Decontamination children

Decontamination after a chemical terrorist attack needs to be well planned, efficient, and cognizant of the special needs of children. It is well recognized that the unique vulnerabilities of children may lead to a disproportionate number of pediatric victims after a chemical attack. Without proper planning and consideration as to how children will be decontaminated, the potential for preventable pediatric casualties is increased due to time loss and confusion. It is highly recommended for pediatricians to be involved in the development of each hospital s plans for decontamination. Over the last several years, many advances have been made in the management of the critically injured child. In fact, studies have shown that children managed in a pediatric intensive care imit (PICU) have better outcomes than children managed in an adult intensive care unit (Wheeler and Poss, 2003). Not all hospitals have the resources to have their own PICU, but they need to be able to provide the... 

Because central vision tends to recover spontaneously even without treatment, patients with acute quinine toxicity should generally be managed by supportive measures alone. Hyperbaric oxygen has been used in an attempt to increase oxygen delivery to the retina. The use of oral activated charcoal or any other gastric decontamination procedures does not improve clinical outcome and may, in fact, be harmful to the patient. It is important to emphasize preventive measures, such as patient education and dispensing of quinine in child-resistant containers. 

Serious poisoning is uncommon. Most cases of yew berry ingestions result in no symptoms, because the seed must be chewed to release the taxine. One chewed berry may be potentially fatal in a child. Persons who ingest other parts of the plant or multiple berries should have gastric decontamination performed. 

ATSDR and EPA strongly recommend against the use of metallic (liquid) mercury that is not properly enclosed in glass, as it is in thermometers. This form of mercury should not be used or stored in homes, automobiles, day-care centers, schools, offices, or other public buildings. If you notice a child with metallic mercury on his or her clothing, skin, or hair, call the fire department and let them know that the child needs to be decontaminated. 

Contaminated children pose a special challenge, because the decontamination process is often frightening and difficult for them to understand. If possible, parents should accompany their children during the decontamination process. If a parent is not available, a nurse should accompany the child (9). 

In the Tokyo subway sarin attack, primary decontamination was not undertaken at the attack sites, and the first responders and healthcare workers did not wear appropriate personal protective equipment (PPE). Because of this, 135 of 1364 firefighters (9.9%) suffered from symptoms associated with secondary exposure. While the number of policemen who experienced secondary exposure has not been released, the proportion who suffered from secondary exposure is expected to be similar. Fortunately, no deaths were officially attributed to secondary exposure. If higher-purity sarin had been used in the Tokyo subway sarin attack, it is possible that some people might have died from secondary exposure. However, a pregnant nurse who was exposed to sarin at the hospital became concerned whether or not her child would be bom healthy, and after consulting with her doctor, she had an abortion. Therefore, while this was not officially recorded, one life may be said to have been lost due to secondary exposure. 

Prepare in advance a hose with 85°F water, soap, and an old gurney for rapid decontamination outside the emergency department entrance. Have a child s inflatable pool or another container ready to collect water mnoff, if possible. However, do not delay patient decontamination if water runoff cannot be contained easily. 

Boots must almost always be decontaminated after use at a chemical spill incident. A child s wading pool with a mild detergent is suitable for many situations. The water must often be treated as contaminated waste, as is the water from the suit decontaminations noted above. Gloves can be washed separately in a bucket in a manner similar to boots. 

---