The Program for Pediatric PreparednessNational Center for Disaster Preparedness

Pediatric Disaster andTerrorism Preparedness

David Markenson, M.D.David Markenson, M.D.Director, The Program for Pediatric Director, The Program for Pediatric

Preparedness Preparedness Deputy Director, National Center for Deputy Director, National Center for

Disaster PreparednessDisaster PreparednessMailman School of Public Health, Mailman School of Public Health,

Columbia UniversityColumbia UniversityNew York, NYNew York, NY

Unique Anatomy and Physiology

Increased Surface Area/VolumeIncreased Surface Area/Volume More absorptive surfaceMore absorptive surface More susceptible to volume lossesMore susceptible to volume losses

Increased Minute Ventilation/Lower Breathing Increased Minute Ventilation/Lower Breathing ZoneZone

Thinner Epidermis/ Under-keratinized EpidermisThinner Epidermis/ Under-keratinized Epidermis Immature Blood-brain BarrierImmature Blood-brain Barrier Procedural DifficultiesProcedural Difficulties Psychological ImmaturityPsychological Immaturity

Importance of Pediatric Considerations

Children are part of the populationChildren 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 Ignoring children may compromise entire preparedness planpreparedness plan August 2003 SurveyAugust 2003 Survey

90% nationally and 92% in New York City, 90% nationally and 92% in New York City, reported that they would not comply with an official reported that they would not comply with an official evacuation order evacuation order

66% of the national sample; 62% of New Yorkers 66% of the national sample; 62% of New Yorkers listed concern for their children as the main reason listed concern for their children as the main reason

Pediatric Terrorism Exposure

Inadvertently (Inadvertently (Classic ThinkingClassic Thinking)) Secondary victims in terrorist attackSecondary victims in terrorist attack Catastrophic event at chemical/ nuclear plantCatastrophic event at chemical/ nuclear plant

Intentionally targeted (Intentionally targeted (New ThinkingNew Thinking))

What is Pediatric Surge?

Secondary VictimsSecondary Victims Proportion of normal censusProportion of normal census

Uniquely Pediatric EventUniquely Pediatric Event Out of proportion to normal censusOut of proportion to normal census School, day care, school bus, campSchool, day care, school bus, camp

Family UnitFamily Unit Ability to care for family without separating Ability to care for family without separating

children and adultschildren and adults

Pediatric Surge Planning Address Pediatrics out of Proportion to Normal Address Pediatrics out of Proportion to Normal

NumbersNumbers Emergency operations plansEmergency operations plans ProvidersProviders Equipment and pharmaceuticalsEquipment and pharmaceuticals Drills and exercisesDrills and exercises

Plans for Care of ChildrenPlans for Care of Children Adult providersAdult providers Adult unitsAdult units Adult equipmentAdult equipment

Plans for Care of Adults in Pediatric UnitsPlans for Care of Adults in Pediatric Units

Federal and State Resources Strategic National Stockpile (SNS)Strategic National Stockpile (SNS)

Improved but limited pediatric contentImproved but limited pediatric content Restricted to FDA indicated usagesRestricted to FDA indicated usages

Disaster Medical Assistance Team/ National Disaster Medical Assistance Team/ National Disaster Medical System (DMAT/NDMS)Disaster Medical System (DMAT/NDMS) No Pediatric requirementsNo Pediatric requirements

StaffStaff PharmaceuticalsPharmaceuticals EquipmentEquipment

2 Self-certified pediatric teams2 Self-certified pediatric teams

Federal and State Resources State StockpilesState Stockpiles

Based on SNSBased on SNS Medical Reserve Corps (MRC)Medical Reserve Corps (MRC)

No defined pediatric capabilityNo defined pediatric capability Questionable functionalityQuestionable functionality

Time DelayTime Delay Federal Federal

66――48 hours48 hours Pediatric Alternative Pediatric Alternative

UnknownUnknown

Decontamination Water pressureWater pressure

Will it injure childWill it injure child Water temperatureWater temperature

HypothermiaHypothermia Non-ambulatory childNon-ambulatory child

Infants and toddlersInfants and toddlers Children with special healthcare Children with special healthcare

needsneeds Mental health concernsMental health concerns

Will children follow instructionsWill children follow instructions Long term effectsLong term effects

What Are Some Of The Solutions?

National Advisory Committee on Children National Advisory Committee on Children and Terrorismand Terrorism

Pediatric Disaster and Terrorism Pediatric Disaster and Terrorism Preparedness: National Consensus Preparedness: National Consensus GuidelinesGuidelines

Pediatric Expert Advisory PanelPediatric Expert Advisory Panel

Pediatric Disaster and TerrorismPreparedness: National Guidelines

Preparedness and Preparedness and TreatmentsTreatments BiologicBiologic ChemicalChemical RadiologicRadiologic NPSNPS DecontaminationDecontamination

Natural DisastersNatural Disasters

Hospital PreparednessHospital Preparedness Mental Health SchoolsMental Health Schools Primary Care ProvidersPrimary Care Providers Displaced ChildrenDisplaced Children National Disaster National Disaster

Medical SystemMedical System TrainingTraining Drills and SimulationsDrills and Simulations

Pediatric Expert Advisory Panel The purpose of the The purpose of the Pediatric Expert Pediatric Expert

Advisory Panel (PEAP) Advisory Panel (PEAP) is to: is to: Discuss and analyze current issuesDiscuss and analyze current issues

Multi-disciplinaryMulti-disciplinary Governmental and non-governmental bridgeGovernmental and non-governmental bridge On-going program On-going program Ability for rapid analysisAbility for rapid analysis Dissemination of findingsDissemination of findings

• WebWeb• InfoBriefInfoBrief• Conference or SymposiaConference or Symposia

Pediatric Expert Advisory Panel Pediatric Dosage AtroPenPediatric Dosage AtroPen®®

Approved by FDA in past few monthsApproved by FDA in past few months Questions regarding:Questions regarding:

IndicationsIndications RoleRole Pediatric AtroPen or Mark IPediatric AtroPen or Mark I

• IndicationsIndications

• ProtocolsProtocols

• StockpileStockpile