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Chemical-Biological Terrorism and Its Impact on Children Sarita Chung, MD, FAAP,A Carl R

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Chemical-Biological Terrorism and Its Impact on Children Sarita Chung, MD, FAAP,A Carl R TECHNICAL REPORT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children Chemical-Biological Terrorism and Its Impact on Children Sarita Chung, MD, FAAP,a Carl R. Baum, MD, FACMT, FAAP,b Ann-Christine Nyquist, MD, MSPH, FAAP,c DISASTER PREPAREDNESS ADVISORY COUNCIL, COUNCIL ON ENVIRONMENTAL HEALTH, COMMITTEE ON INFECTIOUS DISEASES Children are potential victims of chemical or biological terrorism. In recent abstract years, children have been victims of terrorist acts such as the chemical attacks (2017–2018) in Syria. Consequently, it is necessary to prepare for and respond to the needs of children after a chemical or biological attack. A broad range of public health initiatives have occurred since the terrorist attacks of September 11, 2001. However, in many cases, these initiatives have not ensured the protection of children. Since 2001, public health preparedness has aDivision of Emergency Medicine, Boston Children’s Hospital and broadened to an all-hazards approach, in which response plans for terrorism Harvard Medical School, Harvard University, Boston, Massachusetts; bSection of Pediatric Emergency Medicine, Departments of Pediatrics are blended with those for unintentional disasters or outbreaks (eg, natural and Emergency Medicine, School of Medicine, Yale University, New events such as earthquakes or pandemic influenza or man-made catastrophes Haven, Connecticut; and cSection of Pediatric Infectious Diseases and Epidemiology, Department of Pediatrics, Children’s Hospital Colorado such as a hazardous-materials spill). In response to new principles and and School of Medicine, University of Colorado, Aurora, Colorado programs that have evolved over the last decade, this technical report Technical reports from the American Academy of Pediatrics benefit supports the accompanying update of the American Academy of Pediatrics from expertise and resources of liaisons and internal (AAP) and “ external reviewers. However, technical reports from the American 2006 policy statement Chemical-Biological Terrorism and its Impact on Academy of Pediatrics may not reflect the views of the liaisons or the Children.” The roles of the pediatrician and public health agencies continue to organizations or government agencies that they represent. evolve, and only their coordinated readiness and response efforts will ensure Dr Chung provided substantial contributions to the conception and design of the work, contributed to drafting and revising it critically for that the medical and mental health needs of children will be met successfully. important intellectual content, gives final approval of the version to be In this document, we will address chemical and biological incidents. Radiation published, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any disasters are addressed separately. part of the work are appropriately investigated and resolved; Drs Baum and Nyquist provided substantial contributions to the conception and design of the work and contributed to drafting and revising it critically for important intellectual content; and all authors approved the final manuscript as submitted. BACKGROUND INFORMATION The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking In 2000, the American Academy of Pediatrics (AAP) published the policy into account individual circumstances, may be appropriate. statement “Chemical-Biological Terrorism and its Impact on Children.” All technical reports from the American Academy of Pediatrics Preceding events such as the 1995 sarin attack in Tokyo, Japan, illustrate automatically expire 5 years after publication unless reaffirmed, the reality that acts of domestic chemical terrorism can occur, with revised, or retired at or before that time. significant impact on the health of children. The subsequent 2006 policy statement highlighted the need for increased awareness and preparedness To cite: Chung S, Baum CR, Nyquist A-C, AAP DISASTER in response to additional acts of chemical and biological terrorism, PREPAREDNESS ADVISORY COUNCIL, COUNCIL ON ENVIRONMENTAL including the release of anthrax spores through the US postal system, HEALTH, COMMITTEE ON INFECTIOUS DISEASES. Chemical-Biological intentional toxic chemical contamination of food in Michigan and Terrorism and Its Impact on Children. Pediatrics. 