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  • Few hospitals have disaster plans that specifically address pediatric patients.
  • Differences in developmental capability, size, weight, and physiology are important considerations in mass casualty incidents involving children.
  • Appropriate equipment and access to age- and weight-adjusted doses of medications in treating pediatric patients.
  • Care must be taken during decontamination of children in order to avoid hypothermia.
  • Children have age-dependent psychological issues that must be taken into account.


Recent history has reinforced the need for mass casualty event (MCE) preparedness. The effect of a disaster is nondiscriminatory, although certain populations are more vulnerable than others. Most MCE preparedness has been devoted to the population in general, which often assumes an adult patient. However, children are not simply small adults. Unique issues surround the care and clinical management of the child. This chapter discusses the unique issues involving the provision of care to children in an MCE.


A MCE is an event that is characterized by an imbalance between the needs and resources available within a health care system. There is no predetermined number of victims that designates an MCE; however, many programs consider an influx of ten patients as an MCE.1 The inciting event can be owing to natural disasters, transportation-related failures, civil disturbances, war, or terrorist-related activities. Whether an event targets children, as was the case in Breslan, Russia, where in September 2004, Chechen terrorists took a school hostage in a situation that resulted in hundreds of child deaths,2 or children are secondarily involved, pediatric patients have physiologic, developmental, and behavioral differences from adults that influence their management in an MCE.


Age, Size, Weight


While there is no consensus regarding what age defines a child, many consider the pediatric population to consist of patients from birth to 18 years of age.3,4 However, treating an 18-year-old is obviously far different than treating an infant or child. An MCE involving pediatric victims demands a wide range of skills and the availability of equipment to accommodate a range of sizes and weights. In terms of clinical management, age is often considered a surrogate for size and weight. Medications like antibiotics, vaccines, or antidotes need to be dosed according to the age, size, and/or weight of a child. Because of the metabolic differences in children when compared to adults, response to medication treatment may vary.4


Developmental and Behavioral Considerations


The stage of motor and cognitive development of a child will influence a responder's ability to communicate with and care for a victim. Nonverbal children are not able to voice their complaints or injuries, and may not be able to cognitively distinguish between one who is trying to help them from one who may be trying to hurt them. Nonambulatory children will not be able to flee a dangerous situation and need to be carried and transported away. Depending on the age and cognitive development of a ...

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