Public Health Emergency Preparedness
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Table 5.1. Pediatric Vulnerabilities To Chemical Terrorism
||Increased respiratory exposure (higher minute ventilation, live closer to the ground)
||Early warning, shelteringa (gas masks not advised because of risk of poor fit, suffocation)
|Increased dermal exposure (thinner, more permeable skin; larger body surface area/mass ratio)
||Protective clothing, early decontamination1
|Increased risk of dehydration, shock with illness-induced vomiting, diarrhea (decreased fluid reserves, larger body surface area/mass ratio)
||Recognition, aggressive fluid therapy
|Increased risk of hypothermia during decontamination (larger body surface area/mass ratio)
||Warm water decontamination
|More fulminant disease; (possible) physiologic detoxification immaturity; more permeable blood-brain barrier
||Pediatric-specific research for early diagnosis and treatment of chemical weapons victims1
||Less ability to escape attack site, take appropriate evasive actions (developmental immaturity, normal dependence on adult caregivers who might be injured or dead)
||Less coping skill of children who suffer injury or witness parental, sibling death (psychological immaturity)
||Child psychiatry involvement, research for preventing pediatric post-traumatic stress disorder1
|Greater anxiety over reported incidents, hoaxes, media coverage, etc
||Pediatric counseling of parents and childrenb
||Less capacity to cope with influx of critical pediatric patients
||Community and regional planning with significant pediatric input
|Loss of routine hospital transfer protocols
|Limited ability to expand pediatric hospital bed capacity through NDMS
a Plausible, but unproved or unstudied, and/or not intuitively obvious.
b For American Academy of Pediatrics (AAP) and American Academy of Child and Adolescent Psychiatrists (AACAP) resources for parents and pediatricians, go to http://www.aap.org/advocacy/releases/disastercomm.htm and http://www.aacap.org/publications/factsfam/disaster.htm.
1 Adapted from Rotenberg JS, Newmark J. Nerve agent attacks on children: diagnosis and management. Pediatrics 2003; 112:648-58.
Note: EMS = emergency medical services; NDMS = National Disaster Medical System.
Source: Adapted from Henretig FM, Cieslak TJ, Eitzen EM Jr. Biological and chemical terrorism. J Pediatr 141:311-326, ©2002, with permission from Elsevier.
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