Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

medical care throughout the United States. In addition, the National Highway Traffic Safety
Administration (NHTSA) is charged with coordinating the development of national standard
curricula for and education of EMTs.
During the past 25 years, the scope and complexity of care rendered by prehospital EMS
providers have expanded greatly. Four levels of prehospital emergency medical personnel are
currently recognized, in order of increasing skill level with respect to the care of the trauma
patient (Table 3.1).
In recent years, the addition and expansion of initial and continuing education in prehospital
pediatric trauma care (such as that provided by the Pediatric Emergencies for Prehospital
Professionals [PEPP] course of the American Academy of Pediatrics), as well as the provision of
expert pediatric medical direction, have greatly enhanced the capabilities of most regional EMS
systems. In most regions, injured children can now receive emergency medical assistance
comparable to that of injured adults.
Hospitals
In mass casualty incidents, including those involving release of biological or chemical agents,
both children and adults are likely to be significantly affected. Children would probably be
disproportionately affected by such an incident, so pediatricians should assist in planning
coordinated responses for local hospitals that may have limited pediatric resources (see Chapter
1). Health care facilities could also be a primary or secondary target. At the very least, facilities
will be overwhelmed by a massive number of anxious and worried individuals.
The problems associated with terrorist incidents differ from those usually faced by hospital
disaster alert systems. In the typical scenario, most victims are triaged in the field and then
carefully distributed among available resources, to avoid a single facility from being
overwhelmed. In a terrorist attack, facilities will be particularly vulnerable to inundation with
many victims who have not been appropriately triaged or transported by EMS. Arrivals without
full notification could interfere with attempts to isolate contaminated victims and ensure
protection of health care personnel. In addition, terrorist events will be further complicated by
the issues of security and forensics.
Hospital emergency department personnel become involved both before and after the arrival of
victims. Activities prior to arrival include processing current patients in the emergency
department to prepare for new arrivals, checking all equipment, activating additional personnel,
assigning team leaders, and possibly assigning liaisons to government agencies. On arrival of
patients, emergency department staff should ascertain (whenever possible) a victim’s location
with respect to detonation, whether a victim was within an enclosed space or near a body of
water, or whether the victim was crushed by debris. These data provide valuable information as
to the degree of injury to expect in other victims.
Triage is crucial, given the large number of minimally injured and ambulatory victims presenting
to emergency departments after a terrorist incident. The importance of triage is highlighted by
the Oklahoma City experience in April 1995. This explosion caused 759 casualties, of whom 167
died, 83 were hospitalized, and 509 were treated as outpatients either in an emergency room or
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