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Kobi Peleg, PhD Michael Stein, MD John A. Weigelt, MD Mental Health Issues Section Editor David Szydlo, MD, PhD Education and Curriculum Development Director National Center for Children Exposed to Violence Associate Research Scientist, Child Study Center Yale University School of Medicine, New Haven, CT Currently Director, Centro de Estudios Psicoanaliticos A.C., Mexico Contributors Steven Berkowitz, MD, FAAOS, FACS, CIME Medical Director National Center for Children Exposed to Violence, Child Study Center Yale University School of Medicine, New Haven, CT Associate Director, Connecticut Trauma Response Program, New Haven, CT Russell T. Jones, PhD Terrorism Disaster Branch National Center for Child Traumatic Stress, Blacksburg, VA Professor of Clinical Psychology Virginia Tech University, Blacksburg, VA Betty Pfefferbaum MD, JD Director and Professor of Psychiatry and Behavioral Sciences Department of Psychiatry and Behavioral Sciences University of Oklahoma Health Sciences Center, Oklahoma City, OK Acknowledgment Steven Marans, PhD Director, National Center for Children Exposed to Violence, Child Study Center Harris Associate Professor of Child Psychoanalysis Associate Professor of Psychiatry Yale University School of Medicine, New Haven, CT Integrating Preparedness into Your Pediatric Practice Section Editors David Markenson, MD, FAAP Director, Center for Disaster Medicine School of Public Health, New York Medical College Chief, Pediatric Emergency Medicine Maria Fareri Children's Hospital Westchester Medical Center, New York, NY 339
Irwin Redlener, MD, FAAP President and Co-Founder Children’s Health Fund, New York, NY Director, National Center for Disaster Preparedness Associate Dean for Public Health Advocacy and Preparedness Mailman School of Public Health Columbia University, New York, NY Contributor Danielle Laraque, MD, FAAP Debra and Leon Black Professor of Pediatrics Chief, Division of General Pediatrics Mount Sinai School of Medicine Mount Sinai Medical Center, New York, NY Working with Government Agencies and Advocacy Section Editors and Contributors David Markenson, MD, FAAP Irwin Redlener, MD, FAAP Conclusion and Lessons Learned Section Editor George L. Foltin, MD, FAAP, FACEP Contributors Steven Baldwin, MD, FAAP Dan Kavanaugh, MSW Director, Emergency Medical Services for Children Program Health Resources Services Administration Maternal & Child Health Bureau, Rockville, MD Errol McRae, RN, MN Executive Director, Louisiana Chapter–ACEP Baton Rouge, LA Gretchen Mahan AAP Chapter Executive Director Mississippi Chapter–AAP, Jackson, MS Keith E. Parker, RN Director, Bureau of Emergency Medical Services Mississippi Department of Health, Jackson, MS William D. Payne, MD, FAAP President, Mississippi Chapter–AAP, Jackson, MS 340
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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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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 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 352 and 353: Lou E. Romig MD, FAAP, FACEP Childr
Page 354: Maternal & Child Health Bureau Dan
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