Children remain potential victims of chemical or biological terrorism. In recent years, children have even been specific targets of terrorist acts. Consequently, it is necessary to address the needs that children would face after a terrorist incident. A broad range of public health initiatives have occurred since September 11, 2001. Although the needs of children have been addressed in many of them, in many cases, these initiatives have been inadequate in ensuring the protection of children. In addition, public health and health care system preparedness for terrorism has been broadened to the so-called all-hazards approach, in which response plans for terrorism are blended with plans for a public health or health care system response to unintentional disasters (eg, natural events such as earthquakes or pandemic flu or manmade catastrophes such as a hazardous-materials spill). In response to new principles and programs that have appeared over the last 5 years, this policy statement provides an update of the 2000 policy statement. The roles of both the pediatrician and public health agencies continue to be emphasized; only a coordinated effort by pediatricians and public health can ensure that the needs of children, including emergency protocols in schools or child care centers, decontamination protocols, and mental health interventions, will be successful.
In April 2000, the American Academy of Pediatrics (AAP) Committee on Environmental Health and Committee on Infectious Diseases published the technical report “Chemical-Biological Terrorism and Its Impact on Children.”1 Events until that time, including the 1995 sarin attack in Tokyo, Japan, had made clear the possibility that acts of domestic terrorism can occur, with significant impact on the health of children. Since publication of the 2000 technical report, many additional acts of chemical and biological terrorism have occurred, including the release of anthrax spores through the US postal system, intentional food contamination by toxic chemicals in Grand Rapids, Michigan, and Fresno, California, and the identification of ricin-laden letters in a post office in South Carolina.
Immediately after the September 11, 2001, terrorist attacks in the United States, which soon were followed by anthrax releases, the AAP, recognizing the need to address the impact of terrorism on children, initiated a series of unprecedented actions. These actions included (1) formation of the AAP Task Force on Terrorism, (2) creation of a comprehensive Web site on the AAP home page devoted to providing information on terrorism and its impact on children (www.aap.org/ terrorism/index.html), (3) publication of the technical report “Radiation Disasters and Children,”2 (4) publication of a policy statement on smallpox immunization,3(5) an addition to the Red Book of descriptions of biological weapons and management of the diseases they produce,4 (6) publication of a technical report5 and policy statement6 on the pediatrician and disaster preparedness, and (7) publication of the CD-ROM Feelings Need Checkups Too, designed to address mental health consequences of terrorism in children (www.aap.org/profed/ childrencheckup.htm).
RECOMMENDATIONS TO GOVERNMENT
1. The needs of children should be addressed in all preparedness efforts at the federal, state, regional, and local levels.
2. All recommendations made by the National Advisory Committee on Children and Terrorism (www.bt.cdc. gov/children/recommend.asp), designed to ensure that children are included in emergency-response planning, should be implemented.
3. Public health agencies should make a concerted effort to assist schools and school districts in their preparedness efforts. Emergency-response plans for schools should be tailored to the individual school and its location, population, staff, and resources.
4. DMATs created by the National Disaster Medical System will play a key role in a mass-casualty incident involving children. The pediatric training of these teams should be comprehensive. Creation of additional pediatric DMATs should be considered.
5. Public health agencies should continue to actively provide assistance and resources to hospitals, pediatric offices, CHCs, and other health care facilities to ensure that they are prepared to respond to a chemical or biological terrorist incident that involves children.
6. As funding for emergency preparedness continues, the needs of children should always be included among the deliverables and performance benchmarks.