model of intervention in the children’s school. Clin Pediatr. 1989; 28(1):27-33. • Schonfeld D. Almost one year later: looking back and looking ahead. J Dev Behav Ped. 2002;23(4):1–3. • Schonfeld D. School-based crisis intervention services for adolescents: Position paper of the Committees on Adolescence and School Health, Connecticut Chapter of the American Academy of Pediatrics. Pediatrics. 1993;91(3):656–657. • Schonfeld D, Kline M, and Members of the Crisis Intervention Committee. School-based crisis intervention: an organizational model. Crisis Intervention and Time-Limited Treatment. 1994;1(2):155–166. • Schonfeld D, Lichtenstein R, Pruett MK, et al. How to Prepare for and Respond to a Crisis (2nd ed). Alexandria, VA: Association for Supervision and Curriculum Development; 2002. • Substance Abuse and Mental Health Services Administration. National Child Traumatic Stress Network. Available at: http://www.nctsnet.org Accessed September 18, 2006. Risk Communication and Media Issues • Substance Abuse and Mental Health Services Administration. Communicating in a Crisis: Risk Communication Guidelines for Public Officials. Rockville, MD: 2002. SAMHSA Publication No. SMA02-3461. 291
Table 8.1 Concepts of death and implications of incomplete understanding for adjustment to loss Concept Irreversibility Death is seen as a permanent phenomenon from which there is no recovery or return. Finality (Nonfunctionality) Death is seen as a state in which all life functions cease completely. Inevitability (Universality) Death is seen as a natural phenomenon that no living being can escape indefinitely. Causality A realistic understanding of the causes of death is developed. Example of incomplete understanding Child expects the deceased to return, as if from a trip. Child worries about a buried relative being in pain or trying to dig himself or herself out of the grave; child wishes to bury food with the deceased. Child views significant individuals (i.e., self, parents) as immortal. Child who relies on magical thinking is apt to assume responsibility for death of a loved one by assuming bad thoughts or unrelated actions were causative. Implication Failure to comprehend this concept prevents child from taking the first step in the mourning process, that of appreciating the permanence of the loss and the need to adjust ties to the deceased. Can lead to preoccupation with physical suffering of the deceased and may impair readjustment; serves as the basis for many horror stories and films directed at children and youth (e.g., zombies, vampires, and other “living dead”). If child does not view death as inevitable, he or she is likely to view death as a punishment (either for actions or thoughts of the child or the deceased), leading to excessive guilt and shame. Tends to lead to excessive guilt that is difficult for child to resolve. Adapted from Schonfeld D. Crisis intervention for bereavement support: a model of intervention in the children’s school. Clin Pediatr 1989;28(1):27-33. Reprinted with permission of Sage Publications, Inc. 292
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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
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• Peter RU, Gottlober P. Manageme
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Recommendations for State and Local
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Figure 6.2. Environmental exposure
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Figure 6.4. Bone marrow irradiated
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Figure 6.6. Classic Andrews diagram
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Figure 6.8. Examples of radiation s
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Figure 6.10. Localized radiation ef
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Table 6.2. Biodosimetry based on ac
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Table 6.4. Diagnostic steps in acut
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Table 6.6. Dose assessment summary
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Table 6.8. Antibiotics for treatmen
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Table 6.10. Radionuclide specific t
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Introduction Chapter 7. Blast Terro
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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
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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 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
Page 324 and 325: Table 11.1 Environmental constraint
Page 326 and 327: Table 11.2 Pediatric medical compla
Page 328 and 329: • The post-storm environment is h
Page 330 and 331: Acronyms AAP American Academy of Pe
Page 332 and 333: RIA RTG SCIWORA SEB SI SNS SSRI STA
Page 334 and 335: Appendix A. Pediatric Terrorism and
Page 336 and 337: 1. List which biological agents (mi
Page 338 and 339: 19. Identify chemical terrorism tox
Page 340 and 341: 39. Provide followup care, being mi
Page 342 and 343: Learning Objectives: At the end of
Page 344 and 345: Lead Editors Appendix B. List of Co
Page 346 and 347: James Tsung, MD, FAAP Attending Phy
Page 348 and 349: Gerald S. Braley, PhD Major, United
Page 350 and 351: Kobi Peleg, PhD Michael Stein, MD J
Page 352 and 353:
Lou E. Romig MD, FAAP, FACEP Childr
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Maternal & Child Health Bureau Dan
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