Medical Aspects of Chemical Warfare (2008) - The Black Vault

Medical Management of Chemical Toxicity in PediatricsFig. 21-5. Antidote drug card for pediatric dosing of atropine; close-up of drug chart component.as a result of a single Mark I injection (2 mg atropine,and 600 mg 2-PAM Cl), which has been extrapolatedto the weight zones of the color-coded system, 70 suggestingthat children in the yellow zone (3 years old) orhigher may receive one Mark I autoinjector. 70,71 Option2 is based on the comparison of the total milligram-perkilogramdose an adult would normally receive over60 to 90 minutes versus the milligram-per-kilogramamount that would be received with a single Mark Iinjection, even in a smaller child. 71 This suggests thatin the absence of another option, one Mark I may begiven to any child in extremis, regardless of size. Baum,Henretig, and Wiley are developing a comprehensivecolor-coded toolkit for the management of both biologicaland chemical agents in children based on thesephilosophies.Other Pediatric ResourcesAnother group instrumental in providing guidanceon terrorism in children is the Program for PediatricPreparedness of the National Center for Disaster Preparednessat Columbia University. This group wasestablished to determine appropriate managementand intervention for children in all types of disasters,including chemical emergencies. The program hasfive main goals:1. to assess pediatric preparedness at the com-munity, facility, local, regional, and nationallevels;2. to conduct and foster research on pediatricdisaster, terrorism, and public health emergencypreparedness and response;3. to provide resources to children, parents,communities, and governmental and nongovernmentalagencies on pediatric preparedness;4. to build collaboration among disciplines andoccupations that must work together to carefor children during an emergency; and5. to advocate for children in all forums relatedto preparedness.To achieve these goals, the group produces a quarterlynewsletter on pediatric issues and preparedness,distributes informational bulletins on pediatric issues,has developed an expert advisory board to help guidedevelopment of preparedness tools, and has created aWeb site to share its resources. The group also initiateda pediatric preparedness national consensus conference.The first conference was held in Washington,DC, in February 2003, and led to recommendationsand treatment guidelines. 120The American Academy of Pediatrics also continuallyprovides updated and valuable resources regardingchildren, terrorism, and disaster planning. It providesan updated bibliography of literature related to chemi-683