Medical Countermeasures for Children in Radiation and Nuclear Disasters: Current Capabilities and Key Gaps

Abstract

Objective: Despite children’s unique vulnerability, clinical guidance and resources are lacking around use of the radiation medical countermeasures (MCMs) available commercially and in the Strategic National Stockpile to support immediate dispensing to pediatric populations. To better understand the current capabilities and shortfalls, a literature review and gap analysis were performed. Methods: A comprehensive review of the medical literature, Food and Drug Administration (FDA)-approved labeling, FDA summary reviews, medical references, and educational resources related to pediatric radiation MCMs was performed from May 2016–February 2017. Results: Fifteen gaps related to the use of radiation MCMs in children were identified. The need to address these gaps was prioritized based upon the potential to decrease morbidity and mortality, improve clinical management, strengthen caregiver education, and increase the relevant evidence base. Conclusions: Key gaps exist in information to support safe and successful use of MCMs in children during radiation emergencies; failure to address these gaps could have negative consequences for families and communities. There is a clear need for pediatric-specific guidance to ensure clinicians can appropriately identify, triage, and treat children who have been exposed to radiation, and for resources to ensure accurate communication about the safety and utility of radiation MCMs for children.

Pediatric Medical Countermeasures: Antidotes and Cytokines for Radiological and Nuclear Incidents and Terrorism

“…1) Advanced Hazmat Life Support (AHLS) for Radiological Incidents and Terrorism 2 : This is an interdisciplinary, international, 4-hour, continuing education course whose textbook is in its fifth edition (2020), that is co-presented by the American Academy of Clinical Toxicology (AACT) 3 and AHLS 4 within the Arizona Emergency Medicine Research Center 5 at the University of Arizona College of Medicine. 8 The AACT is an international multi-disciplinary organization uniting scientists and clinicians to promote research, education, prevention, and treatment of diseases caused by chemicals, drugs, and toxins.…”

“…2 Ultimately, children are at a higher exposure risk, at more risk of negative outcomes, and may need pharmaceutical countermeasures, or antidotes with specific dosing and administration considerations for radiological and nuclear incidents. [1][2][3][4][5][6][7] As a result of this concern, the Western Regional Alliance for Pediatric Emergency Management (WRAP-EM) 1 conducted this study to assess existing, standard references detailing pediatric medical countermeasures and antidotes for radiological and nuclear incidents, including acts of war and terrorism.…”

“…2 Ultimately, children are at a higher exposure risk, at more risk of negative outcomes, and may need pharmaceutical countermeasures, or antidotes with specific dosing and administration considerations for radiological and nuclear incidents. [1][2][3][4][5][6][7] As a result of this concern, the Western Regional…”

Children in a disaster: health protection and intervention

“…Provision of separate or adapted decontamination procedures for children is key but will be challenging to implement unless planned for in advance. The efficacy and dosing for common medical countermeasures for CBRN agents can also differ from those in adults or may simply not be validated for use 16. Stocks of paediatric-appropriate medical countermeasures may be a vital consideration, depending on the type of disaster being responded to.…”