Introduction

The special medical needs of children make it essential that health care facilities be prepared for both pediatric and adult victims of bioterrorism attacks, including those resulting from dispersal of airborne or foodborne agents.^1,2 Moreover, while terrorist attacks on the United States have provoked the development of guidelines for hospital responses to acts of bioterrorism, few have focused on pediatric facilities.² Compounding the problem is that many disaster plans that have been designed for children's hospitals are not designed to accommodate large numbers of contagious individuals capable of disseminating highly lethal infectious agents. 

This document is designed to address the topic of converting pediatric hospitals from standard operating capacity to surge capacity in response to large numbers of children with communicable airborne and foodborne agents. A secondary goal is to assist general emergency departments in developing plans to provide care to large numbers of critically ill pediatric patients. With the recommendations provided in this review, clinicians and hospital administrators will be able to develop unique responses to mass casualty events involving pediatric patients who are victims of bioterrorism. Following the all-hazards approach, the recommendations within this monograph can also be used in consequence management after the exposure to emerging infections of public health importance such as pandemic influenza. 

Definitions

For the purposes of this document, we will use the definitions that follow.

1. Child:  One who fits within the parameters of a Broselow-Luten Resuscitation Tape ("Broselow Tape"), a common tool used in pediatric emergencies to determine a child's weight, drug doses, and the size of resuscitation equipment. Typically, the Broselow Tape is designed to be applied to children ages 12 and under. 
2. Pediatric Hospital: An accredited health care facility dedicated to the specialized care of infants, children, and adolescents. Although adults may occasionally be treated for medical conditions in these facilities, the expertise of a pediatric hospital is focused on caring for patients 21 years old or younger. 
3. Surge Capacity: The ability of a health care facility to provide medical care in excess of the standard operating capacity. In this monograph, the term will refer to increases in patient volume from external emergencies. 
4. Biological Weapon: A biological entity, whether wild-type, genetically altered, or weaponized, that is used to incite terror by producing disease in a portion of a target population. 
5. Airborne Pathogen: A disease-causing agent that can reside in an air stream. In the context of this monograph, an airborne pathogen will be considered to be an infectious agent. Two types of airborne pathogens exist—communicable and noncommunicable. 
   1. Communicable airborne pathogens are those that are transmissible from one individual to another by means of respiratory droplets or another body fluid. Examples of these pathogens include smallpox, plague, Ebola, and other viral hemorrhagic fevers. 
   2. Noncommunicable airborne pathogens are those agents that cause disease by direct contact and are not transmitted secondarily from person to person. Examples of these pathogens are anthrax and tularemia.
6. Foodborne and Waterborne Pathogens: A foodborne pathogen produces illness as a result of consuming a particular food. A foodborne illness outbreak is the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Infectious agents that produce illness after consumption or use of water intended for drinking, or illnesses associated with recreational water such as swimming pools, water parks, and naturally occurring fresh and marine surface waters are waterborne pathogens.

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