pediatric decontamination dennis heon, md, faap new york university langone medical center bellevue...
TRANSCRIPT
![Page 1: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/1.jpg)
Pediatric Decontamination
Dennis Heon, MD, FAAPNew York University Langone Medical Center
Bellevue Hospital Center
The smaller the patient, the bigger the problem
![Page 2: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/2.jpg)
Disclosure
Nothing to declare
![Page 3: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/3.jpg)
Learning Objectives Differences in children – physiological,
behavioral
Triage
Pre Decon interventions - Antidote dosing
Decon for children
![Page 4: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/4.jpg)
Why do we care?
Easy, high value targets
Labor intensive
Equipment / training
![Page 5: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/5.jpg)
Chemical Incidents
![Page 6: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/6.jpg)
Radiation Incidents
![Page 7: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/7.jpg)
Your Neighborhood?
![Page 8: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/8.jpg)
Exposure
Fail to recognize danger
Unable to rescue themselves
Unable to report exposures
Often clustered
![Page 9: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/9.jpg)
Chemical
Inhalation – increased resp rate, lower to ground
Absorption – greater surface area to body mass ratio, skin more permeable, more susceptible to fluid losses
![Page 10: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/10.jpg)
Radiation
Rapidly dividing cells
Immature Immune System
Increased uptake + longer life cancer
![Page 11: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/11.jpg)
Pre – Hospital Issues
Lack of training Vital signs, normal behavior
Poor or no preparation Few peds drills, not realistic
Limited peds equipment and medications
Errors in triage
![Page 12: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/12.jpg)
Disaster Triage Categories Black – not expected to survive, DOA
Red – emergent, life threatening injury
Yellow – urgent, significant injury
Green – walking wounded or worried well
![Page 13: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/13.jpg)
Disaster Triage Algorithms
![Page 14: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/14.jpg)
Risk Assessment
Nature of the agent
Extent of exposure
Route of exposure
Duration of exposure
If you know the agent, get information Call the Local Poison Center (1-800-222-1222) CDC/NIOSH website: www.cdc.gov/niosh/idih/ 800-CDC-INFO
![Page 15: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/15.jpg)
Protective Wear
Nerve agent PAPR
or wet liquid splash suit
Unknown agent N95 mask & goggles
(non-nerve agent) splash suit
Known agent: N95 mask & goggles
bio or radioactive standard trauma gear
Scenario Gear
![Page 16: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/16.jpg)
General Rule
Whatever exposure the patient had, the hospital staff will have far less
Never assume patient properly decontaminated
![Page 17: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/17.jpg)
Chemical Screening
'SLUDGE' is a convenient way to remember the signs and symptoms of nerve gas exposure.
S= Salivation
L= Lacrimation (tearing)
U= Urination
D= Defecation or Diarrhea
G= GI Distress
E= Emesis (vomiting)
![Page 18: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/18.jpg)
Chemical Antidotes
Atropine 0.05mg/kg IM or 0.02mg/kg IV Toddler = 0.5mg, child 1mg, >90pounds=2mg No max dose
2-PAM (Pralidoxime) 15mg/kg IM or 20-50 mg/kg IV over 15 mins Autoinjector conc = 300mg/ml Max dose 600 mg, may give 3 times
Duodote kit = 2-PAM 600mg, Atropine 2.1mg
![Page 19: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/19.jpg)
Radiation Screening
![Page 20: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/20.jpg)
Radioactive Iodine
Potassium Iodide (KI) indications Nuclear explosions Nuclear reactor incidents
KI not indicated for “dirty bombs” No nuclear reaction No radioactive Iodide present
![Page 21: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/21.jpg)
Potassium Iodide (KI) Dosing
Adults/Adolescents – 1 tab (130mg)
Children 3-12 years – ½ tab (65mg)
1 month – 3 years – ¼ tab (32.5 mg)
Birth – 1 month – 1/8 tab (16.25mg)
Dosage: take for 10 days
65mg tabs and liquid may be available
Do not ingest 'Tincture of Iodine‘ - Poison!
![Page 22: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/22.jpg)
Strategic National Stockpile Federal push packs
Available within 12 hours Limited liquid preparations
![Page 23: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/23.jpg)
Hospital Issues
PROTECT YOUR FACILITY!!!
EARLY ACTIVATION
![Page 24: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/24.jpg)
Hospital Issues
![Page 25: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/25.jpg)
Hospital Issues
Limited expertise PEM, PICU, burns, trauma, peds
surgeons
Lack of appropriate supplies Wards, equipment, medications Cribs, diapers, baby food, formula
![Page 26: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/26.jpg)
Pediatric Decon Problems
Poor / regressive communication skills
Inability to follow directions
Unwilling to disrobe, separate from items
Require supervision
Afraid of shower
Emotional involvement of caregiver and responders
![Page 27: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/27.jpg)
Fear !!!
