At-Risk / Special Needs Populations
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Managing At-Risk / Special Needs Populations - General
- At-risk / special needs populations require special attention during a radiation incident.
- Health care providers must identify and respect their needs and respond appropriately to them, considering the resources available.
- Selected issues particularly relevant to radiation incidents are discussed below
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- 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
- Cognitive issues may need to be addressed
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- Whole body radiation exposure will exacerbate pre-existing diminished immune functions.
- Countermeasures (e.g., myeloid cytokines) used to enhance blood cell production may be less effective.
- Affected individuals are more susceptible to infection.
- These individuals usually require leuko-reduced, irradiated blood.
- May not be able to tolerate radiation-induced 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
Radiation Incidents and Children
- AHRQ Resources:
- Planning and Preparedness for Children's Needs in Public Health Emergencies (HHS/AHRQ, May 2009)
- Pediatric Hospital Surge Capacity in Public Health Emergencies (HHS/AHRQ, January 2009)
- School-based Emergency Preparedness: A National Analysis and Recommended Protocol (HHS/AHRQ, January 2009)
- Decontamination of Children - Preparedness and Response for Hospital Emergency Departments (HHS/AHRQ, October 2008)
- Terrorism and Disaster Preparedness Resource for Pediatricians
(AHRQ Publication No. 06-0048, October 28, 2006)
- 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)
- Public Health Emergency Preparedness — Surge Capacity (HHS/AHRQ)
- Other HHS agencies
- Other government agencies
- American Academy of Pediatrics
- Useful Guidance
- Mace SE, Sharieff G, Bern A, Benjamin L, Burbulys D, Johnson R, Schreiber M. Pediatric issues in disaster management, Part 1: the emergency medical system and surge capacity. Am J Disaster Med. 2010 Mar-Apr;5(2):83-93. [PubMed Citation]
- Mace SE, Sharieff G, Bern A, Benjamin L, Burbulys D, Johnson R, Schreiber M. Pediatric issues in disaster management, Part 2: evacuation centers and family separation/reunification. Am J Disaster Med. 2010 May-Jun;5(3):149-61. [PubMed Citation]
- Mace SE, Sharieff G, Bern A, Benjamin L, Burbulys D, Johnson R, Schreiber M. Pediatric issues in disaster management, Part 3: special healthcare needs patients and mental health issues. Am J Disaster Med. 2010 Sep-Oct;5(5):261-74. [PubMed Citation]
- Helping Children Cope with Terrorism and War (National Child Care Information Center, September 2008)
- Responding to Terrorism and War: Information for Parents (PDF - 93.6 KB) (National Youth Violence Prevention Resource Center)
- Disaster Preparedness Resource Guide for Welfare Agencies (PDF - 491 KB) (Annie E. Casey Foundation, 2009)
- Pediatric Disaster and Terrorism Preparedness, by David Markenson, M.D., Columbia University, July 13, 2004 (PowerPoint® - 1135 KB) (Text version))
- Pediatric Emergency Preparedness for Natural Disasters, Terrorism and Public Health Emergencies (PDF - 4.93 MB) (National Center for Disaster Preparedness, Mailman School of Public Health, Columbia University)
- 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 - 170 KB) (University of California Los Angeles, School of Public Health)
- "Listen, Protect, and Connect" - Psychological First Aid for Teachers and Schools (PDF - 715 KB) (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)
- Psychological First Aid: Field Operations Guide (PDF - 3.37 MB) (National Child Traumatic Stress Network, National Center for PTSD, 2nd edition, July 2006)
- Children in Disasters: Hospital Guidelines for Pediatric Preparedness (PDF - 1.81 MB) (New York City Department of Health and Mental Hygiene, August 2008)
- Preparedness Focus Areas: Pediatric Preparedness (NYC Healthcare PREPARES)
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.
Mass Casualty Triage in Children
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
PowerPoint® files can be viewed with Microsoft® PowerPoint® or with a free PowerPoint® Viewer.
- 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
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Pregnant Woman and Fetus
- International Committee on Radiation Protection (ICRP)
- Biological effects after prenatal irradiation (embryo and fetus), ICRP Publication 90, Ann. ICRP 33(1-2), 2003.
- Doses to infants from radionuclides ingested in mothers' milk, ICRP Publication 95, Ann. ICRP 34(3-4), 2004. Errata published (PDF - 62 KB)
- Doses to the embryo and fetus from intakes of radionuclides by the mother, ICRP Publication 88, Ann. ICRP 31(1-3), 2001.
- Pregnancy and medical radiation, ICRP Publication 84, Ann. ICRP 30(1), 2000.
- Health Physcis Society (HPS)
- Government publications
- Health Protection Agency (HPA, United Kingdom)
- Other publications
- Mabuchi K, Fukiwara S, Preston DL, Shimizu Y, Nakamura N, Shore RE. Atomic-bomb survivors: Long-term health effects of radiation, Chapter 8, pp 89-113 in Human Radiation Injury, Shrieve DC, Loeffler JS, eds.: Wolters Kluwer | Lippincott Williams & Wilkins, Philadelphia, PA, 2011.
- Brent RL. The effects of embryonic and fetal exposure to x-rays and isotopes. in: Barron WM, Lindheimer MD, eds. Medical disorders during pregnancy. 3rd ed. St. Louis: Mosby Yearbook; 2000, pp. 586-610.
- Brent RL. Utilization of developmental basic science principles in the evaluation of reproductive risks from pre- and postconception environmental radiation exposures. Teratology. 1999 Apr;59(4):182-204. Review. [PubMed Citation]
- Brent RL. Counseling patients exposed to ionizing radiation during pregnancy. Rev Panam Salud Publica. 2006; 20(2/3): 198-204. [PubMed Citation]
- Boice JD, Miller RW. Childhood and adult cancer after intrauterine exposure to ionizing radiation. Teratology 1999;59:227-233. [PubMed Citation]
- Donnelly EH, Smith JM, Farfan EB, Ozcan I. Prenatal Radiation Exposure: Background Material for Counseling Pregnant Patients Following Exposure to Radiation. Disaster Med Public Health Prep. 2011 Mar;5(1):62-8. [PubMed Citation]
- Izumi S, Suyama, A, Koyama K. Radiation-related mortality among offspring of atomic bomb survivors: a half-century of follow-up. Int J Cancer. 2003 Nov 1;107(2):292-7. [PubMed Citation]
- Schull WJ, The children of atomic bomb survivors: a synopsis. J Radiol Prot. 2003 Dec;23(4):369-84. [PubMed Citation]
- Brent RL and Mettler FA, Pregnancy Policy. AJR Am J Roentgenol. 2004 Mar;182(3):819-22. [PubMed Citation]
- Prasad KN, Cole WC, Haase GM. Health risks of low dose ionizing radiation in humans: a review. Exp Biol Med (Maywood). 2004 May;229(5):378-82. Review. [PubMed Citation]
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Persons with Disabilities and Other Special Needs
- 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, and other chronic medications.
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