Public Health Emergency Preparedness
This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.
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The special medical needs of
children make it essential that health care facilities be prepared for both pediatric
and adult victims of bioterrorism attacks, including those resulting from
dispersal of airborne or foodborne agents.1,2 Moreover,
while terrorist attacks on the United States have provoked the development of guidelines
for hospital responses to acts of bioterrorism, few have focused on pediatric
the problem is that many disaster plans that have been designed for children's
hospitals are not designed to accommodate large numbers of contagious
individuals capable of disseminating highly lethal infectious agents.
This document is designed to
address the topic of converting pediatric hospitals from standard operating
capacity to surge capacity in response to large numbers of children with
communicable airborne and foodborne agents. A secondary goal is to assist
general emergency departments in developing plans to provide care to large
numbers of critically ill pediatric patients. With the recommendations provided
in this review, clinicians and hospital administrators will be able to develop unique
responses to mass casualty events involving pediatric patients who are victims
of bioterrorism. Following the all-hazards approach, the recommendations within
this monograph can also be used in consequence management after the exposure to
emerging infections of public health importance such as pandemic influenza.
For the purposes of this
document, we will use the definitions that follow.
- Child: One who fits within the parameters of a
Broselow-Luten Resuscitation Tape ("Broselow Tape"), a common tool used in
pediatric emergencies to determine a child's weight, drug doses, and the
size of resuscitation equipment. Typically, the Broselow Tape is designed
to be applied to children ages 12 and under.
- Pediatric Hospital:
An accredited health care facility dedicated to the specialized care of
infants, children, and adolescents. Although adults may occasionally be
treated for medical conditions in these facilities, the expertise of a
pediatric hospital is focused on caring for patients 21 years old or younger.
- Surge Capacity: The ability of a health care facility to
provide medical care in excess of the standard operating capacity. In this
monograph, the term will refer to increases in patient volume from
- Biological Weapon: A biological entity, whether wild-type,
genetically altered, or weaponized, that is used to incite terror by
producing disease in a portion of a target population.
- Airborne Pathogen: A disease-causing agent that can reside in an
air stream. In the context of this monograph, an airborne pathogen will be
considered to be an infectious agent. Two types of airborne pathogens
exist—communicable and noncommunicable.
- Communicable airborne
pathogens are those that are transmissible from one individual to another
by means of respiratory droplets or another body fluid. Examples of these
pathogens include smallpox, plague, Ebola, and other viral hemorrhagic
- Noncommunicable airborne
pathogens are those agents that cause disease by direct contact and are
not transmitted secondarily from person to person. Examples of these
pathogens are anthrax and tularemia.
- Foodborne and Waterborne
Pathogens: A foodborne pathogen
produces illness as a result of consuming a particular food. A foodborne illness
outbreak is the occurrence of two or more cases of a similar illness
resulting from the ingestion of a common food. Infectious agents that
produce illness after consumption or use of water intended for drinking,
or illnesses associated with recreational water such as swimming pools,
water parks, and naturally occurring fresh and marine surface waters are
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