At-Risk / Special Needs Populations
- Infants and Children
- General Principles of Radiation Safety are the Same in Children and Adults
- Potential Reasons for Stricter Radiation Protection for Infants and Children
- Radiation Protection Guidance and Radiation Effects on Children
- Management of Febrile Neutropenia in Children
- Decontamination in Children
- Mass Casualty Triage in Children (Not Specific for Radiation Incidents)
- Crisis Standards of Care and Children (Not Specific for Radiation Incidents)
- General Issues About Children and Disasters (Not Necessarily Limited to Radiation)
- Guidance About Mental Health Issues in Children (Not Necessarily Limited to Radiation)
- See also: Prototype/Template for Pediatric Hospital Orders During a Radiation Emergency (PDF - 692 KB)
General Principles of Radiation Safety are the Same in Children and Adults
- Time Distance Shielding (See illustration)
- Minimize time child is exposed to radiation source
- Maximize child's distance from the radiation source
- Maximize the shielding between the source of radiation and the child
- "ALARA" is another basic radiation protection principle: "As Low (a dose) as Reasonably Achievable"
- Musolino SV, DeFranco J, Schlueck R, The ALARA principle in the context of a radiological or nuclear emergency. Health Phys 2008;94(2):109-11. [PubMed Citation]
Potential Reasons for Stricter Radiation Protection for Infants and Children
- Unique anatomy and physiology of children (adapted from Pediatric Disaster and Terrorism Preparedness, by David Markenson, M.D. (PowerPoint® - 1135 KB) (Text version))
- Increased surface area/volume ratio
- More absorptive surface
- More susceptible to volume loss
- Increased breathing rate
- Shorter stature: lower breathing zone, closer to ground contamination
- Enhanced transdermal absorption: thinner, under-keritinized epidermis
- Immature blood brain barrier
- Greater propensity to dehydration and shock
- Psychological immaturity, dependent, more difficulty following complex directions
- May have pre-existing conditions that confer extra vulnerability
- Special vulnerability to late carcinogenic effects, especially thyroid
- Increased surface area/volume ratio
- Special needs of children during decontamination procedures (Adapted from& Considerations in Emergency Preparedness: A Two-track Conference, by David Markenson, M.D. (PowerPoint® - 95 KB) (Text Version))
- Decontamination must be done with high-volume, low-pressure, heated water systems
- Infants and young children may need to be held by adult during decontamination, but all surfaces must be reached
- Hypothermia issues must be addressed; replacement clothing or covering must be available immediately in cold environments
- Decontamination of Children video (AHRQ, October 2005)
- Drug doses appropriate for children must be available (e.g., agents for decorporation and treatment of Acute Radiation Syndrome)
- Treatment protocols for children are different from those for adults
- Selected policy recommendations for children
- Protective actions to minimize radiation dose to the thyroid gland and use of potassium iodide: recommendations in children
- Protective Action Guides for the Public: for RDD and IND Incidents: Children's issues
- Clinical Decision Guide doses: dose for initiating radionuclide countermeasures for children (0-18 years of age) who experience internal contamination are much lower than those for adults (See NCRP reports 161 and 166)
- Pediatric Counter-Terrorism Measures (FDA, February 2010). See information on KI, DTPA, and Prussian Blue.
- See also
- Radiation Protection Guidance and Radiation Effects on Children
- Adams TG, Sumner LE, Casagrande R. Estimating Risk of Hematopoietic Acute Radiation Syndrome in Children. Health Phys. 2017 Dec;113(6):452-457. [PubMed Citation]
Radiation Protection Guidance and Radiation Effects on Children
ICRP
- Statement on Tissue Reactions / Early and Late Effects of Radiation in Normal Tissues and Organs - Threshold Doses for Tissue Reactions in a Radiation Protection Context, ICRP Publication 118, Ann. ICRP 41(1/2), 2012
- ICRP Publication 95: Doses to Infants from Ingestion of Radionuclides in Mother's Milk, 95 (International Commission of Radiological Protection, ICRP Publication 95, 2004)
NCRP
- Preconception and Prenatal Radiation Exposure: Health Effects and Protective Guidance, (NCRP Report No. 174), Bethesda, MD, 2013.
