An opportunity to prepare

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Congress is working on the reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA), a strongly supported bipartisan law enacted in 2006 that has improved the nation’s public health and medical preparedness and response capabilities for emergencies.

Sadly, the current law does little to require that children’s needs be addressed in disasters. In light of the tragedies affecting children—from tornadoes in Alabama and Missouri to the most recent devastation caused by Hurricane Irene—it is time to correct this oversight.
 
Children are even more susceptible than adults to the aftermath of these disasters. They may be physically or emotionally incapable of caring for themselves, are at greater risk when separated from loved ones, and may be unable to communicate their needs to adults around them.  Children are particularly vulnerable to images or descriptions in the media that portray devastation or acts of terrorism. Children depend on the adults in their lives to "make things okay again." But when adults themselves are struggling in the face of loss of life, home, or job, children may not be receiving the care they need at home.
 
The Strategic National Stockpile (SNS) is the country’s national repository of antibiotics, vaccines, and other critical medical equipment and supplies to be used in the event of a disaster. Two non-partisan expert bodies, the National Commission on Children and Disasters and the National Biodefense Science Board, have each reported that the SNS is not only under-stocked with medical countermeasures for children, but that there is also an alarming lack of information on correct pediatric dosing for existing medical countermeasures.

Leaders in Washington must take notice and insist that we close the significant, known gaps in the development and stockpiling of pediatric medical countermeasures. When disaster strikes, children will be at risk if we don’t have countermeasures that can be safely delivered in the right dose, in the right formulation, and at the right time.
 
These discrepancies are particularly concerning when put in the context of children’s unique physiological vulnerabilities: Children breathe more times per minute than adults—meaning they are exposed to more doses of an airborne substance in the same period of time. Because these agents are heavier than air, they accumulate close to the ground – in the breathing zone of children.

And because children’s organs are still developing, lasting damage can be caused during a chemical or biological disaster. Because of this, children need equipment specifically designed for their size, and drugs that are available in appropriate pediatric formulations and dosages.
 
In the face of a disaster, hospitals must manage large numbers of patients - including children - in a short amount of time. With emergency department overcrowding and diversions being the norm in many communities, a disaster situation will quickly overwhelm even the best-prepared hospitals.  As we saw during the recent H1N1 pandemic, the scenario of a surge of sick children in emergency rooms is all too real. Yet, less than one-third of hospitals have guidelines for increasing pediatric surge capacity. Every hospital should take the time to plan for the needs of children before a disaster. Our laws should reflect this.
 
The fact remains that disasters – natural or manmade – don’t discriminate: Everyone is at risk. So now is the time to engage in preparedness efforts in our own homes and local communities.  Congress should seize this moment to ensure that federal laws like PAHPA refocus our awareness and renew our commitment to improving outcomes for children affected by disasters.
 
O. Marion Burton is President of the American Academy of Pediatrics.