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Appendix A. Pediatric Terrorism and Disaster Preparedness: Learning Objectives Chapter 1. Introduction Goal: To prepare pediatricians to participate in pediatric disaster planning, taking into consideration the differences between children and adults. Learning Objectives: At the end of this chapter, the reader will be able to: 1. Describe the phases of terrorism and disaster planning. 2. Access the major Web sites available for further information on disaster preparedness to meet the needs of children. 3. Work in concert with response agencies when providing disaster relief. 4. Advocate for resources and products that currently do not exist for children, especially for children with special health care needs. 5. Identify children’s anatomic, physiologic, immunologic, developmental, and psychological considerations that are different from adults and potentially could affect children’s vulnerability to injury and response in a disaster. 6. Participate in community planning efforts that consider all potential aspects of a child’s life. 7. Prepare for disasters at all phases of planning, response, recovery, and mitigation. Chapter 2. Systems Issues Goal: To prepare pediatricians to participate in pediatric disaster planning, by ensuring their familiarity with the U.S. disaster response system infrastructure. Learning Objectives: At the end of this chapter, the reader will be able to: 1. List the five major types of natural disasters. 2. Define and describe anthropogenic disasters. 3. Identify the lead federal agencies involved in planning, preparedness, emergency medical services (EMS), and other disaster response. 4. Access the Clinician Information Line run by the Centers for Disease Control Director’s Emergency Operations Center. 323
Chapter 3. Responding to a Disaster Goal: To prepare pediatricians to respond to a disaster. At the end of this chapter, the reader will be able to: 1. Identify and describe the four phases of response to a disaster or act of terrorism (preparedness, actual response to the event, mitigation, and recovery). 2. Describe the function of the National Incident Management System and how it could be used as part of local emergency response plans. 3. Determine who would be in charge of an incident when there is a multi-agency response. 4. Describe the various types of EMS personnel and their function. 5. Identify problems that may be encountered by hospitals when dealing with a disaster or act of terrorism, including issues related to regional coordination, surge capacity, protection of personnel, and levels of precaution. 6. Describe potential problems with using personal protective equipment (PPE). 7. Describe the structure and function of an Incident Command System, including a Hospital Emergency Incident Command System, and its key participants. 8. Describe how hospitals coordinate their response to a disaster with other community and medical entities. 9. Provide a number of examples of the roles pediatricians may play in regional hospital to community planning. 10. Participate in the organization, implementation, and quality assurance activities related to disaster drills. 11. Assist in integrating children’s services into disaster life support drills. 12. Refer children and families to existing support services in their communities. 13. Explain the new Joint Commission on Accreditation of Healthcare Organizations (JCAHO) disaster preparedness standards. 14. Explain the importance of appropriate triage. 15. Describe the major management functions of the Incident Command System (incident command, operations, planning, logistics, finance/administration). 16. Recognize the standardized position titles used for ICS supervisory personnel. 17. Describe the roles of smaller ICS functional units (staging, triage, treatment/decontamination, transport). Chapter 4. Biological Terrorism Goal: To prepare pediatricians to recognize signs and symptoms, diagnose, treat, perform infection control measures, and report biological terrorism agents and events. Learning Objectives: At the end of this chapter, the reader will be able to: 324
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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
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Treatment. Treatment should be guid
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• Before notifying the family, br
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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
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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 330 and 331: Acronyms AAP American Academy of Pe
Page 332 and 333: RIA RTG SCIWORA SEB SI SNS SSRI STA
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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