Health care entities have been challenged by a variety of threats, including emerging infectious diseases, mass shootings and chemical-biological-radiological-nuclear-explosive threats secondary to terrorism, environmental accidents and natural disasters.
Children are more vulnerable to these threats by virtue of their anatomic, physiologic, developmental/behavioral and immune system characteristics.
The Academy and the pediatric health community have collaborated with federal agencies to ensure that various medical countermeasures (MCMs) such as equipment, devices, supplies, vaccines and medications are readily available to meet the needs of children in disaster situations. While great strides have been made over the past five years, major gaps remain in the development and acquisition of critical MCMs, putting children at significant risk.
The new AAP policy statement Medical Countermeasures for Children in Public Health Emergencies, Disasters, or Terrorism provides recommendations for continued development and use of MCMs in children during public health emergencies or disasters. The policy statement is available at www.pediatrics.org/cgi/doi/10.1542/peds.2015-4273 and will be published in the February issue of Pediatrics.
Pediatric challenges
Many MCMs were developed for use by the military and have been evaluated only in adults. Some agents are contraindicated for use in children, are not produced in doses or formulations suitable for children, or have no information on which to base appropriate dosing decisions. During a public health emergency or disaster event, pediatricians will need access to information about available MCMs, including their risks and benefits, adverse effects, dosing, etc.
In addition, it is important that pediatric health care providers and the medical home be aware of local plans for MCM distribution. Therefore, they should get to know their local emergency management agency manager and public health officer (local health department). Cultivating such relationships prior to an event will allow for better cooperation and incorporation of children’s needs in disaster planning.
Recommendations
The policy statement, from the AAP Disaster Preparedness Advisory Council, enumerates the following recommendations to close the gaps in MCMs for children, while providing a guide for pediatricians, federal and state governments, and other entities.
- Federal, state and local governments should acquire and maintain adequate amounts of MCMs appropriate for children of all ages in caches such as the federal Strategic National Stockpile. Stockpiles should include MCMs with appropriate formulations (e.g., liquids), delivery devices (e.g., pediatric auto-injectors) and age- or size-based dosing instructions.
- Federal agencies should collaborate with industry, academia and other partners to research, develop and procure pediatric MCMs for all public health emergency, disaster and terrorism scenarios and report on progress made. Products should be tested in pediatric populations, and long-term medical and developmental consequences of treatment should be minimized.
- Reasonable steps should be taken to protect children as human subjects, but such protections should not justify the failure to identify pediatric indications for MCMs.
- Plans to distribute MCMs should address the needs of children and families. For example, schools, child care programs and other community programs should be considered for storage and distribution of MCMs.
- Easy-to-follow instructions for caregivers (e.g., using pictograms, videos and other visual aids) on the proper preparation, dosing and administration of MCMs for use by children should be developed.
- Pediatric health care professionals should have access to current information on appropriate dosing, drug/food interactions and possible adverse reactions of MCMs as well as local distribution plans so they can provide effective health care to children and advise families during a public health emergency.
Dr. Fagbuyi is a lead author of the policy statement and member of the AAP Disaster Preparedness Advisory Council.
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