1. The Program for Pediatric Preparedness National Center for Disaster Preparedness Pediatric Disaster and Terrorism Preparedness David Markenson, M.D. Director, The Program for Pediatric Preparedness Deputy Director, National Center for Disaster Preparedness Mailman School of Public Health, Columbia University New York, NY

2. Unique Anatomy and Physiology Increased Surface Area/Volume Increased Surface Area/Volume  More absorptive surface  More susceptible to volume losses Increased Minute Ventilation/Lower Breathing Zone Increased Minute Ventilation/Lower Breathing Zone Thinner Epidermis/ Under-keratinized Epidermis Thinner Epidermis/ Under-keratinized Epidermis Immature Blood-brain Barrier Immature Blood-brain Barrier Procedural Difficulties Procedural Difficulties Psychological Immaturity Psychological Immaturity

3. Importance of Pediatric Considerations Children are part of the population Children are part of the population   26% of the U.S. population are children and youth   More than 20 million are under the age of 6 years Ignoring children may compromise entire preparedness plan Ignoring children may compromise entire preparedness plan  August 2003 Survey  90% nationally and 92% in New York City, reported that they would not comply with an official evacuation order  66% of the national sample; 62% of New Yorkers listed concern for their children as the main reason

4. Pediatric Terrorism Exposure Inadvertently (Classic Thinking) Inadvertently (Classic Thinking)  Secondary victims in terrorist attack  Catastrophic event at chemical/ nuclear plant Intentionally targeted (New Thinking) Intentionally targeted (New Thinking)

5. What is Pediatric Surge? Secondary Victims Secondary Victims  Proportion of normal census Uniquely Pediatric Event Uniquely Pediatric Event  Out of proportion to normal census  School, day care, school bus, camp Family Unit Family Unit  Ability to care for family without separating children and adults

6. Pediatric Surge Planning Address Pediatrics out of Proportion to Normal Numbers Address Pediatrics out of Proportion to Normal Numbers  Emergency operations plans  Providers  Equipment and pharmaceuticals  Drills and exercises Plans for Care of Children Plans for Care of Children  Adult providers  Adult units  Adult equipment Plans for Care of Adults in Pediatric Units Plans for Care of Adults in Pediatric Units

7. Federal and State Resources Strategic National Stockpile (SNS) Strategic National Stockpile (SNS)  Improved but limited pediatric content  Restricted to FDA indicated usages Disaster Medical Assistance Team/ National Disaster Medical System (DMAT/NDMS) Disaster Medical Assistance Team/ National Disaster Medical System (DMAT/NDMS)  No Pediatric requirements  Staff  Pharmaceuticals  Equipment  2 Self-certified pediatric teams

8. Federal and State Resources State Stockpiles State Stockpiles  Based on SNS Medical Reserve Corps (MRC) Medical Reserve Corps (MRC)  No defined pediatric capability  Questionable functionality Time Delay Time Delay  Federal  6―48 hours  Pediatric Alternative  Unknown

9. Decontamination Water pressure Water pressure  Will it injure child Water temperature Water temperature  Hypothermia Non-ambulatory child Non-ambulatory child  Infants and toddlers  Children with special healthcare needs Mental health concerns Mental health concerns  Will children follow instructions  Long term effects

10. What Are Some Of The Solutions? National Advisory Committee on Children and Terrorism National Advisory Committee on Children and Terrorism Pediatric Disaster and Terrorism Preparedness: National Consensus Guidelines Pediatric Disaster and Terrorism Preparedness: National Consensus Guidelines Pediatric Expert Advisory Panel Pediatric Expert Advisory Panel

11. Pediatric Disaster and Terrorism Preparedness: National Guidelines Preparedness and Treatments Preparedness and Treatments  Biologic  Chemical  Radiologic  NPS  Decontamination Natural Disasters Natural Disasters Hospital Preparedness Hospital Preparedness Mental Health Schools Mental Health Schools Primary Care Providers Primary Care Providers Displaced Children Displaced Children National Disaster Medical System National Disaster Medical System Training Training Drills and Simulations Drills and Simulations

12. Pediatric Expert Advisory Panel The purpose of the Pediatric Expert Advisory Panel (PEAP) is to: The purpose of the Pediatric Expert Advisory Panel (PEAP) is to:  Discuss and analyze current issues  Multi-disciplinary  Governmental and non-governmental bridge  On-going program  Ability for rapid analysis  Dissemination of findings WebWeb InfoBriefInfoBrief Conference or SymposiaConference or Symposia

13. Pediatric Expert Advisory Panel Pediatric Dosage AtroPen ® Pediatric Dosage AtroPen ®  Approved by FDA in past few months  Questions regarding:  Indications  Role  Pediatric AtroPen or Mark I IndicationsIndications ProtocolsProtocols StockpileStockpile