Pediatrics: Special Considerations for Children - Preparing Hospitals for Bioterror - page 147

Table 10.2 Standardized courses that teach pediatric assessment, triage, and care

Course title Intended audience Organization/contact information

Pediatric advanced life support (PALS) Paramedics, physician's assistants,

nurse practitioner, nurses, and
physicians

American Heart Association,
at 800/242-8721, or at
www.americanheart.org.

Pediatric education for the prehospital
provider (PEPP).
PALS renewal may be offerred with some
courses.

EMT and paramedics American Academy of Pediatrics, American

College of Emergency Physicians at
www.peppsite.com,

Emergency nurses pediatric course
(ENPC).
PALS renewal may be offerred with some
courses.

Nurses Emergency Nurses Association, email at

[e-mail] or call Course Operations
Department of the ENA National Office,
phone [phone].

Advanced pediatric life support (APLS,
may be combined with PALS
certification in some courses)

Physicians, physician's assistants,
and nurse practitioner

American Academy of Pediatrics (AAP) at
800/433-9016, ext 4795 or the American
College of Emergency Physicians (ACEP)
at 800/798-1822, ext 3292

Pediatric disaster life support (PDLS) Physicians, Nurses, Nurse

Practitioners, and Physician
Assistants

American Medical Association,
Phone: [phone]
E-mail: [e-mail]

Proper equipment size and correct pharmaceut-
ical dosing present significant obstacles to quality
pediatric care in a general hospital. Systems for
pediatric equipment use and drug dosing such
as the Broselow-Luten system provide a stan-
dard approach for general hospitals to ensure
proper medication therapy with minimal error.
The color-coded Broselow-Luten organizes equip-
ment and provides specific drug dosing informa-
tion based on a weight reference. When weight
is known, then the proper equipment and drug
doses can be read directly off the reference.
When the weight is not known, a tape can be
used to determine the weight range based on the
patient's height. The corresponding color on the
tape provides equipment sizes and drug doses
based on this weight. Expansions of this system
allow for organization of equipment by these color
designations. A new adaptation of this system,
the Pediatric Disaster Assistance Tool (PDAT),
developed by Drs. Wiley and Baum, supplies a
readily available resource for the provision of
timely and accurate treatment of children exposed
to weapons of mass destruction (Figures 10.2
and 10.3). Additional pediatric information in

pdf or html format for download is available at
the following websites www.bt.cdc.gov/children
(Centers for Disease Control) [16], www.aap.org/
terrorism/index.html (American Academy of Pedi-
atrics) [5], and www.ems-c.org/disasters/ framedis-
asters.htm (Emergency Medicine Services for
Children). Care priorities for children based on
specific agents are discussed below.
From the behavioral standpoint, children require
much greater supervision than adults. Children
under 4 years of age may not be able to understand
instructions and are likely to be uncooperative
with medical personnel when frightened. Keeping
families together as much as possible while dele-
gating control of children to their parents will
minimize disruption of important procedures such
as wet decontamination. In the setting where a
parent or older sibling is not available or is too
sick to provide supervision, personnel with the
ability to rapidly establish rapport with children
must provide the needed supervision. Child life
specialists, social workers, schoolteachers, and day
care workers represent personnel who can assist
with this important task. This response capability