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?” FEMA Photo Library
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 thing you can do to people is aim at 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?
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 FEMA Photo Library
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 FEMA Photo Library
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 FEMA Photo Library
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 FEMA Photo Library
As Time Goes On Introduce a family ritual to honor victims and responders, especially if loved ones and acquaintances were involved. FEMA Photo Library
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. FEMA Photo Library
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