Disaster preparedness, pediatric considerations in primary blast injury, chemical, and biological terrorism

Table 1 Pediatric specific vulnerabilities to terrorist attacks

Vulnerability	Blast Injury	Biological agents	Chemical agents
Proximity to ground		Agents settle to the ground	Agents tend to pool in lower areas
Increased minute ventilation		Increased exposure to inhaled agents	Increased exposure to inhaled agents
Provider unfamiliarity with pediatric dosing of medications		Dosing of antibiotics different	No prepackaged store of antidotes in pediatric doses
Lack of knowledge or inability to flee danger	Either unaware or unable to flee from explosion Potentially curious about ordinance	Unlikely to recognize signs/symptoms of biologic agents	Would not know to flee from strange odor or seek medical help with symptoms
Lack of stockpile of pediatric dosed antidotes and vaccines		Prepackaged stockpiles of vaccines and antidotes not dosed for small children[32]	Lack of guidelines for dosing of antidotes in children
Less blood volume/physiologic reserve	More rapidly develop life threatening blood loss	Prone to dehydration with illness. Lower functional residual capacity	More prone to respiratory distress/failure with nerve agents, vesicants, and pulmonary agents
Thinner skin			Faster absorbtion of agents
Increased BSA to mass ratio	Prone to hypothermia during triage, evacuation and treatment		Prone to hypothermia with decontamination
Developmental immaturity	Unable to follow mental status exam/communicate other injuries early	Present later in the course of biologic agents	Unable to promptly communicate symptoms
Increased head size compared to body	Increased head AIS when compared to adults[2]

AIS: Abbreviated injury score; BSA: Body surface area.