Pediatric emergency medicine trisk 4583 4583
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casualty situations. Predisaster planning for both intentional and unintentional
chemical releases must take such factors into account. The National Response
Framework and the National Disaster Medical System, augmented if necessary by
military medical assets from the Department of Defense, provide a framework for
activating medical assistance at the federal level.
Availability of specific antidotes and medications in the context of planning for
a chemical exposure event involving mass casualties is an additional challenge.
Stockpiling pharmaceuticals such as the Cyanokit may be prohibitively
expensive. HAZMAT incident planning should establish some mechanism for
local or regional stockpiling of these critical medications and as a means to
replenish initial stores. Table 132.7 offer an attempt to quantify the amount of
antidotal medications that might be needed in one ED for the management of a
nerve agent or cyanide attack involving both pediatric and adult victims on a
scale of the Tokyo sarin attack. A biologic agent attack would place similar
enormous demands on the hospital pharmacy for antibiotics, vaccines, and
antitoxins. A federal system for stockpiling pharmaceuticals and emergency
medical supplies, managed through the CDC, has been created to augment local
resources in this critical logistical arena. The first large-scale deployment of this
Strategic National Stockpile occurred in the hours following the September 11,
2001 attacks on New York and Washington, DC. However, because prompt
treatment is crucial in chemical emergencies, national stockpiles should be
viewed as a resupply source and do not obviate the need for each hospital to
develop its own stockpile of antidotes that might be needed during the first few
hours after such a mass-casualty incident.