![Page 28: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/28.jpg)
Arrival
EMS/Fire will decon patients at the scene 60-80% of people will bypass EMS and self-
present to hospitals Closer hospital > risk
Contaminated? Keep non-contaminated patients separate Most patients who are able to self-present have
mild contamination and can self-decontaminate Undressing is 90% of decon
![Page 29: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/29.jpg)
Arrival
Life saving interventions pre-decon Basic airway maneuvers Control hemorrhage IM Antidotes
Order through decon – Red tags first
![Page 30: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/30.jpg)
Arrival
Keep families together Exception: red parent, green child
Need more assistance Fear of shower (hand held sprayers) Inability to wash self Modesty issues > 8 yrs old
Hypothermia Greater surface to body mass ratio 98 degrees minimum
![Page 31: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/31.jpg)
Identification / Tracking
Unaccompanied ID band, pictures: face, entire child Report to database NCMEC, HERDS
Accompanied Maternity ID bands: name/DOB of parent and
child
Pediatric safe area(s) in hospital Well staffed Decrease hazards, secure area Age appropriate distractions
![Page 32: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/32.jpg)
Disrobing
All clothing removed Place in bag with unique ID number
Jewelry and comfort items placed in different bag
Protect modesty / ensure warmth between disrobing area and decon shower Poncho Sheets
![Page 33: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/33.jpg)
Disrobing
![Page 34: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/34.jpg)
Shower Basics
Use warm water – 98.6° minimum
Length of time unknown, variable Entire body, no exceptions Remove bandages / dressings
Water – mild liquid soap OK Do NOT use bleach / chemicals
Long board / C-collar – hand held sprayers
![Page 35: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/35.jpg)
![Page 36: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/36.jpg)
Non-Ambulatory Children
Caregiver assistance when possible
Stretcher +/- backboard, C-collar if trauma
Hand held sprayers
PROTECT AIRWAY!
![Page 37: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/37.jpg)
8-18 Years Old
Separate by gender
Ensure modesty
Need supervision for complete decon Need both genders in hot zone
![Page 38: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/38.jpg)
2-8 Years Old
Separate by gender if able
Slowest group Incomplete washing Fear or shower or first responder
Need extensive supervision Need both genders in hot zone
Allow caregiver to remain with child
![Page 39: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/39.jpg)
0-2 Years Old Never carry infant through shower
Stretcher, basket Remain in contact entire time
Greatest risk Airway and hypothermia
Caregiver unable to decon self and infant
![Page 40: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/40.jpg)
Special Needs Children
Increased risk - poor protoplasm
Remove appliances if symptomatic Trach, home ventilator, GT Replace in cold zone
Decon water resistant equipment Non waterproof – keep in hot zone
Caregiver to accompany if possible
![Page 41: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/41.jpg)
![Page 42: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/42.jpg)
Post Shower
Dry at once
Covering for modesty and warmth
Repeat triage Separate peds red / yellow / green
zones
Ensure ID for tracking Keep with caregiver
![Page 43: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/43.jpg)
Post Medical Evaluation
Child friendly area Age appropriate distractions Safe and contained Supervised
Psych services Event Decon process Future changes
![Page 44: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/44.jpg)
Take Home Points
Advance planning Train and retrain Include children
Children > risk morbidity / mortality Increased surface area to body mass ratio Faster respiratory rates Rapidly dividing cells Fail to recognize danger
![Page 45: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/45.jpg)
Take Home Points
Children more labor intensive Fear/regressive behavior prolong process Use caregiver when possible ID / tracking for reunification
Pediatric Antidote dosing Peds capable responder in hot zone
![Page 46: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/46.jpg)
Take Home Points
Decon Shower Everyone / everything Keep warm Separate by gender Same gender personnel Children slower Never carry child
![Page 47: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/47.jpg)
References / Resources
Children in Disasters: Hospital Guidelines for Pediatric Preparedness. 3rd Edition August 2008 Created by: Centers for Bioterrorism Preparedness Program Pediatric Task Force NYC DOHMH Pediatric Disaster Advisory Group NYC DOHMH Healthcare Emergency Preparedness Program
“Pediatric Disaster Toolkit: Hospital Guidelines for Pediatrics in Disasters.” 3nd Edition Aug 2008 Created by: Centers for Bioterrorism Preparedness Program Pediatric Task Force NYC DOHMH Pediatric Disaster Advisory Group NYC DOHMH Bioterrorism Hospital Preparedness Program
Freyberg CW. Arquilla B. Fertel BS. Tunik MG. Cooper A. Heon D. Kohlhoff SA. Uraneck KI. Foltin GL: Disaster preparedness: hospital decontamination and the pediatric patient--guidelines for hospitals and emergency planners. Prehospital & Disaster Medicine. 2008; 23(2):166-73.
![Page 48: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/48.jpg)
References / Resources
Heon D, Foltin GL: Principles of Pediatric Decontamination. Clinical Pediatric Emergency Medicine. 2009; 10(3): 186-194.
The Decontamination of Children, DVD, AHRQ, Children’s Hospital Boston
OSHA Best Practices for Hospital First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances, Jan 2005
http://www.osha.gov/dts/osta/bestpractices
![Page 49: Pediatric Decontamination Dennis Heon, MD, FAAP New York University Langone Medical Center Bellevue Hospital Center The smaller the patient, the bigger](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649e245503460f94b12fa0/html5/thumbnails/49.jpg)
Questions
?