Disaster preparedness, pediatric considerations in primary blast injury, chemical, and biological terrorism

Abstract

Both domestic and foreign terror incidents are an unfortunate outgrowth of our modern times from the Oklahoma City bombings, Sarin gas attacks in Japan, the Madrid train bombing, anthrax spores in the mail, to the World Trade Center on September 11^th, 2001. The modalities used to perpetrate these terrorist acts range from conventional weapons to high explosives, chemical weapons, and biological weapons all of which have been used in the recent past. While these weapons platforms can cause significant injury requiring critical care the mechanism of injury, pathophysiology and treatment of these injuries are unfamiliar to many critical care providers. Additionally the pediatric population is particularly vulnerable to these types of attacks. In the event of a mass casualty incident both adult and pediatric critical care practitioners will likely be called upon to care for children and adults alike. We will review the presentation, pathophysiology, and treatment of victims of blast injury, chemical weapons, and biological weapons. The focus will be on those injuries not commonly encountered in critical care practice, primary blast injuries, category A pathogens likely to be used in terrorist incidents, and chemical weapons including nerve agents, vesicants, pulmonary agents, cyanide, and riot control agents with special attention paid to pediatric specific considerations.

Keywords: Terrorism; Bioterrorism; Chemical terrorism; Blast injuries; Mass casualty incidents; Disasters; Pediatrics

Core tip: Terrorism and mass casualty events continue to increase on a global scale. Many injuries specific to terrorist incidents including blast injury, biological, and chemical casualties are unfamiliar to the critical care provider. We review the presentation, pathophysiology and care of these casualties. We give specific consideration to the pediatric population as they are a particularly vulnerable population and both adult and pediatric critical care specialists would be called upon to care for children in the event of a massive casualty terrorist event.