PDLS: Children as Victims of Terrorism: Risk Assessment

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PDLS Children as Victims of Terrorism Risk
Assessment Response

• Dr. Jim Courtney
• Assistant Professor of Emergency Medicine

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Objectives

• Identify why children can be specific targets of
  terrorism
• Discuss the differences that may make children
  more susceptible to certain acts of terrorism
• Discuss specific treatment modalities and/or
  dosing that are unique to children

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Guiding Principles

• The best approach to disaster preparedness is to
  plan for all pertinent hazards.

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Guiding Principles

• Dont need separate disaster plans for kids
• Do need to focus on their unique needs and the
  critical differences between children and adults

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Pediatric Issues in Terrorism

• Children at risk
• Assessing your communitys risks
• Community preparation issues
• Family preparation issues
• Psychological issues with children
• Resources

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Collateral damage?
FEMA Photo Library
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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 thing you can do to people is to aim at
  their children
• 
  
  

(From AP story 5/30/06)
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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

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Children at Risk Vulnerabilities

• Low to ground
• Faster respiratory rates
• Larger skin surface area to mass ratio
• Vulnerable to fluid loss

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Children at Risk Vulnerabilities

• More permeable blood-brain barrier
• Many rapidly reproducing cells
• Unable to escape (longer exposure)
• Found in large groups (contagion)

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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 care

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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

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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

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There may be proportionally

• MORE CHILRDEN THAN ADULTS THAT ARE SICK

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And children may be

• SICKER
• THAN THE ADULTS

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December 3, 1984 Bhopal, India
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Union Carbide Plant

• Shortly after midnight, 100,000 lbs of toxic
  Methyl Isocyanate (MIC) was released from the
  Union Carbide Plant
• 500,000 people were exposed
• Within 24 hours 8,000 people died
• Since the disaster 25,000 deaths have been
  attributed to the gas release

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Quote from survivor

• When I saw the leaves on the trees curl and turn
  black and birds fall dead out of the sky, I knew
  that this was Death, come among us as foretold.
  My regret is that I survived.

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Methyl Isocyanate (MIC)

• Intermediate in pesticide production
• Potent irritant of eyes and lungs
• Can cause permanent damage to lungs and eyes but
  not through cyanide toxicity
• Other unknown chemicals were also released at the
  same time

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Lasting Effects

• Union Carbide sold to Dow Chemicals in 2001
• Site remains as it was in 1984
• City of Bhopal still does not have clean drinking
  water
• Incidence of various cancers and birth defects
  are significantly higher than surrounding areas

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August 21, 1986
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Lake Nyos, Cameroon
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Inhalational Disaster

• In the middle of the night the lake which sits on
  top of a dormant volcano crater belched up 1.6
  million tons of carbon dioxide gas
• Since carbon dioxide is heavier than air, it
  rolled along the ground and into the surrounding
  valleys and killed 1,700 people by
  asphyxiation

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Lake Nyos

• The gas released also contained significant
  amounts of sulfur and hydrogen
• Survivors sustained skin and eye lesions and some
  have permanent pulmonary and eye problems

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Lake Nyos

• The cloud was reported to be 150 feet thick and
  traveled at 15-30 MPH
• The cloud stayed densely packed and was lethal
  for 15 miles
• No children within this radius survived
• The level of the lake dropped by 3 feet
• The cause is unknown, but is believed to have
  been a landslide on the lakeshore

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Livestock insects were killed as well
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Lake Nyos

• Only 3 lakes in the world are known to be
  supersaturated with carbon dixoide
• All are located within Africa
• However, before this disaster, no one knew that
  Lake Nyos was supersaturated with carbon dixoide

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Degassing Lake Nyos
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BIOLOGICAL AGENTS
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Biological Agents

• Typically the treatments are not something
  usually recommended for children
• Ciprofloxacin or doxycycline for Anthrax
• Smallpox vaccine for Smallpox
• Contraindications become very relative in
  situations like that

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Radiation Exposure
Amount Source Symptoms
1 rad X-Ray None
lt50 rads None
50-200 rads H-Bomb Vomiting
gt200 rads Hemorrhaging
gt 450 rads Chernobyl Bone Marrow Suppression/Death
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Chernobyl Experience

• 134 workers were treated for radiation sickness
• 22 had gt 400 rad exposure 32 of those died
• 21 had gt 600 rad exposure 95 of those died
• The larger problem is the risk of cancers,
  especially thyroid, leukemia and lung cancer

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Erythema on a Chernobyl fireman on Day 17
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Severe ulcerative necrotic radiation burns in
Chernobyl fireman on Day 40 after the accident
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Severity of Symptoms
None
Death
Coma
Nausea
Vomiting
Diarrhea
Seizures
Hypotension
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Your Friends During A Radiation Exposure

• Time, Distance Shielding
• The most important things you can do to protect
  yourself
• Potassium Iodide (KI)
• Fill your thyroid with iodine so that I131 wont
  deposit there
• Potassium helps to rid the body of Cesium137
  faster
• Goal is to have this in the hands of everyone
  within 2 hours of exposure

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Treatment Protocols

• Does your system have Chemical, Biological
  Radiological, Nuclear and Explosive (CBRNE)
  protocols?
• Does it address the pediatric population?

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Questions?