Pediatric Issues in Terrorism

http://lordoftheflies.org/img/beslan01.htm

© Lou Romig MD, 2006. Used with permission.

Guiding Principles

Assuring excellence of pediatric emergency care on a daily basis

is the best preparedness for pediatric disaster care.

Preamble

Preparing for the involvement of children as victims of a terrorist

attack is little different than preparing for any other kind of

multicasualty disaster.

Guiding Principles

The best approach to disaster preparedness is to plan for all

pertinent hazards.

Guiding Principles

We don’t need separate disaster plans for kids but we do need to focus on their unique needs and

critical differences when it comes to preparing for any kind of

disaster, including terrorist attacks.

Guiding Principles

We must all be responsible for our own preparedness and that of

our loved ones.

Pediatric Issues in Terrorism Children at risk

Assessing your community’s risks

Community preparation issues

Family preparation issues

Psychological issues with children

Resources

“Collateral damage?”

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Or intentional targets?

When Lee Malvo asked why he planned to attack children in schools and on

buses, convicted sniper John Mohammed allegedly replied:

““For the sheer terror of it – the worst For the sheer terror of it – the worst thing you can do to people is aim at thing you can do to people is aim at

their children.”their children.” (From AP story 5/30/06)

Children at Risk: Targets

Innocent, vulnerable population

Tend to gather in large groups, including daycare centers at places of business

Natural curiosity

May not be able to rescue themselves

Extreme emotional reaction by rescuers and public

Children at Risk: Vulnerabilities

Low to ground

Faster respiratory rates

Larger skin surface area to mass ratio

Vulnerable to fluid loss

Children at Risk: Vulnerabilities

More permeable blood-brain barrier

Many rapidly reproducing cells

Unable to escape (longer exposure)

Found in large groups (contagion)

Is your community at risk?

Is your community at risk?

Major trade, banking or retail centers

Historic landmarks

Military installations

Colleges/schools

Manufacturing plants

Chemical storage centers

Is your community at risk? Government buildings

Major sports, entertainment, and convention venues and events

Technological research centers

Airports, other transportation centers

Religious centers

Hospitals

Are there children near your community’s at-risk sites?

Community Preparation

Local emergency management Assess pediatric venues at risk Assist local medical services and

agencies in preparing for the needs of children and families

Involve local child and family advocate agencies in emergency planning

Community Preparation

Local emergency management Community education addressing

children’s issues

Pediatric aspects of shelter management

CERT programs

Working knowledge of state and federal response resources

Community Preparation

Schools and Child Care Disaster plans and exercises including

initial scene assessment, rescue and triage

Awareness of risk factors in area

Education for teachers, administrators, parents and children

Reunification/ shelter in place/ evacuation planning

Community Preparation

EMS/Fire

Work to be able to take good care of kids on a daily basis Training

Equipment

Quality management

Community Preparation

EMS/Fire

Incorporate children in all MCI drills and exercises

Knowledge of at-risk groups in the area

Knowledge of local hospital pediatric capabilities

Have appropriate protocols/aids for pediatric WMD/WME care

Community Preparation

Hospitals Work to be able to take good care of

kids on a daily basis Training

Equipment

Quality management

Community Preparation

Hospitals Incorporate the needs of children

and families into all aspects of disaster planning and preparedness Acknowledge the likelihood of an

unusual pediatric patient load in the disaster setting

Be aware of available pediatric resources

Community Preparation

Hospitals

Incorporate children and families in all disaster exercises

Work within hospital networks to identify pediatric resources that might be tapped in cases of unusual pediatric load

Prepare for public concerns

Community Preparation

All medical responders/receivers must be prepared to deal with:

Pediatric and adult multicasualty triage

Decontamination issues Children who are unable to self-

decontaminate Risk of hypothermia Post-decon clothing for infants and

children Keeping family members together Children’s fear of “monsters” garbed in

protective equipment

Community Preparation

All medical responders/receivers must be prepared to deal with:

Lack of familiarity with pediatric antidotes and treatments and lack of pediatric drug formulations

Unusual pediatric patient loads and acuities

Relative lack of local pediatric specialty resources due to overwhelming patient volume

Ethical dilemmas in resource-constrained environments

Family Preparation Issues

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Family Preparedness for Terrorism

The best family preparedness plan focuses on all pertinent hazards. The possibility of being

affected by a terrorist attack should be acknowledged and addressed the same as any

other hazard but not emphasized.

The concept of terrorism is now a part of our culture. Children must have a context into which

to place information about terrorism.

