# Presentation: 818609

## Pediatric Disaster andTerrorism 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

## 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

## 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

## Pediatric Terrorism Exposure	

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

## 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

## 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

## 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

## 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

## 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

## 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

## Pediatric Disaster and TerrorismPreparedness: 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

## 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

## 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