- Management of Persons Contaminated with Radionuclides: Scientific and Technical Bases (NCRP Report No. 161, Vol. II), Bethesda, MD, 2010.
- Management of Persons Contaminated With Radionuclides: Handbook (NCRP Report No. 161, Vol. I), Bethesda, MD, 2008.
- Risk to the Thyroid from Ionizing Radiation (NCRP Report No. 159), Bethesda, MD, 2008.
- Radionuclide exposure of the embryo/fetus (NCRP Report No. 128), Bethesda, MD, 1998.
- Genetic effects from internally deposited radionuclides (NCRP Report No. 89), Bethesda, MD, 1987.
UNSCEAR
- Scientific finding on effects of radiation exposure of children UNSCEAR 2013 Report to the General Assembly, Volume II, Scientific Annex B.
Public Health England (PHE)
- Guidance on the application of dose coefficients for the embryo, fetus and breastfed infant in dose assessments for members of the public (RCE-5) (Public Health England [PHE], formerly Health Protection Agency [HPA], 2008)
- Bellman J, Wilkinson E, Dant T, Thurman A, Stricklin D. Impact analysis of age on radiation casualty estimations for nuclear detonation scenarios. Int J Radiat Biol. 2018 Oct 29:1-10. [PubMed Citation]
- Gardner AH, Dziuban EJ, Griese S, Berríos-Cartagena N, Buzzell J, Cobham-Owens K, Peacock G, Kazzi Z, Prasher JM. Medical Countermeasures for Children in Radiation and Nuclear Disasters: Current Capabilities and Key Gaps. Disaster Med Public Health Prep. 2018 Nov 2:1-8. [PubMed Citation]
- Alves Dos Reis A, Ha WH, Kukhta B, Li C. Monitoring and Dose Assessment for Children Following a Radiation Emergency Part I: Reference Values for In Vitro Bioassay. Health Phys. 2017 Mar;112(3):282-293. [PubMed Citation]
- Bartenfeld MT, Peacock G, Griese SE. Public health emergency planning for children in chemical, biological, radiological, and nuclear (CBRN) disasters. Biosecur Bioterror. 2014 Jul-Aug;12(4):201-7. [PubMed Citation]
- Gutmann A. Safeguarding children--pediatric research on medical countermeasures. N Engl J Med. 2013 Mar 28;368(13):1171-3. [PubMed Citation]
- Pfefferbaum B, Shaw JA; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter on disaster preparedness. J Am Acad Child Adolesc Psychiatry. 2013 Nov;52(11):1224-38. [PubMed Citation]
- Ginter PM, Rucks AC, Duncan WJ, Wingate MS, Beeman SK, Reeves J, West MA. Southeastern Regional Pediatric Disaster Surge Network: a public health partnership. Public Health Rep. 2010 Nov-Dec;125 Suppl 5:117-26. [PubMed Citation]
American Academy of Pediatrics
- Paulson JA and the American Academy of Pediatrics Council on Environmental Health, Policy Statement, Pediatric Considerations Before, During, and After Radiological or Nuclear Emergencies. Pediatrics. 2018;142(6): e20183000
- Linet MS, Kazzi Z, Paulson JA and the American Academy of Pediatrics Council on Environmental Health, Technical Report, Pediatric Considerations Before, During, and After Radiological or Nuclear Emergencies. Pediatrics. 2018;142(6):e20183001
- American Academy of Pediatrics Committee on Environmental Health. Radiation disasters and children. Pediatrics. 2003 Jun;111(6 Pt 1):1455-66. [PubMed Citation]
- American Academy of Pediatrics. Committee on Environmental Health. Risk of ionizing radiation exposure to children: a subject review. Pediatrics. 1998 Apr;101(4 Pt 1):717-9. [PubMed Citation]
Meeting Proceedings
- Lane R, Reinhardt P, Thompson P. Evidence of children's vulnerability to radiation in the context of radiological/nuclear events and considerations for emergency response. Radiat Prot Dosimetry. 2010 Nov;142(1):36-9. [PubMed Citation]
- Tracy BL. Would children be adequately protected by existing intervention levels during a radionuclear emergency? Radiat Prot Dosimetry. 2010 Nov;142(1):40-5. [PubMed Citation]
- Chen J. Doses to children from intakes by ingestion. Radiat Prot Dosimetry. 2010 Nov;142(1):46-50. [PubMed Citation]
