Managing Specific Populations - General
- "Specific populations" described below may react differently than the other populations during a radiation event.
- Medical management for these specific populations may be different for reasons summarized below.
- The specifics of each individual patient should be considered in addition to the principles of management reviewed below.
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Elderly
- Bone marrow reserve diminishes with age
- Predisposition to anemia
- Predisposition to infection
- Predisposition to bleeding
- May have increased risk of bleeding due to medications, poor diet, or other factors
- Increasing number of co-existing diseases and conditions may be associated with
- Inability to tolerate certain drugs
- Lesser ability to tolerate aggressive salvage treatments, such as stem cell transplant for treatment of Acute Radiation Syndrome
Resources
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Immune-suppressed
- Radiation effect from whole body exposure is increased because patient starts with diminished immune reserve
- Drugs that usually increase bone marrow elements may not be effective
- May be more susceptible to infection
- Requires leuko-reduced, irradiated blood
- May not be able to tolerate prolonged pancytopenia or stem cell transplant due to underlying condition (e.g., cancer, congenital or acquired immune deficiency)
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Infants and Young Children
Policy Issues
Resources
- 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)
- Terrorism and Disaster Preparedness Resource for Pediatricians
(AHRQ Publication No. 06-0048, October 28, 2006)
- Surge Capacity: Facilities and Equipment (PDF - 165KB) (HHS/AHRQ, October 2005)
- Helping Children Cope with Terrorism and War (PDF - 51 KB)
(National Child Care Information Center, May 2006)
- Acute Mental Health Response to Children Affected by Terrorism (PDF - 795 KB) (HHS/CDC)
- Responding to Terrorism and War: Information for Parents (National Youth Violence Prevention Resource Center)
- 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]
- Pediatric Disaster and Terrorism Preparedness, by David Markenson, M.D., Columbia University, July 13, 2004 (PowerPoint® - 1135 KB) (Text version))
- Emergency Medical Services for Children (HHS/HRSA)
- American Academy of Pediatrics Committee on Environmental Health. Radiation disasters and children. Pediatrics. 2003 Jun;111(6 Pt 1):1455-66. [PubMed Citation]
- 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]
- What You Should Know about the Emotional Impact of Radiological Terrorism with an RDD ("Dirty Bomb") (National Child Traumatic Stress Network)
- "Listen, Protect, and Connect": Psychological First Aid for Children and Parents (PDF - 860 KB) (University of California Los Angeles, School of Public Health)
- "Listen Protect and Connect" - Psychological First Aid for Teachers and Schools (PDF - 2 MB) (University of California Los Angeles, School of Public Health)
- Pediatric Disaster Preparedness Guidelines (PDF - 249 KB ) (Illinois Department of Public Health, Loyola University Medical Center)
- 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)
Video: Decontamination of Infants and Children (HHS/AHRQ, Children's Hospital Boston)
(Watch video  )
- Decontamination of Children (HHS/AHRQ) 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.
- Video focuses on chemical decontamination, but radiation decontamination is similar.
- Some of the differences between chemical and radiation decontamination include:
- Video, available for free, is produced by Children's Hospital of Boston with funding from HHS/AHRQ.
Techniques for Pediatric Incident Mass Casualty Triage
General Principles of Radiation Safety Are the Same as in Adults
- Minimize time child is exposed to radiation source
- Maximize child's distance from the radiation source
- Maximize the shielding between the source and the child
Special Vulnerabilities of 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, underkeritinized 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
- 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
- Obtain 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
PowerPoint® files can be viewed with Microsoft® PowerPoint® or with a free PowerPoint® Viewer.
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Pregnant Women and Fetus with Radiation Exposure or Contamination
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Patients with disability
- Patients with diminished mobility may not be able to
- Evacuate the radiation scene as directed
- Tolerate the austere environments required during the emergency
- Mobilize without assistance for transportation or decontamination
- Transportation issues may need to be arranged to accommodate special needs.
- Patients with diminished mental capacity may not be able to follow directions.
- Patients with limited language proficiency or non-English speakers may not be able to follow directions.
- Patients with medical disabilities may not be able to tolerate standard radiation rescue treatments and may be disconnected from chronic treatments such as dialysis, oxygen, insulin.
Resources
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