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

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Trauma Hospitals.............................................................................................................248 Trauma Centers................................................................................................................248 Non-Trauma Centers........................................................................................................250 Treatment .....................................................................................................................................250 Trauma .............................................................................................................................251 Burns................................................................................................................................251 Multiple Casualties ..........................................................................................................251 Mass Casualties................................................................................................................251 Planning and Mitigation...............................................................................................................252 Planning ...........................................................................................................................252 Mitigation.........................................................................................................................253 Bibliography ................................................................................................................................255 Chapter 8. Mental Health Issues ...............................................................................265 Mental Health and the Role of the Pediatrician...........................................................................265 Trauma-Related Disorders...........................................................................................................265 Reaction to Disasters and Terrorism................................................................................266 Assessment and Treatment ..............................................................................................268 Death Notification and Pediatric Bereavement............................................................................270 Considerations in Notifying Individuals About an Unexpected Death ...........................270 Explaining Death to Children ..........................................................................................275 Common Reactions Among Children Who Have Experienced a Personal Loss.............276 Indications of the Need for Referral ................................................................................277 Attendance of Children at Funerals and Memorial Services ...........................................278 Therapies for Psychic Trauma .....................................................................................................278 Crisis Response................................................................................................................278 Crisis Response for Children and Families......................................................................279 Medication ...................................................................................................................................280 School Crisis Response................................................................................................................282 Anniversary Reactions and Commemorative Activities..............................................................283 Anniversaries ...................................................................................................................283 Memorialization...............................................................................................................284 Planning a Memorial Activity..........................................................................................285 Supporting School Staff...................................................................................................286 Impact on Health Care Providers.................................................................................................286 Make Psychological Contact............................................................................................287 Level of Coping ...............................................................................................................287 Explore Possible Solutions ..............................................................................................287 Take Action......................................................................................................................287 Followup ..........................................................................................................................287 Basic Objectives...............................................................................................................287 Benefits ............................................................................................................................288 Risk Communication and Media Issues.......................................................................................288 Developing Goals and Key Messages..............................................................................288 Delivering Accurate and Timely Information..................................................................289 Bibliography ................................................................................................................................290 viii
Chapter 9. Integrating Terrorism and Disaster Preparedness into Your Pediatric Practice ..................................................................................................293 Relevance for Office-Based Pediatricians ...................................................................................293 Internal Operations of the Practice: Office Readiness.....................................................293 External Operations: Communication and Coordination with Other Agencies...............296 Communicating Directly with Children and Families.....................................................298 Relevance for Hospital-Based Pediatricians................................................................................299 Emergency Department Readiness ..................................................................................299 Inpatient Service Readiness .............................................................................................300 Hospital Infrastructure Needs ..........................................................................................300 Bibliography ................................................................................................................................301 Chapter 10. Working with Government Agencies...........................................303 Introduction..................................................................................................................................303 Community, Government, and Public Health Preparedness........................................................303 Community Response ......................................................................................................303 State Government.............................................................................................................304 Federal Government.........................................................................................................304 Public Health Preparedness..............................................................................................305 Advocating for Children and Families in Preparedness Planning ...............................................305 Resources Available from Government Agencies.......................................................................306 Chapter 11. Conclusion .................................................................................................309 Systems Issues .............................................................................................................................309 Regional, State, and Local Efforts ...............................................................................................309 Vulnerable Populations................................................................................................................310 Separation of Children from Families..............................................................................310 Sheltering Families ..........................................................................................................310 Providing Urgent Medical Care to Large Populations of Displaced Children ............................311 Setting up a Temporary Pediatric Clinic Lessons Learned..............................................311 Environment.....................................................................................................................312 Medical Needs .................................................................................................................312 A Final Word ...............................................................................................................................312 Acronyms...............................................................................................................................319 Appendixes Appendix A. Learning Objectives ...............................................................................................323 Appendix B. List of Contributors ................................................................................................333 ix
Page 1 and 2: Bioterrorism and Other Public Healt
Page 3 and 4: Contents Chapter 1. Introduction ..
Page 5 and 6: Q Fever............................
Page 7: Basic Principles...................
Page 11 and 12: Table 5.4 Nerve agent triage and do
Page 13 and 14: There are many gaps in knowledge, e
Page 15 and 16: injured or killed (see also Chapter
Page 17 and 18: Head injury is common in children.
Page 19 and 20: In situations of disaster, caregive
Page 21 and 22: maintaining and securing the airway
Page 23 and 24: • Schonfeld DJ. In times of crisi
Page 26 and 27: Types of Disasters Chapter 2. Syste
Page 28 and 29: problems noted above for flooding,
Page 30 and 31: Federal Response The United States
Page 32 and 33: The scope of ESF #8 is broad and in
Page 34 and 35: • Centers for Disease Control and
Page 36: Table 2.1 Types of disasters, hazar
Page 39 and 40: Medical staffs need to know what wi
Page 41 and 42: information, health and safety educ
Page 43 and 44: y private physicians. Approximately
Page 45 and 46: even required (particularly if a pe
Page 47 and 48: ICS structure is hierarchical. For
Page 49 and 50: • Provide community education so
Page 51 and 52: • Provide for crisis counseling.
