Chemical terrorism is the intentional use of toxic chemicals to inflict mass casualties and mayhem on an unsuspecting civilian population, including children. Hazardous chemicals are typically categorized by the type of chemical or by the effects that the chemical has on those exposed to it—for example, blistering agents (vesicants), blood agents (cyanogens), caustic/acid agents, inhalant or choking agents, nerve agents or lacrimators (tear gas). The US Department of Health and Human Services Administration for Strategic Preparedness and Response offers a Chemical Hazards Emergency Medical Management website that includes acute patient care guidelines (left navigation bar) and types and categories of hazardous chemicals. The Centers for Disease Control and Prevention also provides a complete list of chemical categories and other resources for chemical emergencies.

Potential differences of a chemical terrorist attack compared with a "routine" hazardous materials incident include the following:

  • Intent to cause mass casualties
  • Great toxicity of substances
  • Greater risk to first responders
  • Overwhelming numbers of patients
  • Mass hysteria, panic

Preparation for Terrorist Threats: Biologic and Chemical Agents and Principles of Pediatric Decontamination provide key information for health professionals.

Chemical Terrorism and Its Effect on Children

Children have inherent physiologic, developmental and psychological differences that may enhance susceptibility and worsen prognosis after chemical agent exposure. Chemical exposures warrant expedient and thorough decontamination to limit continued primary and secondary exposure.

Children who are pre-ambulatory or pre-verbal and those who have special needs are less able to evade danger or effectively seek help. Although first responders and others who aim to help children during a suspected chemical terrorism act should protect themselves by wearing personal protective equipment, they should be aware that this unfamiliar garb may frighten children and potentially increase their posttraumatic response to stress. It is also important to evaluate and ensure treatment of children for mental health sequelae after chemical terrorism because these sequelae can develop days to months after the event.

The Role of the Pediatrician

The pediatrician can be a valuable resource to public health authorities in issues such as first-responder training and hospital preparedness. In addition, pediatrician involvement in these activities increases the likelihood that the needs and vulnerabilities of children will be considered. Pediatricians should become knowledgeable about principles of preparation and response to public health emergencies and participate in local public health activities in chemical terrorism preparedness. Pediatricians should also work, where possible, with local school systems to develop plans for rapid evacuation, relocation, triage and initial care of children who are in school when an act of chemical or biological terrorism occurs.

Because pediatric victims of chemical or biological terrorism may present to their pediatrician's office, plans and protocols for management of these children should be considered. Preparation may include the establishment of out-of-building decontamination protocols and isolation of potentially infectious patients from others. Every office needs a written emergency or disaster preparedness plan. When a biological or other type of terrorism event is suspected, the office staff should have a plan for how they will handle the potentially large number of clients who may call on the phone or arrive at the office without an appointment. The plan needs to address how to triage and sort those who are worried/anxious from those who need care.

The following resources will be helpful:

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, are addressed.

Text adapted from the Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians manual and the AAP policy statement Chemical-Biological Terrorism and its Impact on Children.

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American Academy of Pediatrics