- Hutton D. Vulnerability of children: more than a question of age. Radiat Prot Dosimetry. 2010 Nov;142(1):54-7. [PubMed Citation]
- Conway B, Pike J. Hospital response for children as a vulnerable population in radiological/nuclear incidents. Radiat Prot Dosimetry. 2010 Nov;142(1):58-62. [PubMed Citation]
- Waller EJ. First response considerations for children exposed to a radiological dispersal device. Radiat Prot Dosimetry. 2010 Nov;142(1):63-7. [PubMed Citation]
- Lemyre L, Corneil W, Johnson C, Boutette P. Psychosocial considerations about children and radiological events. Radiat Prot Dosimetry. 2010 Nov;142(1):70-6. [PubMed Citation]
- Rodrigues M, Chaput J, Bellman C, Cousins T. Children as vulnerable populations in radiological/nuclear events: discussion scenarios. Radiat Prot Dosimetry. 2010 Nov;142(1):77-82. [PubMed Citation]
Management of Febrile Neutropenia in Children
See Management of febrile neutropenia
Decontamination in Children
- Decontamination of Children - Preparedness and Response for Hospital Emergency Departments (HHS/AHRQ/Boston Children’s Hospital, October 2008)
(Watch video
) - This video provides a step-by-step decontamination demonstration in real time, and trains clinicians about the nuances of treating infants and children, who require special attention during decontamination.
- For example, children may be frightened not only by the emergency situation itself, but also by the decontamination process as well.
- Decontamination of children also takes longer than decontamination of adults.
- While this video focuses on chemical decontamination, radiation decontamination is similar in many ways.
- Some of the differences between chemical and radiation decontamination include:
- Responders may use different personal protective equipment for radiation than that used for chemical decontamination.
- Rigorous skin rubbing is used for chemical, but less rigorous skin rubbing for radiation decontamination of skin.
- It may not be feasible to capture contaminated waste water in a large mass casualty event.
- Soap and water are used for radiation decontamination, but after some chemical events, bleach and alcohol may be used for skin decontamination.
- Although the video mentions at least 5 minutes/child for one cycle of chemical decontamination, showering techniques used for radiation decontamination may require less than 5 minutes per child per cycle.
Mass Casualty Triage in Children (Not Specific for Radiation Incidents)
- Algorithm: JumpSTART
- JumpSTART Pediatric Multicasualty Incident Triage Tool (Lou E. Romig, MD, Team Life Support, Inc.)
- The JumpSTART Algorithm (Lou E. Romig, MD, Team Life Support, Inc.)
Crisis Standards of Care and Children (Not Specific for Radiation Incidents)
- Lemmon ME, Truog RD, Ubel PA. Allocating Resources Across the Life Span During COVID-19-Integrating Neonates and Children Into Crisis Standards of Care Protocols. JAMA Pediatr. 2020 Dec 14. [PubMed Citation]
General Issues About Children and Disasters
(Not Necessarily Limited To Radiation)
American Academy of Pediatrics
- AAP DISASTER PREPAREDNESS ADVISORY COUNCIL. Medical Countermeasures for Children in Public Health Emergencies, Disasters, or Terrorism. Pediatrics. 2016;137(2):e20154273 (PDF - 1.05 MB)
- Schonfeld DJ, Demaria T; Disaster Preparedness Advisory Council and Committee on Psychosocial Aspects of Child and Family Health. Providing Psychosocial Support to Children and Families in the Aftermath of Disasters and Crises. Pediatrics. 2015 Oct;136(4):e1120-30. [PubMed Citation] (Free PDF)
- Pediatric Preparedness Resource Kit (PDF - 8.3 MB) (American Academy of Pediatrics, 2013)
- This excellent document provides organizational, policy, and practical recommendations for a variety of issues related to childhood and maternal health during disasters.
