Managing Specific Populations - General
- "Specific populations" described below may react differently than the other populations during a radiation event.
- Medical management for these specific populations may be different for reasons summarized below.
- The specifics of each individual patient should be considered in addition to the principles of management reviewed below.
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Elderly
- Bone marrow reserve diminishes with age
- Predisposition to anemia
- Predisposition to infection
- Predisposition to bleeding
- May have increased risk of bleeding due to medications, poor diet, or other factors
- Increasing number of co-existing diseases and conditions may be associated with
- Inability to tolerate certain drugs
- Lesser ability to tolerate aggressive salvage treatments, such as stem cell transplant for treatment of Acute Radiation Syndrome
Resources
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Immune-suppressed
- Radiation effect from whole body exposure is increased because patient starts with diminished immune reserve
- Drugs that usually increase bone marrow elements may not be effective
- May be more susceptible to infection
- Requires leuko-reduced, irradiated blood
- May not be able to tolerate prolonged pancytopenia or stem cell transplant due to underlying condition (e.g., cancer, congenital or acquired immune deficiency)
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Infants and Young Children
Policy Issues
Resources
- U.S. Government
- Strategies and Tools for Meeting the Needs of Children: Public Health Emergencies
(HHS/AHRQ, a free Web conference, 4 Web lectures, broadcast January 11, 2006)
- Terrorism and Disaster Preparedness Resource for Pediatricians
(AHRQ Publication No. 06-0048, October 28, 2006)
- Surge Capacity: Facilities and Equipment (PDF - 165KB) (HHS/AHRQ, October 2005)
- Acute Mental Health Response to Children Affected by Terrorism (PDF - 795 KB) (HHS/CDC)
- Coping with Disasters and Strengthening Systems, A Framework for Child Welfare Agencies (PDF - 1 MB) (National Child Welfare Resource Center for Organizational Improvement, Children's Bureau, HHS)
- Emergency Medical Services for Children (HHS/HRSA)
- American Academy of Pediatrics
- International
- Other
- Helping Children Cope with Terrorism and War (National Child Care Information Center, September 2008)
- Responding to Terrorism and War: Information for Parents (PDF - 93.6 KB) (National Youth Violence Prevention Resource Center)
- How to Talk to Children About Disasters (Johns Hopkins Center for Public Health Preparedness Conference, February 1, 2007, free online symposium with streaming video, requires login)
- Pediatric Disaster and Terrorism Preparedness, by David Markenson, M.D., Columbia University, July 13, 2004 (PowerPoint® - 1135 KB) (Text version))
- Gurwitch RH, Kees M, Becker SM, Schreiber M, Pfefferbaum B, Diamond D. When disaster strikes: responding to the needs of children. Prehospital Disaster Med. 2004 Jan-Mar;19(1):21-8. [PubMed Citation]
- What You Should Know about the Emotional Impact of Radiological Terrorism with an RDD ("Dirty Bomb") (National Child Traumatic Stress Network)
- "Listen, Protect, and Connect": Psychological First Aid for Children and Parents (PDF - 860 KB) (University of California Los Angeles, School of Public Health)
- "Listen, Protect, and Connect" - Psychological First Aid for Teachers and Schools (PDF - 2 MB) (University of California Los Angeles, School of Public Health)
- Pediatric Disaster Preparedness Guidelines (PDF - 249 KB) (Illinois Department of Public Health, Loyola University Medical Center)
- Psychological First Aid: Field Operations Guide (PDF - 792 KB) (National Child Traumatic Stress Network, National Center for PTSD, 2nd edition, July 2006)
Video: Decontamination of Infants and Children (HHS/AHRQ, Children's Hospital Boston)
(Watch video  )
- Decontamination of Children (HHS/AHRQ) provides a step-by-step decontamination demonstration in real time, and trains clinicians about the nuances of treating infants and children, who require special attention during decontamination.
- For example, children may be frightened not only by the emergency situation itself, but also by the decontamination process as well.
- Decontamination of children also takes longer than decontamination of adults.
- Video focuses on chemical decontamination, but radiation decontamination is similar.
