Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities

The American Academy of Pediatrics (AAP) has reviewed the draft guidance, "Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities" and STRONGLY recommends that the document be expanded to include a section specific to children or a pediatric annex. While best practices for pediatric decontamination have not yet been identified, there is information on this topic available. One example is a 2009 article that provides detailed information that could easily be adapted for use in the guidance (Citation: Hoen D, Foltin G. Principles of Pediatric Decontamination. Clinical Pediatric Emergency Medicine. Volume 10, Issue 3, Pages 186-194, September 2009.) Specifically, Figure 2, an algorithm for decontamination of pediatric patients, and the summary of key points at the end of the article, should be considered for inclusion. Another good resource is the manual, Children in Disasters: Hospital Guidelines for Pediatric Preparedness, New York City Department of Health and Mental Hygiene, 3rd Edition, 2008, available online at: http://www.nyc.gov/html/doh/downloads/pdf/bhpp/hepp-peds-childrenindisasters-010709.pdf. At a minimum, the AAP recommends that the section on children address at least the following topic areas: Planning Should Address the Needs of Children: Each hospital must have its own system or plan for decontamination, with protocols specific to children. Because of their unique needs and vulnerabilities, children will take more time to disrobe and prepare (emotionally) for the decontamination. Another issue with children is that the signs and symptoms of acute toxicity for nerve agents may be difficult to assess in an upset, unaccompanied young child. Advance planning will greatly alleviate the time/resources needed for pediatric decontamination. Keep Families Together: Unless strictly contraindicated due to medical needs, families should undergo decontamination together. Keeping a parent or caregiver with children during a mass casualty incident will help to reduce the psychological stress for children and will also decrease the resources needed for decontamination and post decontamination care. When necessary, to aid family reunification, consider tagging children with a bracelet or bar code device that includes information such as a field triage number as well as hospital and family member's data. While the suggestions on page Pages 65 and 81 (having escorts to protect unaccompanied children and to expedite reunification with their families) seem reasonable, this can be challenging to implement (Who will the escorts be? How do these escorts confirm they are reunifying children with their official guardians?). Communication using cell phones will be disrupted, as cell phones will be removed during the decontamination process, and therefore it will be very challenging for family members to reconnect. It may be necessary to place a hospital bracelet on children who are separated from their parents, particularly if care is handed off between escorts. Expect a Psychological Impact: When children are exposed to circumstances are beyond the usual scope of human experience (such as exposure to chemical incidents or chemical terrorism), they may have difficulty understanding and coping with the events and the necessary follow-up, including the decontamination process. For unaccompanied minors, psychosocial support should be provided in a child friendly environment with age appropriate activities. This may include support from child life specialists/social workers in a play therapy area for medically cleared patients. Children at certain ages may become more anxious when asked to disrobe, and it is recommended to have both male and female hot zone personnel to assist older children who may have modesty issues. Staff helping with decontamination should receive training on the vulnerabilities of children and how to address these. Plan for Physical Adaptations: During decontaminat…