- CHILDisaster NETWORK - Child Health International Large Scale Disaster (CHILDisaster) (American Academy of Pediatrics)
- American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American Academy of Pediatrics Committee on Medical Liability; Task Force on Terrorism. The pediatrician and disaster preparedness. Pediatrics. 2006 Feb;117(2):560-5. [PubMed Citation]
- American Academy of Pediatrics Committee on Environmental Health. Radiation disasters and children. Pediatrics. 2003 Jun;111(6 Pt 1):1455-66. [PubMed Citation]
- American Academy of Pediatrics, Committee on Pediatric Emergency Medicine and American College of Emergency Physicians, and Pediatric Committee. Care of children in the emergency department: guidelines for preparedness. Pediatrics. 2001 Apr;107(4):777-81. [PubMed Citation]
Institute of Medicine
- Preparedness, Response, and Recovery Considerations for Children and Families - Workshop Summary (Institute of Medicine of the National Academies, December 17, 2013)
- IOM Forum on Medical and Public Health Preparedness for Catastrophic Events: Medical and Public Health Preparedness, Response and Recovery Considerations for Children and Families. (Institute of Medicine of the National Academies, June 10, 2013)
- Infographic: Taking Care of Kids: Are You Prepared for an Emergency? (Institute of Medicine of the National Academies)
HHS
- Disaster Mental Health Resources (HHS): aggregation of many resources
- Pediatric Preparedness for Healthcare Coalitions (HHS, June 20, 2013). Meeting summary (text) with video and extensive list of resources.
- Health Resources on Children in Disasters and Emergencies (Disaster Information Management Research Center, NIH/HHS)
- Pediatric Counter-Terrorism Measures (FDA, February 2010). See information on KI.
- Caring for Children in a Disaster (HHS/CDC)
- Addressing Preparedness Challenges for Children in Public Health Emergencies
- CDC Public Health Grand Rounds on strategies for addressing unique vulnerabilities of children in every stage of emergency planning. Broadcast Mar 18, 2015
- Coping with Disasters and Strengthening Systems, A Framework for Child Welfare Agencies (PDF - 1 MB) (National Child Welfare Resource Center for Organizational Improvement, Children's Bureau, HHS)
- AHRQ Resources:
- Planning and Preparedness for Children's Needs in Public Health Emergencies (HHS/AHRQ, May 2009)
- Pediatric Hospital Surge Capacity in Public Health Emergencies (HHS/AHRQ, January 2009)
- School-based Emergency Preparedness: A National Analysis and Recommended Protocol (HHS/AHRQ, January 2009)
- Terrorism and Disaster Preparedness Resource for Pediatricians
(AHRQ Publication No. 06-0048, October 28, 2006) - Strategies and Tools for Meeting the Needs of Children: Public Health Emergencies
(HHS/AHRQ, a free Web conference, 4 Web lectures, broadcast January 11, 2006) - Public Health Emergency Preparedness — Surge Capacity (HHS/AHRQ)
Other
- Emergency Medical Services for Children / Innovation & Improvement Center (EMSC/IIC)
- Established in 1991 to help improve the pediatric emergency to help improve the pediatric emergency care infrastructure in the US and its territories
- Provides many resources for training and education.
Commissions and Reports
National Advisory Committee on Children and Disaster (NACCD)
- About NACCD
- National Commission on Children and Disasters: 2010 Report to the President and Congress, (October 2010)
- Markenson D, Redlener IE, Pediatric Preparedness for Disasters, Terrorism and Public Health Emergencies: A National Consensus Conference: Executive Summary and Final Report, (National Center for Disaster Preparedness, Columbia University, March 2007)
- NACCT Recommendations to Secretary of HHS (PDF - 704 KB) (June 12, 2003)
- Schools and Terrorism: A Supplement to the National Advisory Committee on Children and Terrorism. J Sch Health. 2004 Feb;74(2):39-51. [PubMed Citation]
Other US government agencies
- Readiness Information for Kids (Ready.gov)
- Post-Disaster Reunification of Children: A Nationwide Approach, (FEMA, HHS, American Red Cross, National Center for Missing and Exploited Children, November 2013)
Publications
