Pediatric Terrorism and Disaster Preparedness: Table 5.1

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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, sheltering^a (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
Psychological	Greater anxiety over reported incidents, hoaxes, media coverage, etc	Pediatric counseling of parents and children^b
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 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.

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