- Some of the differences between chemical and radiation decontamination include:
- Video, available for free, is produced by Children's Hospital of Boston with funding from HHS/AHRQ.
Techniques for Pediatric Incident Mass Casualty Triage
General Principles of Radiation Safety Are the Same as in Adults
- Minimize time child is exposed to radiation source
- Maximize child's distance from the radiation source
- Maximize the shielding between the source and the child
Special Vulnerabilities of Children
- Unique anatomy and physiology of children (adapted from Pediatric Disaster and Terrorism Preparedness, by David Markenson, M.D. (PowerPoint® - 1135 KB) (Text version))
- Increased surface area/volume ratio
- More absorptive surface
- More susceptible to volume loss
- Increased breathing rate
- Shorter stature: lower breathing zone, closer to ground contamination
- Enhanced transdermal absorption: thinner, underkeritinized epidermis
- Immature blood brain barrier
- Greater propensity to dehydration and shock
- Psychological immaturity, dependent, more difficulty following complex directions
- May have pre-existing conditions that confer extra vulnerability
- Special vulnerability to late carcinogenic effects, especially thyroid
- Special needs of children during decontamination procedures (Adapted from Considerations in Emergency Preparedness: A Two-track Conference, by David Markenson, M.D. (PowerPoint® - 95 KB) (Text Version))
- Decontamination must be done with high-volume, low-pressure, heated water systems
- Infants and young children may need to be held by adult during decontamination, but all surfaces must be reached
- Hypothermia issues must be addressed; replacement clothing or covering must be available immediately in cold environments
- Obtain Decontamination of Children video (AHRQ, October 2005)
- Drug doses appropriate for children must be available (e.g., agents for decorporation and treatment of Acute Radiation Syndrome)
- Treatment protocols for children are different from those for adults
PowerPoint® files can be viewed with Microsoft® PowerPoint® or with a free PowerPoint® Viewer.
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Pregnant Women and Fetus with Radiation Exposure or Contamination
- Guidance on the application of dose coefficients for the embryo, fetus and breastfed infant in dose assessments for members of the public (RCE-5) (Health Protection Agency, 2008)
- Possible Health Effects of Radiation Exposure on Unborn Babies (HHS/CDC, May 10, 2006)
- Prenatal Radiation Exposure: A Fact Sheet for Physicians (HHS/CDC, May 10, 2006)
- Kal HB, Struikmans H. Radiotherapy during pregnancy: fact and fiction. Lancet Oncol. 2005 May;6(5):328-33. Review. [PubMed Citation]
- Prasad KN, Cole WC, Haase GM. Health risks of low dose ionizing radiation in humans: a review. Exp Biol Med (Maywood). 2004 May;229(5):378-82. Review. [PubMed Citation]
- Biological effects after prenatal irradiation (embryo and fetus) (International Commission on Radiological Protection, ICRP Publication 90, 2004)
- Doses to the embryo and fetus from intakes of radionuclides by the mother (International Commission on Radiological Protection, ICRP Publication 88, 2002)
- Pregnancy and medical radiation (International Commission on Radiological Protection, ICRP Publication 84, 2001)
- Brent RL. Utilization of developmental basic science principles in the evaluation of reproductive risks from pre- and postconception environmental radiation exposures. Teratology. 1999 Apr;59(4):182-204. Review. [PubMed Citation]
- Pregnancy and Radiation (PDF - 222 KB) (Health Physics Society)
- Pregnancy and Radiation (PowerPoint® - 189 KB) (Health Physics Society)
- Radiation Exposure and Pregnancy (PDF - 96 KB) (Health Physics Society)
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Persons with disability
- Patients with diminished mobility may not be able to
- Evacuate the radiation scene as directed
- Tolerate the austere environments required during the emergency
- Mobilize without assistance for transportation or decontamination
- Transportation issues may need to be arranged to accommodate special needs.
- Patients with diminished mental capacity may not be able to follow directions.
- Patients with limited language proficiency or non-English speakers may not be able to follow directions.
- Patients with medical disabilities may not be able to tolerate standard radiation rescue treatments and may be disconnected from chronic treatments such as dialysis, oxygen, insulin, and other chronic medications.
Resources
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