Disaster Preparedness: Hospital Decontamination and the Pediatric Patient— Guidelines for Hospitals and Emergency Planners

Abstract

In recent years, attention has been given to disaster preparedness for first responders and first receivers (hospitals). One such focus involves the decontamination of individuals who have fallen victim to a chemical agent from an attack or an accident involving hazardous materials. Children often are overlooked in disaster planning. Children are vulnerable and have specific medical and psychological requirements. There is a need to develop specific protocols to address pediatric patients who require decontamination at the entrance of hospital emergency departments. Currently, there are no published resources that meet this need. An expert panel convened by the New York City Department of Health and Mental Hygiene developed policies and procedures for the decontamination of pediatric patients.The panel was comprised of experts from a variety of medical and psychosocial areas.Using an iterative process, the panel created guidelines that were approved by the stakeholders and are presented in this paper.These guidelines must be utilized, studied, and modified to increase the likelihood that they will work during an emergency situation.

When Mr Yuck Meets Mr Bubble: A Primer on Pediatric Decontamination

“…7 Some may also have difficulty following directions, which may mean that more hospital staff are required to assist with the decontamination process. 7 With undeveloped or decreased communication skills, key findings may be missed by the nurse performing the triage when the child cannot describe his or her symptoms or history. 7 Ophthalmic and facial injuries are found more often in children because they may not cover their faces instinctively, as does the adult, when exposure occurs.…”

“…7 With undeveloped or decreased communication skills, key findings may be missed by the nurse performing the triage when the child cannot describe his or her symptoms or history. 7 Ophthalmic and facial injuries are found more often in children because they may not cover their faces instinctively, as does the adult, when exposure occurs. 7 Children have an increased minute volume and lung surface area-tobody ratio and thus can inhale a greater number of airborne toxins.…”

“…7 Ophthalmic and facial injuries are found more often in children because they may not cover their faces instinctively, as does the adult, when exposure occurs. 7 Children have an increased minute volume and lung surface area-tobody ratio and thus can inhale a greater number of airborne toxins. 6 The airway differences commonly discussed in this population, such as large tongue and small trachea, also contribute to potential respiratory problems.…”

“…Ideally, keeping a caregiver or parent with the child will decrease psychological stress and will help to decrease the need for hospital resources unless a serious medical condition warrants otherwise. 7 To provide family-centered care for hospitals that do not typically care for all age groups, such as pediatric hospitals, a plan should be in place to decontaminate and treat the adult patient, as well as the child, in the event of this emergency. 8 The ability to move the child through the shower is age dependent and relies on his or her ability to ambulate either developmentally or because of injury.Those not able to ambulate will need to go through decontamination on a stretcher, whereas those who can ambulate may proceed accompanied by hospital personnel and a family member or caregiver.…”

“…One recommendation for shower throughput in this age group is that infants and small children be placed in a car seat, with the cushion previously removed and holes exposed. 7 This will allow for safe progress through the decontamination line while maintaining the child's airway in a neutral position or with the head turned slightly to the side while accompanied by staff to ensure that the airway and breathing remain intact. For a child who is developmentally delayed, the nurse should allow for additional time and perhaps staff to aid in disrobing of the child and moving him or her through the shower.…”