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Gerald S. Braley, PhD Major, United States Air Force Science Advisor, Office of Emergency Response National Nuclear Security Administration, Department of Energy, Germantown, MD Itzhak Brook, MD Professor of Pediatrics Georgetown University School of Medicine, Washington DC Curtis Cummings, MD, MPH Associate Professor of Environmental and Occupational Health Drexel University School of Public Health, Philadelphia, PA William E. Dickerson, MD Colonel, Medical Corps, United States Air Force Director of Military Medical Operations Staff Radiological Oncologist Armed Forces Radiobiology Research Institute, Bethesda, MD Gary Francis, MD, PhD Professor of Pediatrics and Pediatric Endocrinology Director of Pediatric Endocrinology Fellowship Program Uniformed Services University of Health Sciences, Bethesda, MD Sarah K. Kirtland, MS Commander, United States Navy Deputy Director of Military Medical Operations Armed Forces Radiobiology Research Institute, Bethesda, MD Philip L. Liotta, PhD Former Chief Health Physicist, Former Chairman Radiation Sciences Department Armed Forces Radiobiology Research Institute Robert W. Miller, MD, DrPH Pediatric Epidemiologist, Clinical Epidemiology Branch National Cancer Institute, Bethesda, MD Pataje Prasanna, PhD Radiation Biologist Armed Forces Radiobiology Research Institute, Bethesda, MD Richard Sedlak, MD, MPH Colonel, United States Army Director, Military Medical Operation Armed Forces Radiobiology Research Institute, Bethesda, MD 337
Horace Tsu, MD Lieutenant Colonel, Medical Corps, United States Air Force Former Deputy Head, Military Medical Operations Armed Forces Radiobiology Research Institute, Bethesda, MD Clifton E. Yu, MD Lieutenant Colonel, Medical Corps, United States Army Assistant Professor of Pediatrics Director, National Capital Consortium Residency in Pediatrics Uniformed Services University of the Health Sciences, Bethesda, MD Acknowledgments Donna Solyan Head of Illustration and Editing Section Armed Forces Radiobiology Research Institute, Bethesda, MD Nimae Angwafo, MD, AFRRI LCDR Charles R. Woodruff, AFRRI Jamie Waselenko, MD, AFRRI Blast Trauma Section Editor Arthur Cooper, MD, MS, FACS, FAAP, FCCM Director of Trauma and Pediatric Surgical Services Columbia University Affiliation Harlem Hospital Center, New York, NY Contributors Julie Quintero, MD Attending Physician Assistant Professor of Pediatrics and Emergency Medicine Robert Wood Johnson University Hospital, New Brunswick, NJ Former Fellow in Pediatric Emergency Medicine Bellevue Hospital Center, New York, NY Acknowledgments Sherlita Amler, MD Yaron Bar-Dayan, MD Susan M. Briggs, MD Lt. Gen. Paul K. Carlton, Jr., MC, USAF (Ret) T. Forcht Dagi, MD Timothy E. Davis, MD, MPH Yoel Donchin, MD Zvi Feigenberg, MD Eric R. Frykberg, MD Pinchas Halpern, MD Richard D. Hunt, MD Catherine Y. Lee, MPH 338
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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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• 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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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 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 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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