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The scope of ESF #8 is broad and involves supplemental health and medical assistance to meet the needs of victims of a major disaster, emergency, or terrorist attack. In the FRP, this support is categorized in the following functional areas: • Assessment of health/medical needs. • Health surveillance. • Medical care personnel. • Health/medical equipment and supplies. • Patient movement/evacuation. • Patient care. • Safety and security of human drugs, biologics, medical devices, veterinary drugs, etc. • Blood and blood products. • Food safety and security. • Agriculture safety and security. • Worker health/safety. • All-hazard public health and medical consultation, technical assistance, and support • Behavioral health care. • Public health and medical information. • Vector control. • Potable water/wastewater and solid waste disposal. • Victim identification/mortuary services. • Protection of animal health. Federal resources that supplement regional, State, and local response are primarily from within DHHS and ESF #8 support agencies. However, other non-Federal sources such as major pharmaceutical suppliers, hospital supply vendors, the National Foundation for Mortuary Care, and certain international disaster response organizations and international health organizations also provide support. Department of Defense The Department of Defense (DOD) has many capabilities through which it can provide assistance to lead Federal agencies in response to a disaster. DOD medical and support capabilities include the following: • Triage and medical treatment. • Displaced populations support. • Hospital personnel augmentation. • Epidemiologic support. • Stress management. • Preventive medicine support. • Veterinary support. • Prophylaxis and immunization augmentation. • Mortuary affairs. • Medical logistics. • Transportation. 21
• Communication. • Technical augmentation (e.g., modeling). • Surveying and monitoring the incident site. • Facility decontamination. For more information about DOD and its capabilities, go to http://www.defenselink.mil/. Summary Federal assistance has been used successfully for many years to respond to the emergent medical requirements of victims of natural disasters throughout the United States. Recent terrorist attacks within the United States have increased the Nation’s investment in homeland security through increased State, local, and regional health and medical resource development and acquisition in response to events involving weapons of mass destruction. Federal assistance is provided through the lead and supporting agencies designated within the NRP, including DoD. While Federal response assets are robust, timely management focused on the needs of at-risk groups is paramount to victim survival and positive medical outcome. Pediatric patients are among the populations gaining national attention regarding the need for appropriate medical support, including appropriate supplies and equipment, during a disaster. Historical data on disaster response, including the personal experiences of health care providers and victims, reinforce the medical requirements of pediatric populations. All sectors—Federal, State, regional, and local—must continue to be prepared to provide medical resources to a disaster, but these entities also must give attention to the needs of specific populations, including children. This is the best way to improve morbidity and mortality in response to mass casualty events. Bibliography • Centers for Disease Control and Prevention. About CDC. Available at: http://www.cdc.gov/aboutcdc.htm. Accessed August 17, 2006. • Centers for Disease Control and Prevention. Biological and chemical terrorism: strategic plan for preparedness and response. Recommendations of the CDC Strategic Work Group. MMWR. 2000;49(No. RR-4):1–14. • Centers for Disease Control and Prevention. PHIN’s Early Event Detection Component. Available at: http://www.cdc.gov/phincomponents/PHIN%20Brochure- %20BioSense%20.ppt. Accessed August 17, 2006. • Centers for Disease Control and Prevention. CDC’s Disease Surveillance System Efforts: Testimony of Joseph M. Henderson, Director, Centers for Disease Control and Prevention, Before the Select Committee on Homeland Security, Subcommittee on Emergency Preparedness and Response, U.S. House of Representatives, September 24, 2003. Available at: http://www.cdc.gov/washington/testimony/Bi924200355.htm. Accessed August 17, 2006. • Centers for Disease Control and Prevention. CDC Clinician Registry. Available at: http://www.bt.cdc.gov/clinregistry/index.asp. Accessed August 7, 2006. • Centers for Disease Control and Prevention. Epidemic Intelligence Service. Available at http://www.cdc.gov/eis/index.htm. Accessed August 17, 2006. 22
Page 1 and 2: Bioterrorism and Other Public Healt
Page 3 and 4: Contents Chapter 1. Introduction ..
Page 5 and 6: Q Fever............................
Page 7 and 8: Basic Principles...................
Page 9 and 10: Chapter 9. Integrating Terrorism an
Page 11 and 12: Table 5.4 Nerve agent triage and do
Page 13 and 14: There are many gaps in knowledge, e
Page 15 and 16: injured or killed (see also Chapter
Page 17 and 18: Head injury is common in children.
Page 19 and 20: In situations of disaster, caregive
Page 21 and 22: maintaining and securing the airway
Page 23 and 24: • Schonfeld DJ. In times of crisi
Page 26 and 27: Types of Disasters Chapter 2. Syste
Page 28 and 29: problems noted above for flooding,
Page 30 and 31: Federal Response The United States
Page 34 and 35: • Centers for Disease Control and
Page 36: Table 2.1 Types of disasters, hazar
Page 39 and 40: Medical staffs need to know what wi
Page 41 and 42: information, health and safety educ
Page 43 and 44: y private physicians. Approximately
Page 45 and 46: even required (particularly if a pe
Page 47 and 48: ICS structure is hierarchical. For
Page 49 and 50: • Provide community education so
Page 51 and 52: • Provide for crisis counseling.
Page 53 and 54: incident command officer is most of
Page 55 and 56: Figure 3.1 National Response Plan D
Page 58 and 59: Background History of Bioterrorism
Page 60 and 61: Epidemiology of a Terrorist Attack
Page 62 and 63: and may be watery, purulent, or blo
Page 64 and 65: fluid in these vesicles. A painless
Page 66 and 67: determined to be due to an agent of
Page 68 and 69: cared for using standard precaution
Page 70 and 71: may be providing longer term and mo
Page 72 and 73: The vaccine has a number of common
Page 74 and 75: Vaccination Large-scale vaccination
Page 76 and 77: cutaneous lesions; however, previou
Page 78 and 79: common food source is identified du
Page 80 and 81: treated people experience some degr
Page 82 and 83:
treatment for plague meningitis. An
Page 84 and 85:
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
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
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Spalling effect. When a blast wave
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Clinical findings and diagnosis. Cl
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highest position. Because of the pr
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perilymph in the membranous labyrin
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• Hemoptysis. • Subcutaneous em
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management and immediately involve
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considered (see Chapter 4, Biologic
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• Circumstances (weather conditio
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Bibliography Explosives, Incendiary
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Trauma Systems and Planning/Mitigat
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Table 7.2 Spectrum of primary blast
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Table 7.3 Principles of Advanced Tr
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Determine the severity of the burn
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Chapter 8. Mental Health Issues Men
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• Amnesia for important parts of
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Treatment. Treatment should be guid
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• Before notifying the family, br
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• Be conscious of nonverbal commu
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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
Page 302 and 303:
• 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
Page 330 and 331:
Acronyms AAP American Academy of Pe
Page 332 and 333:
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
Page 338 and 339:
19. Identify chemical terrorism tox
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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
Page 354:
Maternal & Child Health Bureau Dan
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