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Pediatric Terrorism and Disaster Preparedness

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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Table 5.1. Pediatric Vulnerabilities To Chemical Terrorism

Realm Potential Vulnerability Potential Response
Physiologic 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
Developmental Less ability to escape attack site, take appropriate evasive actions (developmental immaturity, normal dependence on adult caregivers who might be injured or dead) ?
Psychological 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
EMS 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 and Exit Disclaimer

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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