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Health care involvement in disaster preparedness in its current form grew out of the September 11, 2001, attack on the World Trade Center and the subsequent postal anthrax dissemination. In the wake of Hurricane Katrina, and with growing international concern about an impending influenza pandemic, preparation for terrorist and bioterrorist attacks has broadened to an “all-hazards” approach, including preparedness for natural and infectious disasters.

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Disaster is “a sudden calamitous event bringing great damage, loss, or destruction.”1 In preparedness circles, any event in which needs exceed local capacity is considered a disaster. Disaster preparedness covers a wide range of threats, varying from the commonplace to the hypothetical.2

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Pediatricians have a significant role in disaster preparedness: as trusted resources for parents; as experts on the unique needs and vulnerabilities of infants, children, and adolescents; as advocates for the pediatric population; and as skilled first responders. Without pediatric input at all phases of a disaster, children’s unique vulnerabilities mean that they will bear a disproportionate burden of disaster consequences. By being part of disaster planning, pediatricians can improve disaster response and recovery and pediatric outcomes.3

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Children’s physiologic and developmental characteristics put them at greater risk of harm in a disaster. They inhale and ingest larger quantities of potentially contaminated air, food, and water for their weight than do adults; they absorb toxins more readily because of increased skin permeability and greater proportionate body-surface area; they are smaller in size, stature, and muscle mass than adults; they are more exposed to toxins that collect near ground level; they have less fluid reserve; they are less able to recognize and flee danger and less skilled at self-preservation.2,4 These susceptibilities, as well as the extent to which children are dependent on adults, vary with age and developmental stage. In addition, there are many gaps in knowledge regarding issues such as pediatric doses and formulations for disaster response medications, posttraumatic stress disorder management in pediatrics, appropriate prioritization of vaccines and drugs, and implications of school or childcare dismissal.

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Disaster preparedness requires a basic understanding of the Incident Command System, a standard structure for disaster response that facilitates efficient coordination and mobilization of resources across agencies, sectors, and regions. Disaster response relies on the availability of “mutual aid,” accessed through the Incident Command System, to augment local capacity.5-8 The Incident Command System is a departure from the normal chain of command, especially for health care professionals accustomed to autonomous decision making.

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In the United States, state and local health departments receive funding for preparedness work from the federal Department of Health and Human Services. The Hospital Preparedness Program funds health care facility emergency preparedness.9 The Centers for Disease Control, through its Public Health Emergency Preparedness Cooperative Agreement, provides funding for public health department preparedness.10,11

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Disaster preparedness requires planning and coordination at the international, national, state, and ...

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