2020;145(2): e20193750 California, and the identification of ricin-laden letters in a post office in Downloaded from www.aappublications.org/news by guest on September 25, 2021 PEDIATRICS Volume 145, number 2, February 2020:e20193750 FROM THE AMERICAN ACADEMY OF PEDIATRICS South Carolina. Unfortunately, since government also created the National period. Moreover, principles of the the publication of the 2006 policy Commission on Children and care of children after chemical and statement, there have been additional Disasters, the National Advisory biological terrorism are evolving, and chemical attacks affecting children, Committee on Children and Disasters, these approaches will continue to such as the 2017 sarin1 and 2018 and the National Biodefense Science inform future work. chlorine attacks2 in Syria. These Board, all of which included pediatric attacks have led to significant subject matter experts. The AAP hosts pediatric morbidity and mortality. a comprehensive Web site for STATEMENT OF THE PROBLEM Emerging biological threats, such as pediatric health care providers with Pediatricians play a pivotal role in Ebola and Zika viruses, have provided a page devoted to information on providing care in the medical home opportunities to test the systems of terrorism and its impact on children and supporting the community pediatric disaster preparedness (www.aap.org/disasters/terrorism). before, during, and after a chemical or nationally and internationally. In the Additional AAP activities to promote biological event. It is critical for same time frame, there continues to pediatric disaster awareness include pediatricians and others who care for be substantial progress as new publication of disaster policy children in all care settings to chemical and biological medical statements such as “Ensuring the continue to educate themselves countermeasures (MCMs) are Health of Children in Disasters” and regarding the pediatric consequences approved by the US Food and Drug “Providing Psychosocial Support to of a chemical or biological attack. Administration (FDA), additional Children and Families in the Readiness resources and approaches methods for surveillance are in place, Aftermath of Disasters and Crises” will vary depending on practice and advances in pediatric disaster along with education on specific setting, such as community hospitals, preparedness and education are chemical and biological threats in the pediatric hospitals, emergency available to assist emergency AAP manual Pediatric Environmental departments, and office practices. The responders with evidence-based best Health (the “Green Book”) and the role of the pediatrician and others practices. AAP manual Red Book: 2018 Report of who care for children in ensuring the the Committee on Infectious health of children in disasters has Since the September 11, 2001, Diseases.3–6 The AAP has also been described.3,8 Specificto terrorist attacks and subsequent promoted pediatric preparedness chemical and biological terrorism, anthrax releases in the United States, through implementation of a 2016 pediatricians and their staff will need the AAP has recognized the need to regional pediatric and public health to be prepared to promote and share strategically address the impact of tabletop exercise and a 2017 virtual information on readiness approaches, terrorism (ie, an act designed to tabletop exercise (www.aap.org/ advise on pediatric decontamination frighten, hurt, or kill people) on disasters/tabletop).7 strategies, provide appropriate children at the national, state, and medical care, offer anticipatory local level. This has led to the The unfortunate continuing guidance to families, report appointment of the AAP Disaster occurrence of chemical and biological appearances of unusual disease Preparedness Advisory Council, terrorism demonstrates the ongoing clusters, and help guide families after which collaborates with federal need to improve public health and events. This technical report partners (including the Department health care system preparedness in summarizes relevant information of Health and Human Services all respects, including the detection of and evidence. Although the [DHHS] Office of the Assistant covert events, establishment of focus of this document is geared Secretary for Preparedness and comprehensive response protocols toward the US health care system, Response [ASPR], Centers for Disease for children, and implementation of principles of this technical report can Control and Prevention [CDC], plans for rapid resource mobilization be applied to international health Department of Homeland Security to care for children. At the care settings. [DHS], FDA, Federal Emergency governmental level, the passage of Management Agency, and the key federal legislation (Table 1) has National Institute of Child Health and facilitated these efforts. However, NEW INFORMATION Human Development) as well as more there remains a need for pediatric This technical report and its than 70 AAP member disaster health care providers to be accompanying policy statement9 preparedness
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