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Medscape Medical News
Preparations for Terrorist Attack Fail to Address
Children's Needs
Tinker Ready Oct. 24, 2002 (Boston) — The evolving medical response to the possibility of another major terrorist attack in the U.S. fails to adequately account for the unique needs of children, military and civilian doctors told members of the American Academy of Pediatrics (AAP) at their annual meeting on Tuesday. Several key vaccines and treatments for biowarfare agents have never been tested in children. Protective gear is designed for adults to treat adults. And few schools and day care centers near nuclear power plants stock protective potassium iodide (KI), the doctors said. "We have to create for ourselves pediatric protocols for drug administration, decontamination, and key immunizations," said Michael Shannon, MD, a pediatrician at Children's Hospital in Boston and a member of the AAP Task Force on Terrorism. Children have unique risks in the event of a chemical, biological, or nuclear attack, said Dr. Shannon and Theodore Cieslak, MD, chairman of the San Antonio Military Pediatric Center. Children are physiologically different than adults, Dr. Cieslak said. "They have a quicker respiratory rate," he said. "A child can breathe in a lethal dose (of a toxic agent) more quickly than an adult." Children have a thinner blood-brain barrier than adults and are closer to the ground, where chemicals are likely to linger, he said. And they are more vulnerable to some agents, such as Venezuelan equine encephalitis and radiation. He noted that this generation of children is also growing up without any immunity to smallpox. Smallpox and anthrax are the two most likely candidates for a biological attack. Although there will soon be a plentiful supply of smallpox vaccine, Dr. Cieslak said, it is still not available to civilians. Dr. Cieslak said he is personally opposed to vaccinating children because of the potential for complications. He also thinks the anthrax vaccine, which must be administered in six shots over 18 months, is a "logistical nightmare." In addition, it has never been tested in children. Dr. Shannon reminded the doctors of the 1995 sarin gas attack in a Tokyo subway. In that case, 4,000 people contaminated with the gas made their way on foot to a nearby hospital and proceeded to contaminate and incapacitate one-third of the medical staff. Hospitals are not accustomed to receiving emergency patients who haven't been treated by a paramedic or decontaminated before arriving, he said. Most emergency department staff knows that adults are decontaminated after a 10-minute shower, "but no one knows how to decontaminate a baby," Shannon said. Personal protection equipment will be no help either, he said. "You can't handle an infant and it will be very difficult to manage a small child wearing that equipment," he said. "If you may be face to face with a victim of terrorism, this is what you have to worry about." Shannon said that "preparations at schools [are] woefully inadequate." Schools need to have an out-of-state contact in case parents are incapacitated, and they need to review their health proxy policies, he said. The Nuclear Regulatory Commission recommends that KI should be available to anyone living within 10 miles of a nuclear power plant in the event of an accident. Since children are more vulnerable to thyroid cancer than adults and KI provides protection, Shannon recommended that pediatricians help at-risk schools to stockpile the drug. "We've got a lot to learn," he said. "It's inescapable. It's our responsibility." Kathleen Devany, MD, is a pediatrician in a group practice in Andover, Massachusetts. Her patients' parents have been asking about the smallpox vaccine, but not KI. "We are not far from the Seabrook [N.H.] Nuclear Power plant," she said after the session. "I'm going to make sure anyone living within ten miles of the plant has KI." AAP 2002 National Conference. Presented Oct. 22, 2002. Reviewed by Gary D. Vogin, MD Tinker Ready is a freelance writer for Medscape.</ -- Content
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