TERRORISM: TAKING ACTION
In this third and final issue of our series on terrorism the authors will provide concise information on the recognition and management of pediatric victims of chemical agent attacks. The content of this issue is perhaps the most sobering of the three issues in this series. The use of chemical agents in warfare is a historical reality that evokes horrible images of World War I trenches and blinded soldiers with blistering skin lesions wandering the battlefield. Contemplating such scenarios in a civilian context is almost beyond our allowable imagination. However, another historical reality is that chemical agents have been deployed against civilian population in other nations, including the well-publicized release of Sarin gas, a nerve agent, in the subways of Tokyo and the confirmed use of sulfur mustard, a vesicant agent, by the Iraqi government on its Kurdish minority population in 1988. We should not let the incomprehensibility of such events impair our ability to be prepared and to develop appropriate and effective medical management aimed at saving lives and reducing morbidity should such an event occur on our soil.
In many of our minds it is a nation's glamorous cities and population centers that appear as the most likely targets for a terrorist group. However, what you will discover about some of the chemical agents discussed in this issue is that they do not require a military industrial complex to produce or sophisticated devices to deliver. Many of these agents are by-products of legitimate industry and are accessible via the roadway and railway transit containers of industrialized nations. Thus dispersion of these agents by malevolent groups using low-tech means poses a potential threat to a broad range of communities in our society, crossing all geographic, economic, racial, and religious boundaries. Consequently, every community in our nation needs to assess its real-world vulnerability to such threats and develop appropriate prehospital and hospital response plans.
As with the other potential terrorist agents, we must recognize that many physical and cognitive aspects of childhood make children uniquely vulnerable to chemical agents and more likely to suffer adversely from an exposure. Unfortunately, for many of these agents there is also a paucity of evidence-based information on ideal management strategies and appropriate antidote dosing for the child. Our pediatric authors have done a commendable job of reviewing available literature, including published anecdotal experience with chemical agents, to provide what is likely the most concise and informative series of reviews on the subject, focusing on the child victim. We hope this is information mat is never needed.
In this issue our Resident's Column is written from the perspective of a third-year military pediatric resident who was previously deployed and now faces being a single parent as his wife, also a military physician, is deployed in support of potential operations in the Middle East. Resilience is a hallmark of military family life. In these trying times it is the resilience of our families, our communities, and our nation that will allow us to confront difficult tasks.
Where do we go from here? In this series we have laid before you a daunting body of information on often unfamiliar and terrifying topics. We must face this task of preparing for potential terrorist assaults on our communities head on. Empowered with information about these threats we must assess the readiness of our communities and assume our role as advocates for children in every venue where terrorism preparedness planning is occurring. In the final piece of this issue we will ask you to consider how you can play a role in terrorism preparedness as a child advocate. It is an unfortunate truth that if we, as advocates of children, are not at the table to provide insight into the unique issues of pediatric victims in terrorist events, they are not likely to be considered.
The opinions and 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.