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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 ...