Pediatric emergency medicine trisk 1134
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there is now considerable recent experience with the use of these antibiotics for
selected serious pediatric infections. Furthermore, the risk of morbidity and
mortality from these biologic agent–induced diseases far outweighs the minor
risks (tendinopathy with fluoroquinolones, dental staining with tetracyclines)
associated with short-term pediatric use of these medications. In fact,
ciprofloxacin, levofloxacin, and doxycycline have lower risk of these adverse
effects and are approved by the U.S. Food and Drug Administration (FDA) for
use in children for the treatment and prophylaxis of anthrax and plague following
inhalational exposure (i.e., in the context of terrorism).
TABLE 132.1
CHARACTERISTICS OF CHEMICAL AND BIOLOGIC ATTACKS
Chemical weapons attack
(differences in comparison to
“routine” hazardous materials
incidents)
Biologic weapons attack (differences
in comparison to natural infectious
disease epidemics)
Intent to cause mass casualties
Intent to cause mass casualties
More toxic substances
More virulent agents
Initial substance identification delayed Rare, nonendemic diseases, delayed
diagnosis
Greater risk to EMS first responders
Greater risk to physicians and other
first receivers
Overwhelming numbers of patients
Overwhelming numbers of patients
Many “worried well”
Many “worried well”
Mass hysteria, panic
Mass hysteria, panic
Discovery of chemical dispersal device Discovery of biologic agent dispersal
device
Time frame may or may not be
More compressed time frame of
compressed
outbreak
High attack rates near release site
Very high infection rates, morbidity,
mortality
Dead and dying animals
More respiratory forms of disease than
in natural forms
Multiple epidemics at once
Reduced rate of infection in sheltered
persons
Infected, dying animals
EMS, emergency medical services.
Adapted from Henretig FM, Cieslak TJ, Eitzen EM Jr. Biological and chemical terrorism. J Pediatr
2002;141:311–326. Copyright © 2002 Elsevier. With permission.
TABLE 132.2
PEDIATRIC VULNERABILITIES TO BIOLOGIC AND CHEMICAL
TERRORISM
Realm
Potential vulnerability
Potential response
Physiologic
Increased respiratory
exposure (higher minute
ventilation, time spent
“closer to the ground”)
Early warning, sheltering a
(gas masks for the general
population are not
advised at present due to
risk of poor fit,
suffocation)
Protective clothing, earlier
decontamination a
Developmental
Increased dermal exposure
(thinner, more permeable
skin; larger body surface
area/mass ratio)
Increased risk of
dehydration, shock with
toxin-induced vomiting,
diarrhea (decreased fluid
reserves, larger body
surface area/mass ratio)
Increased risk of
hypothermia during
decontamination (larger
body surface area/mass
ratio)
More fulminant disease
(possible), immunologic
immaturity, more
permeable blood–brain
barrier
Differing disease
manifestations
Relative antibiotic
contraindications
Less capacity to understand
and follow complex
instructions, escape attack
site, take appropriate
evasive actions
Recognition, aggressive
fluid therapy
Warm water
decontamination
Pediatric-specific research
for early diagnosis and
treatment of biologic and
chemical weapons
victims a
Education
Research trials in children
Increased public education,
especially of parents,
teachers, and caregivers
