Chemical-Biological Terrorism and Its Impact on Children: A Subject Review

There is an increasing threat that chemical and biological weapons will be used on a civilian population in an act of domestic terrorism. Casualties among adults and children could be significant in such an event. Federal, state, and local authorities have begun extensive planning to meet a chemical-biological incident by developing methods of rapid identification of potential agents and protocols for management of victims without injury to health care personnel. Because children would be disproportionately affected by a chemical or biological weapons release, pediatricians must assist in planning for a domestic chemical-biological incident. Government agencies should seek input from pediatricians and pediatric subspecialists to ensure that the situations created by multiple pediatric casualties after a chemical-biological incident are considered. This statement reviews key aspects of chemical-biological agents, the consequences of their use, the potential impact of a chemical-biological attack on children, and issues to consider in disaster planning and management for pediatric patients.

[1]  M. Hugh-jones,et al.  The Sverdlovsk anthrax outbreak of 1979. , 1994, Science.

[2]  T J Cieslak,et al.  Biological warfare : A historical perspective , 1997 .

[3]  J F Waeckerle,et al.  Emergency physicians and biological terrorism. , 1999, Annals of emergency medicine.

[4]  M Kirk,et al.  Emergency department hazardous materials protocol for contaminated patients. , 1999, Annals of emergency medicine.

[5]  F. Howes.  Poisonous Plants , 1958, Nature.

[6]  S. Ishimatsu,et al.  The Tokyo subway sarin attack: disaster management, Part 1: Community emergency response. , 1998, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[7]  A. Kaufmann,et al.  Principles for emergency response to bioterrorism. , 1999, Annals of emergency medicine.

[8]  A J GLASS,et al.  Psychological aspects of disaster. , 1959, Journal of the American Medical Association.

[9]  K. Hyams,et al.  War Syndromes and Their Evaluation: From the U.S. Civil War to the Persian Gulf War , 1996, Annals of Internal Medicine.

[10]  H. Feldman,et al.  How pediatricians can respond to the psychosocial implications of disasters. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health, 1998-1999. , 1999, Pediatrics.

[11]  D A Henderson,et al.  The looming threat of bioterrorism. , 1999, Science.

[12]  J. R. Ferguson,et al.  Biological weapons and US law. , 1997, JAMA.

[13]  R. Danzig,et al.  Why should we be concerned about biological warfare? , 1997, JAMA.

[14]  F. Sidell,et al.  Progress in medical defense against nerve agents. , 1989, JAMA.

[15]  T Okumura,et al.  Report on 640 victims of the Tokyo subway sarin attack. , 1996, Annals of emergency medicine.

[16]  T Okumura,et al.  The Tokyo subway sarin attack: disaster management, Part 3: National and international responses. , 1998, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[17]  P. Jahrling,et al.  Clinical recognition and management of patients exposed to biological warfare agents. , 1997, JAMA.

[18]  E. Eitzen,et al.  Medical preparedness for a terrorist incident involving chemical or biological agents during the 1996 Atlanta Olympic Games. , 1998, Annals of emergency medicine.

[19]  T Okumura,et al.  The Tokyo subway sarin attack: disaster management, Part 2: Hospital response. , 1998, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[20]  C. Bearer,et al.  How are children different from adults? , 1995, Environmental health perspectives.

[21]  D. Trunkey,et al.  Terrorism in America. An evolving threat. , 1997, Archives of surgery.

[22]  Gina Pugliese,et al.  Anthrax as a Biological Weapon: Medical and Public Health Management , 1999 .

[23]  J. D. Simon,et al.  Biological terrorism. Preparing to meet the threat. , 1997, JAMA.

[24]  R. Tauxe,et al.  A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. , 1997, JAMA.

[25]  D. Goodenberger.  Clinical management of poisoning and drug overdose , 1983 .

[26]  T J Cieslak,et al.  Clinical recognition and management of patients exposed to biological warfare agents. , 1997, Clinics in laboratory medicine.

[27]  J. D. Malone,et al.  Anthrax as a potential biological warfare agent. , 1998, Archives of internal medicine.

[28]  J. Tucker,et al.  National health and medical services response to incidents of chemical and biological terrorism. , 1997, JAMA.

[29]  R. Lüthy,et al.  Preparation for emergency relief after biological warfare. , 1997, Journal of Infection.

[30]  M. Kirk,et al.  Chemical warfare. Nerve agent poisoning , 1997 .

[31]  F. Burkle,et al.  Acute-phase mental health consequences of disasters: implications for triage and emergency medical services. , 1996, Annals of emergency medicine.

[32]  Philip K. Russell,et al.  Anthrax as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. , 1999, JAMA.

[33]  Robert W Pinner,et al.  Bioterrorism alleging use of anthrax and interim guidelines for management--United States, 1998. , 1999, MMWR. Morbidity and mortality weekly report.

[34]  A. Steinberg,et al.  A public mental health approach to the postdisaster treatment of children and adolescents. , 1998, Child and adolescent psychiatric clinics of North America.

[35]  J F Waeckerle,et al.  Chemical warfare agents: emergency medical and emergency public health issues. , 1999, Annals of emergency medicine.

[36]  C E Haley,et al.  An outbreak of Shigella dysenteriae type 2 among laboratory workers due to intentional food contamination. , 1997, JAMA.

[37]  B. W. Flynn.  Psychological aspects of disasters. , 1997, Renal Failure.

[38]  C. Fullerton,et al.  The threat of biological weapons. Prophylaxis and mitigation of psychological and social consequences. , 1997, JAMA.

[39]  D. Esseltine,et al.  Immunotoxin therapy of small-cell lung cancer: a phase I study of N901-blocked ricin. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[40]  James F. Winchester,et al.  Clinical Management of Poisoning and Drug Overdose , 1998 .