Pediatric Disaster and Terrorism Preparedness

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Pediatric Disaster andTerrorism Preparedness

• David Markenson, M.D.
• Director, The Program for Pediatric Preparedness
• Deputy Director, National Center for Disaster
  Preparedness
• Mailman School of Public Health, Columbia
  University
• New York, NY

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Unique Anatomy and Physiology

• Increased Surface Area/Volume
• More absorptive surface
• More susceptible to volume losses
• Increased Minute Ventilation/Lower Breathing Zone
• Thinner Epidermis/ Under-keratinized Epidermis
• Immature Blood-brain Barrier
• Procedural Difficulties
• Psychological Immaturity

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Importance of Pediatric Considerations

• Children are part of the population
• 26 of the U.S. population are children and youth
  
• More than 20 million are under the age of 6 years
• Ignoring children may compromise entire
  preparedness plan
• August 2003 Survey
• 90 nationally and 92 in New York City, reported
  that they would not comply with an official
  evacuation order
• 66 of the national sample 62 of New Yorkers
  listed concern for their children as the main
  reason

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Pediatric Terrorism Exposure

• Inadvertently (Classic Thinking)
• Secondary victims in terrorist attack
• Catastrophic event at chemical/ nuclear plant
• Intentionally targeted (New Thinking)

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What is Pediatric Surge?

• Secondary Victims
• Proportion of normal census
• Uniquely Pediatric Event
• Out of proportion to normal census
• School, day care, school bus, camp
• Family Unit
• Ability to care for family without separating
  children and adults

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Pediatric Surge Planning

• Address Pediatrics out of Proportion to Normal
  Numbers
• Emergency operations plans
• Providers
• Equipment and pharmaceuticals
• Drills and exercises
• Plans for Care of Children
• Adult providers
• Adult units
• Adult equipment
• Plans for Care of Adults in Pediatric Units

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Federal and State Resources

• Strategic National Stockpile (SNS)
• Improved but limited pediatric content
• Restricted to FDA indicated usages
• Disaster Medical Assistance Team/ National
  Disaster Medical System (DMAT/NDMS)
• No Pediatric requirements
• Staff
• Pharmaceuticals
• Equipment
• 2 Self-certified pediatric teams

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Federal and State Resources

• State Stockpiles
• Based on SNS
• Medical Reserve Corps (MRC)
• No defined pediatric capability
• Questionable functionality
• Time Delay
• Federal
• 6?48 hours
• Pediatric Alternative
• Unknown

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Decontamination

• Water pressure
• Will it injure child
• Water temperature
• Hypothermia
• Non-ambulatory child
• Infants and toddlers
• Children with special healthcare
• needs
• Mental health concerns
• Will children follow instructions
• Long term effects

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What Are Some Of The Solutions?

• National Advisory Committee on Children and
  Terrorism
• Pediatric Disaster and Terrorism Preparedness
  National Consensus Guidelines
• Pediatric Expert Advisory Panel

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Pediatric Disaster and TerrorismPreparedness
National Guidelines

• Preparedness and Treatments
• Biologic
• Chemical
• Radiologic
• NPS
• Decontamination
• Natural Disasters

• Hospital Preparedness
• Mental Health Schools
• Primary Care Providers
• Displaced Children
• National Disaster Medical System
• Training
• Drills and Simulations

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Pediatric Expert Advisory Panel

• The purpose of the Pediatric Expert Advisory
  Panel (PEAP) is to
• Discuss and analyze current issues
• Multi-disciplinary
• Governmental and non-governmental bridge
• On-going program
• Ability for rapid analysis
• Dissemination of findings
• Web
• InfoBrief
• Conference or Symposia

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Pediatric Expert Advisory Panel

• Pediatric Dosage AtroPen
• Approved by FDA in past few months
• Questions regarding
• Indications
• Role
• Pediatric AtroPen or Mark I
• Indications
• Protocols
• Stockpile