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At-Risk / Special Needs Populations


Definitions

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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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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
    • Cognitive issues may need to be addressed

Resources

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Immune-suppressed


  • 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


Policy Issues

Radiation Incidents and Children

Resources

Video: Decontamination of Infants and Children (HHS/AHRQ, Children's Hospital Boston)
(Watch video 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

  • 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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Management of Febrile Neutropenia in Children


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Pregnant Woman and Fetus


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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.

Resources

PDF documents can be viewed with the free Adobe® Reader

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US Department of Health & Human Services     
U.S. Department of Health & Human Services Office of the Assistant Secretary for Preparedness and Response National Library of Medicine