Biomedical Engineering Reference
In-Depth Information
10 Pediatrics: Special
Considerations for Children
JAMES F. WILEY, II
10.1 Introduction
As terrorist activities have increased and civilian
targets for terrorism have become more common,
the critical need to develop comprehensive systems
of care for pediatric victims of weapons of mass
destruction has emerged as a national priority in
the United States of America. In recognition of the
importance of this priority, a national consensus
conference on pediatric preparedness for disas-
ters and terrorism convened in New York City
during February 2003 and was reconvened in
Washington, D.C. in November 2005 (Table 10.1).
Over 70 pediatric specialists, representatives from
key government agencies and liaisons for national
pediatric organizations attended this conference.
Their work has served as a touch point for a new
emphasis on the special needs of children in emer-
gency preparedness planning.
The major outcome of this conference was the
development of recommendations and guidelines
for pediatric care following a biological, chemical
or nuclear attack. These recommendations were
structured within eight key areas: (1) pre-hospital
and emergency care, (2) hospital care, (3) emer-
gency preparedness, (4) terrorism preparedness
and response, (5) mental health needs, (6) school
preparedness and response, (7) training and drills,
and (8) future research and funding. The confer-
ence also made priority recommendations that cut
across these major areas [1].
The priority recommendations for hospital
preparedness focus on ensuring ALL hospitals are
prepared to take care of pediatric victims. Children's
hospitals must provide the lead role in preparing
prior to an event and directing the care of children
in general hospitals during an event. For general
hospitals, pediatric training and the availability of 48
hours of pediatric specific medicine and equipment
to care for their average daily number of pediatric
patients plus a surge of 100 additional children is
crucial to this preparedness goal. Additional recom-
mendations focus on assessing specific commu-
nity pediatric vulnerabilities. This risk assessment
then guides proper pediatric training, medicines, and
equipment for the region. Pediatric care and treat-
ment guidelines within all hospital emergency
operations and preparedness policies are vital to a
successful response to a terrorist attack. General
hospitals should partner with their regional pedi-
atric centers to ensure that the children in their
community will receive the highest level of pedi-
atric care during a terrorist event [1]. In the wake
of the atrocity at Beslan, Russia, where children
suffered specifically to further terrorist goals, the
need to build emergency preparedness infrastruc-
ture for children has taken on a new urgency [2].
10.2 Children: Special Vulnerabilities
Children possess unique characteristics that place
them at a disproportionate risk of injury from
terrorist activities relative to adults. As such,
emergency planning that does not account for chil-
dren's physiology, cognitive capability and devel-
opmental needs will fail to protect them during an
event. This section outlines key pediatric differ-
ences and proposes important considerations in
hospital planning to account for children's physical
weaknesses relative to adults.
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