Pediatric Annals

from the guest editors 

Terrorism: Its Impact on Primary Pediatrics, Part II

Gregory S Blaschke, MD, MPH, FAAP; Julia Lynch, MD, FAAP





In the first guest editorial of this series, we described our goal of moving from vulnerability to resilience. In February's issue preparing for mass casualty management, resources for military families and other first responders, and considering how we each fit into the pediatrie public health response from local to national efforts were reviewed. All terrorist events are ultimately local community events that impact the national and global community.

Now, while writing the March editorial for the second of this threepart series, I am a recently re-vaccinated member of the Naval Medical Center San Diego's Smallpox Response Team. It has been 39 years since I first received the vaccine. I have never seen a vaccine reaction nor a child with contact complications. I know that I am not alone. Across the nation, providers of health care from the front lines of homeland security (emergency responders, police, and fire personnel), hospital response teams including many disciplines and specialties, and those who may soon be forward deployed potentially in harm's way - our soldiers, sailors, airmen, and marines - are all rolling up their sleeves. While the voluntary military and reserves are certainly a selfselected group of individuals, the military community is really a cross section of America. All of us are receiving this vaccine - in a world where natural smallpox has been eradicated - to protect those to whom we provide care: ourselves, our children, and communities, whether military or civilian.

As our forces deploy around the globe and specific reservists are called to assist, we hope that February's article featuring support for military families is helpful to those who provide care for this group. As increasing numbers of troops get the smallpox vaccine, we who directly care for military dependents - whether we are in the military ourselves - are likely to be the first to see significant complications from a larg-scale vaccine program. Significant efforts have been undertaken to prevent vaccine complications for those with contraindications to the vaccine for themselves or family members. Of course, if smallpox were to appear, we would all unfortunately have the opportunity to test our preparation and public health response as described in the previous issue of Pediatrie Annals. We all hope this is a line that is never crossed. Obviously, we face significant uncertainty as our military forces vaccinate forward deploying troops for diseases like anthrax and smallpox.

We must remember that thermomechanical, and therefore radiation and chemical terrorism, are all events that, contrary to biological agents, will likely have an obvious onset by a potentially dramatic intentional or accidental event and/or announcement by the perpetrators. Biological agents with incubation periods and nonspecific symptoms will require vigilance by primary care providers and public health departments everywhere if such events are not announced by terrorists. We have all unfortunately become more familiar with agents such as anthrax, smallpox, and ricin as well as other infectious and chemical agents of concern.

In this issue, we asked a former expert from the United States Army Research Institute in Infectious Diseases (along with a civilian colleague) to review biological agents and to provide a suggested approach to preparation and mitigation of any future such events. We cannot be paralyzed with fear. Our children will sense our concern and uncertainty. We also invited an American Academy of Pediatrics (AAP) Terrorism Task Force member to discuss not only psychological effects of terrorism on children, but also how to prepare, detect, and respond to mass casualty and terrorist events for children, families, and communities. As the AAP considers final recommendations for the distribution of potassium iodide to schools, daycare facilities, and other sites where our children "reside," another author in this issue challenges us to prepare for the unthinkable - dirty bombs, nuclear accidents, and nuclear bombs. We also asked a pediatrie resident to share lessons she learned from the anthrax experience as a primary care provider in Washington, DC.

In April, our third and final issue of this series will feature several military experts who review a topic largely unfamiliar to all those who care for children - chemical agents. Because increased knowledge about the effects of chemical agents on children is one invaluable aspect of preparation should their use ever occur, the April issue will continue to focus on specific effects on children and steps to mitigate these effects. Finally, we will provide some thoughts and suggestions for advocating for children, regarding terrorism, within our society and nation. We all hope that preventive efforts will make this knowledge unnecessary.

The opinions ana views expressed herein are those of the authors and do not reflect the official policy or position of the Departments of the Air Force, Army, or Navy; the Department of Defense; or the United States Government.


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