pediatric issues in terrorism © lou romig md, 2006. used with permission
TRANSCRIPT
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