Page 53 and 54: incident command officer is most of
Page 55 and 56: Figure 3.1 National Response Plan D
Page 58 and 59:
Background History of Bioterrorism
Page 60 and 61:
Epidemiology of a Terrorist Attack
Page 62 and 63:
and may be watery, purulent, or blo
Page 64 and 65:
fluid in these vesicles. A painless
Page 66 and 67:
determined to be due to an agent of
Page 68 and 69:
cared for using standard precaution
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may be providing longer term and mo
Page 72 and 73:
The vaccine has a number of common
Page 74 and 75:
Vaccination Large-scale vaccination
Page 76 and 77:
cutaneous lesions; however, previou
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common food source is identified du
Page 80 and 81:
treated people experience some degr
Page 82 and 83:
treatment for plague meningitis. An
Page 84 and 85:
Smallpox is spread most commonly in
Page 86 and 87:
focal, intensely suppurative necros
Page 88 and 89:
Control measures. Some viruses that
Page 90 and 91:
Control measures. Person-to-person
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Signs and symptoms. The incubation
Page 94 and 95:
currently used for individuals trav
Page 96 and 97:
Accessed July 12, 2006. • Centers
Page 98 and 99:
• 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
Page 124 and 125:
Neuromuscular effects. At the neuro
Page 126 and 127:
children. Finally, routine administ
Page 128 and 129:
Treatment Management of cyanide poi
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Sulfur mustard is stockpiled both i
Page 132 and 133:
decontamination is therefore extrem
Page 134 and 135:
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
Page 144 and 145:
Table 5.2. Chemical weapons - Summa
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Table 5.3 Representative classes of
Page 148 and 149:
Table 5.4. Nerve agent triage and d
Page 150 and 151:
Table 5.5. Clinical effects from su
Page 152 and 153:
Table 5.7. Medical treatment of rio
Page 154 and 155:
Chapter 6. Radiological and Nuclear
Page 156 and 157:
from ground zero. For weapons large
Page 158 and 159:
(1000 rem), resulting in four fatal
Page 160 and 161:
cooling systems at Mayak exploded,
Page 162 and 163:
pediatric practices. This put infan
Page 164 and 165:
energy, releasing two photons of ex
Page 166 and 167:
need to be shielded, although the a
Page 168 and 169:
adioactive isotope of potassium. Ba
Page 170 and 171:
An integrated, interactive human bo
Page 172 and 173:
Biodosimetry and Radiological Terro
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primitive/progenitor cells and othe
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permits bacterial translocation and
Page 178 and 179:
To assess radiation dose, a researc
Page 180 and 181:
status? 4. Conduct an initial surve
Page 182 and 183:
explosion, when it is concentrated
Page 184 and 185:
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
Page 194 and 195:
These effects can occur anywhere fr
Page 196 and 197:
manifestations of ARS may range fro
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Neutropenia: Viral and Fungal Infec
Page 200 and 201:
The main reason for targeting pregn
Page 202 and 203:
No significant side effects from it
Page 204 and 205:
axilla, groin, and skin folds. Radi
Page 206 and 207:
Followup Care, Including Risk of Ca
Page 208 and 209:
artificial because followup in almo
Page 210 and 211:
adioactive material in an accident.
Page 212 and 213:
131, canned milk or other milk prod
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home immediately after the incident
Page 216 and 217:
• National Council on Radiation P
Page 218 and 219:
• U.S. Nuclear Regulatory Commiss
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Radiation Detection, PPE, Monitorin
Page 222 and 223:
• National Council on Radiation P
Page 224 and 225:
• Peter RU, Gottlober P. Manageme
Page 226 and 227:
Recommendations for State and Local
Page 228 and 229:
Figure 6.2. Environmental exposure
Page 230 and 231:
Figure 6.4. Bone marrow irradiated
Page 232 and 233:
Figure 6.6. Classic Andrews diagram
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Figure 6.8. Examples of radiation s
Page 236 and 237:
Figure 6.10. Localized radiation ef
Page 238 and 239:
Table 6.2. Biodosimetry based on ac
Page 240 and 241:
Table 6.4. Diagnostic steps in acut
Page 242 and 243:
Table 6.6. Dose assessment summary
Page 244 and 245:
Table 6.8. Antibiotics for treatmen
Page 246 and 247:
Table 6.10. Radionuclide specific t
Page 248 and 249:
Introduction Chapter 7. Blast Terro
Page 250 and 251:
Spalling effect. When a blast wave
Page 252 and 253:
Clinical findings and diagnosis. Cl
Page 254 and 255:
highest position. Because of the pr
Page 256 and 257:
perilymph in the membranous labyrin
Page 258 and 259:
• Hemoptysis. • Subcutaneous em
Page 260 and 261:
management and immediately involve
Page 262 and 263:
considered (see Chapter 4, Biologic
Page 264 and 265:
• Circumstances (weather conditio
Page 266 and 267:
Bibliography Explosives, Incendiary
Page 268 and 269:
Trauma Systems and Planning/Mitigat
Page 270 and 271:
Table 7.2 Spectrum of primary blast
Page 272 and 273:
Table 7.3 Principles of Advanced Tr
Page 274 and 275:
Determine the severity of the burn
Page 276 and 277:
Chapter 8. Mental Health Issues Men
Page 278 and 279:
• 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
Page 286 and 287:
sadness, anger, guilt, or a sense o
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 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 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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