Children Need to Know

If a parent has a potentially hazardous occupation, children need to know

Discuss why parent takes the risk

Talk about general risks to safety; limit details

Stress safety measures taken; allow children to become familiar with protective equipment

Children Need to Know

What to do if they find an unidentified package or substance

How to find safe places and exits

Not to be scared of rescuers

What potentially dangerous areas are located near home and/or school

Family Prep: Reunification Everyone needs to carry ID and an

emergency contact number

Keep current photos of all family members in a secure place

Family members should have a general idea of where others in family are

Appoint one family member to keep track of family travelers

Family Prep: Reunification

Plan on who will pick up children from school, etc if necessary in an emergency

Be familiar with school disaster plans (early pick-up, shelter in place, pre-planned evacuation sites)

Plan family rendezvous points Physical Central communications point

Family Prep: Talking about Terrorism

Terrorism is now a part of our culture. Children need to learn about terrorism the same way they learn about other

aspects of the world’s cultures, history and current events.

Talking about Terrorism

<5 yrs of age Children in this age group have little

concept of the future and will not understand discussion of something that might happen.

Be honest about your emotions if an attack does occur. Tell child that people were hurt but that he/she and the family are safe and that you’ll feel better after awhile.

Talking about Terrorism

5-9 yrs of age Discuss terrorism when child shows curiosity

because of exposure at school or in the media.

Ask the child what they’ve heard about terrorism. Correct misinformation and misunderstanding.

Emphasize the emotions of terrorism rather than the politics.

Talking about Terrorism

5-9 yrs of age Emphasize that many people are working

hard to keep all of us safe.

Discuss who to blame and who not to blame.

Discuss things the child can do to stay safe from all kinds of hazards.

Talking about Terrorism 9 yrs and older

Can begin to discuss “politics”, including why people and countries may disagree

Talk in general about the different things terrorists might use as weapons

Emphasize that it is very unlikely that anyone in the family will be involved in a terrorist incident

Caution children about rumors

Psychology in the Aftermath

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Immediately After An Incident

Allow children to watch media but limit exposure and be present to discuss and handle children's reactions.

Reassure younger children that they didn’t cause an event to happen.

Assure children that an event is not happening again just because they see pictures over and over on TV.

Set aside a time for family discussion.

Immediately After An Incident

Explain in concrete terms what happened and answer questions truthfully.

If possible, reassure children that their loved ones are safe.

If a family member’s status is unknown, tell children why and what is being done to find out.

Immediately After An Incident

Children pick up on adults’ emotions. Don’t hide emotions but try to keep them under control.

Tell children that it’s OK for them to be feeling sad, angry, or numb and that not everyone will be feeling the same way at the same time.

Maintain family routines.

Expect and respect fear for family members in public service

positions

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As Time Goes On

Supervise media exposure

Expect a greater need for physical reassurance

Encourage talking and emotional expression

Emphasize tolerance and unity

Turn thoughts toward recovery

As Time Goes On Common psychological reactions:

Regressive behaviors Sleep disturbances Fatigue Unusual expressions of anger Changes in appetite Mood swings Lack of ability to experience pleasure Substance abuse

As Time Goes On Seek professional assistance if children

have: New behaviors that consistently

interfere with activities of daily life Suicidal thoughts Depression Aggressive behavior Flashbacks Substance abuse Chronic physical symptoms

As Time Goes On

Allow children to

participate in memorials and help in

relief efforts

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As Time Goes On

Introduce a family ritual to honor victims and responders, especially if loved ones

and acquaintances were involved.

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Summary

The best preparation for emergency medical response to children as victims of terrorism is to be able to take excellent care of kids every day.

An all-hazards approach to planning at all levels is probably the most efficient.

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Summary

Individuals and families must plan for the possibility (not probability) that they will be directly or indirectly affected by terrorism.

Terrorism should be discussed with children in appropriate terms.

Help! Children and families are well represented on

many federal and national planning committees. Watch for consensus statements and recommendations.

Broselow/Luten CWIK Response project

Increasing availability of pediatric drug delivery systems such as Meridian Medical’s Atropen® autoinjectors

National Disaster Medical System includes two specialty pediatric teams.

Some Useful Resources

International Critical Incident Stress Foundation @ www.icisf.org

EMS-C National Resource Center @ www.ems-c.org

American Academy of Pediatrics @ www.aap.org

FEMA @ www.fema.gov (includes FEMA for Kids)

Some Useful Resources Centers for Disease Control @

www.cdc.gov Pediatric Preparedness for Disasters and

Terrorism: A National Consensus Conference @ http://www.bt.cdc.gov/children/index.asp

JumpSTART Pediatric MCI Triage @ www.jumpstarttriage.com

Chemical Warfare involving Kids (CWIK) @ http://www.cwikresponse.com