- Gausche-Hill M. Pediatric disaster preparedness: are we really prepared? J Trauma. 2009 Aug;67(2 Suppl):S73-6. [PubMed Citation]
- Pfefferbaum B, North CS. Research with children exposed to disasters. Int J Methods Psychiatr Res. 2008 Dec;17 Suppl 2:S49-56. [PubMed Citation]
- Mace SE, Bern AI. Needs assessment: are Disaster Medical Assistance Teams up for the challenge of a pediatric disaster? Am J Emerg Med. 2007 Sep;25(7):762-9. [PubMed Citation]
- Gurwitch RH, Kees M, Becker SM, Schreiber M, Pfefferbaum B, Diamond D. When disaster strikes: responding to the needs of children. Prehosp Disaster Med. 2004 Jan-Mar;19(1):21-8. [PubMed Citation]
Guidance About Mental Health Issues in Children
(Not Necessarily Limited to Radiation)
- Schreiber, M. (2011). National Children's Disaster Mental Health Concept of Operations. (PDF - 1.21 MB) (Terrorism and Disaster Center at the University of Oklahoma Health Sciences Center)
- Listen, Protect, Connect Program
- Research results
- Ramirez M, Harland K, Frederick M, Shepherd R, Wong M, Cavanaugh JE. Listen protect connect for traumatized schoolchildren: a pilot study of psychological first aid. BMC Psychol. 2013 Nov 27;1(1):26. [PubMed Citation]
- Chandra A, Kim J, Pieters HC, Tang J, McCreary M, Schreiber M, Wells K. Implementing psychological first-aid training for medical reserve corps volunteers. Disaster Med Public Health Prep. 2014 Feb;8(1):95-100. [PubMed Citation]
- Program descriptions
- Psychological First Aid for Students and Teachers: Listen, Protect, Connect - Model and Teach (PDF - 429 KB) (DOE)
- Listen, Protect and Connect: Family to Family, Neighbor to Neighbor: Psychological First Aid for the Community Helping Each Other (PDF - 2.1 MB) (Los Angeles county Department of Public Health Emergency Preparedness and Response Program)
- Listen, Protect, Connect--Model and Teach: Psychological First Aid for Students and Teachers (PDF - 2.03 MB) (UCLA and others)
- Listen, Protect, and Connect: Psychological First Aid for Children and Parents-Helping You And Your Child In Times Of Disaster (PDF - 884 KB) (UCLA and others)
- More mental health resources: Disaster Mental Health Resources (HHS): This is an aggregation of many government resources
- Murray JS. Responding to the psychosocial needs of children and families in disasters. Crit Care Nurs Clin North Am. 2010 Dec;22(4):481-91. [PubMed Citation]
- Psychological First Aid (PDF - 2.9 MB) (National Child Traumatic Stress Network, National Center for PTSD, 2006)
- Mace SE, Sharieff G, Bern A, Benjamin L, Burbulys D, Johnson R, Schreiber M. Pediatric issues in disaster management, Part 1: the emergency medical system and surge capacity. Am J Disaster Med. 2010 Mar-Apr;5(2):83-93. [PubMed Citation]
- Mace SE, Sharieff G, Bern A, Benjamin L, Burbulys D, Johnson R, Schreiber M. Pediatric issues in disaster management, Part 2: evacuation centers and family separation/reunification. Am J Disaster Med. 2010 May-Jun;5(3):149-61. [PubMed Citation]
- Mace SE, Sharieff G, Bern A, Benjamin L, Burbulys D, Johnson R, Schreiber M. Pediatric issues in disaster management, Part 3: special healthcare needs patients and mental health issues. Am J Disaster Med. 2010 Sep-Oct;5(5):261-74. [PubMed Citation]
- Talking to Children About War and Terrorism (National Child Traumatic Stress Network)
- Disaster Preparedness Resource Guide for Child Welfare Agencies (Annie E. Casey Foundation)
- Pediatric Disaster and Terrorism Preparedness, by David Markenson, M.D., Columbia University, July 13, 2004 (PowerPoint® - 1135 KB) (Text version))
- Gurwitch RH, Kees M, Becker SM, Schreiber M, Pfefferbaum B, Diamond D. When disaster strikes: responding to the needs of children. Prehospital Disaster Med. 2004 Jan-Mar;19(1):21-8. [PubMed Citation]
- Psychological First Aid: Field Operations Guide (PDF - 3.37 MB) (National Child Traumatic Stress Network, National Center for PTSD, 2nd edition, July 2006)
- Children in Disasters: Hospital Guidelines for Pediatric Preparedness (PDF - 1.81 MB) (New York City Department of Health and Mental Hygiene, August 2008)
- Research results
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