Pediatric emergency medicine trisk 4531 4531
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CHAPTER 132 ■ BIOLOGICAL AND CHEMICAL
TERRORISM *
RICHARD J. SCARFONE, JAMES M. MADSEN, THEODORE J. CIESLAK, EDWARD M. EITZEN
JR.
GOALS OF EMERGENCY CARE
Biologic and chemical terrorism involves the use of highly virulent or toxic
agents with the intent to cause mass casualties, which could overwhelm regional
emergency medical services (EMS) capacity and would pose unique medical
management challenges. Treatment goals include early syndrome recognition,
understanding specific pediatric vulnerabilities, and knowing the major biologic
and chemical agents of concern and the management of children exposed to them.
KEY POINTS
Even small-scale, technologically primitive biologic or chemical attacks
can cause considerable morbidity and wreak havoc on regional medical
care systems, thereby successfully terrorizing a population. Examples
include the intentional spread of salmonella in The Dalles, Oregon
restaurants in 1984; the 1995 sarin release on Tokyo subways; and the
anthrax release in U.S. mail in 2001.
Chemical attacks can (but do not necessarily) result in almost
immediate effects, whereas biologic attacks evolve over days to weeks
based on the incubation period of the infectious agent used.
Compared to adults, children have several unique vulnerabilities that
will be detailed throughout the chapter, including the following:
Risk of exposure—increased respiratory and dermal exposures
Physiologic response—increased risk of dehydration and hypothermia
Psychological response—less ability to cope with stress and
emotional trauma
Systems vulnerabilities—EMS and ED providers may have less
experience taking care of children
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