Peds patients are more vulnerable in terror attack
Peds patients are more vulnerable in terror attack
Tips for treating children in disasters, terrorism
In all your preparations for disasters and terrorist incidents, you may need to pay special attention to the youngest victims. Children are more vulnerable than adults in the event of a chemical spill or chemical weapons attack, says Lloyd Brown, MD, associate director of the Pediatrics Residency Training Program at Cedars-Sinai Medical Center in Los Angeles.
Brown lists several reasons children are at increased risk. Because they are smaller than adults, it takes less of the chemical to have an adverse affect on them. Children breathe faster than adults do, so pound for pound they take in more air.
That means that in the event of a chemical disaster, kids inhale proportionately more of the harmful chemicals, he points out.
They’re also closer to the ground than are adults. Many chemicals are dense and sink close to the ground, so children breathe in a more concentrated dose. Because children’s skin tends to be thinner and more permeable than that of adults, harmful chemicals are absorbed more easily in kids.
Children often are more prone to vomiting and diarrhea than are adults. Thus, in the event of a chemical event, they are more likely to become dehydrated faster. Because kids’ organs are still growing and developing, there may be greater potential for long-term organ damage when children are exposed to harmful chemicals. Children also are at higher risk for depression and anxiety after a chemical attack.
Young children also might not be able physically to run away from an attack, or they might not be developmentally mature enough to know to that they should run away to protect themselves.
Panel urges special planning for children
The difficulty in treating children during disasters and terrorist acts was addressed recently at a meeting sponsored by the Emergency Medical Services for Children (EMSC) Program, which is jointly administered by the Department of Health and Human Services’ Health Resources and Services Administration and the National Highway Traffic Safety Administration.
Nearly 70 experts from across the nation develop consensus recommendations on the needs of children in disaster and terrorism preparedness.
The challenge for ED physicians is how to treat children differently than other patients in a chemical disaster, Brown says.
Because of some of the differences between children and adults, the standard treatments for chemical exposure can carry their own risks to children. For example, high-pressure hoses and cold-water showers often are used to wash off or decontaminate victims. Because of a child’s thinner skin, the child may go into shock or hypothermia from the cold water, he explains.
Also, antidotes that are available for some chemicals are not formulated in ready-to-give pediatric dosages, Brown says.
Getting ready for pediatric patients
Include specific plans for treating children as part of your disaster preparedness, Brown urges.
These are the recommendations from Brown and the EMSC panel of experts:
• Seek antidote injectors specially formulated with dosages applicable to children, and include pediatric dosing in all disaster protocols. Remind clinical staff that during a chemical emergency, pediatric patients may need more attention and should be triaged appropriately. Incorporate a pediatric-specific triage system for use by all first responders and hospital personnel.
• When preparing decontamination plans, create a special area for the decontamination of children, Brown suggests. If warm water sources will be at a premium during decontamination, give the youngest patients priority to minimize the dangers of hypothermia.
• Equip emergency medical services (EMS) personnel and response vehicles with pediatric-specific equipment and medications. This includes supplies for decontamination and assessment/treatment for biological, chemical, and radiological terrorism.
• Ensure preparedness in all hospitals, with children’s hospitals playing a crucial role in educating the community, training health care providers, and directing the care of children in general hospitals when the number of children or logistics prevent transport to a children’s hospital.
• Keep a 48-hour supply of pediatric equipment and pharmaceuticals on hand for the average daily number of patients plus an additional 100 patients.
• Designate a pediatric specialty resource center and system in every regional and state disaster plan to include pediatric critical care, pediatric trauma, and pediatric burn capabilities.
• Require pediatric medical guidance for all disaster medical assistance teams, and involve care providers who have specific training in pediatrics during deployment, including on specialty teams.
Sources
For more information on treating children in a disaster, contact:
• Lloyd Brown, MD, Associate Director, Pediatrics Residency Training Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048. Telephone: (310) 423-3277.
For many resources on preparing for pediatric patients in the ED, during chemical disasters and otherwise, go to:
• Emergency Medical Services for Children web site at www.ems-c.org.
In all your preparations for disasters and terrorist incidents, you may need to pay special attention to the youngest victims. Children are more vulnerable than adults in the event of a chemical spill or chemical weapons attack, says Lloyd Brown, MD, associate director of the Pediatrics Residency Training Program at Cedars-Sinai Medical Center in Los Angeles.Subscribe Now for Access
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