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Acronyms AAP American Academy of Pediatrics ACEP American College of Emergency Physicians ACIP Advisory Committee on Immunization Practices AFRRI Armed Forces Radiobiology Research Institute AHRQ Agency for Healthcare Research and Quality AMU Atomic mass unit ARDS Acute respiratory distress syndrome ARS Acute radiation sickness/syndrome BAL British antilewisite (dimercaprol) BAT Biodosimetry assessment tool BIGIV Botulism immune globulin intravenous BSA Body surface area BWC Biological Weapons Convention CARD Collaborating Agencies Responding to Disasters CBT Cognitive behavioral treatment CDC Centers for Disease Control and Prevention CERT Citizen Emergency Response Training cGy centiGray CISD/CISM Critical incident stress debriefing/management CNS Central nervous system CPAP Continuous positive airway pressure CPR Cardiopulmonary resuscitation CR Dibenzoxazepine CRS Cutaneous radiation syndrome CS 2-chlorobenzylidene CSF Cerebrospinal fluid DEOC Director’s Emergency Operations Center (CDC) DHHS Department of Health and Human Services DHS Department of Homeland Security DMAT Disaster Medical Assistance Team DMORT Disaster Mortuary Assistance Team DOD Department of Defense DOE Department of Energy DTPA Diethylenetriaminepentaacetate DU Depleted uranium ED Emergency department EEE Eastern equine encephalitis EMDR Eye movement desensitization and reprocessing EMS Emergency medical services EMT Emergency medical technician EPA Environmental Protection Agency ESF #8 Emergency services function #8 FBI Federal Bureau of Investigation FEMA Federal Emergency Management Agency 319
FRP G-CSF GI GIS G-M GM-CSF Gy HEICS HIPAA HVA HVAC IAEA ICS IND JCAHO KT LET LRN MCI MEN MMST MPERT MSU NCRP NDMS NHTSA NIMS NIOSH NRC OEM OSHA PBI PCR PEPP PPE PPV PSI PTA PTS PTSD/S Rad RADIAC RBC RDD REAC-TS REM Federal Response Plan Granulocyte colony stimulating factor Gastrointestinal Geographic information systems Geiger-Mueller Granulocyte macrophage colony stimulating factor Gray Hospital emergency incident command system Health Insurance Portability and Accountability Act Hazard vulnerability analysis Heating, ventilation, air conditioning International Atomic Energy Agency Incident command system Improvised nuclear device Joint Commission on Accreditation of Healthcare Organizations Kiloton Linear energy transfer Laboratory Response Network Mass casualty incident Multiple endocrine neoplasia Metro Medical Strike Team Mobile Pediatric Emergency Response Team Management Support Unit National Council on Radiation Protection and Measurements National Disaster Medical System National Highway Transportation Safety Administration National Incident Management System National Institute for Occupational Safety and Health Nuclear Regulatory Commission Office of Emergency Management Occupational Safety and Health Administration Primary blast injury Polymerase chain reaction Pediatric Emergencies for Prehospital Professionals Personal protective equipment Positive-pressure ventilation Pound(s) per square inch Parent/teacher association Pediatric trauma score Posttraumatic stress disorder/syndrome Radiation absorbed dose Radiation detection, indication, and computation Red blood cell Radiological dispersal device Radiation Emergency Action Center Training Site Roentgen equivalent man 320
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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
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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
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
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 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
Page 354: Maternal & Child Health Bureau Dan
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