That photo of the child holding the terrorist in his hand brings to mind the story of The Indian in the Cupboard. I am concerned about the children more than ever.
This is a long read DC but one you'll be glad you read:
KIDS LEFT VULNERABLE TO TERRORISM, CHILD ADVOCATES SAY
BY BRUCE TAYLOR SEEMAN
© 2004 Newhouse News Service
Sept. 15, 2004
WASHINGTON -- Children, with their smaller bodies, tender skin and rapid breathing, are particularly vulnerable to terrorists' darkest plots.
But too little is being done to compensate for their vulnerabilities, medical experts and child advocates say, a charge with increased relevance since the Beslan, Russia, catastrophe showed extremists' willingness to target children.
"Nobody -- not Congress, not the media -- has put the dots together about how bad a shape we would be in if something happened," said Michael Greenberger, director of the University of Maryland's Center for Health and Homeland Security.
Though there are some signs progress is being made, federal funding intended to crank up the public health system for terrorist attacks has gone flat, critics said, especially when it comes to the unique medical and psychological needs of children.
Many hospitals are inadequately prepared, say medical experts, with no plans to receive or transport large numbers of wounded children, too few child-sized beds or decontamination showers, and uncertain strategies to summon enough pediatric specialists.
In some cases, the problem is a lack of equipment -- not enough child-sized oxygen masks, IV tubes, neck braces and other items.
Not enough terrorism-related medicines for children have been approved by federal regulators, pediatricians say. In a gas attack, for example, the federal drug stockpile would offer a more complete treatment for adults than for children.
On the hopeful side, federal grants in 2004 to hospitals and health departments come with additional emphasis that children be considered in emergency plans. Hospitals, for example, must plan to acquire "portable decontamination facilities" for adults and children before receiving funds from the Department of Health and Human Services (HHS).
A law passed by Congress last December known as "the pediatric rule" now requires pharmaceutical manufacturers to include children in safety and effectiveness tests of new drugs. Another program enacted this year, Project Bioshield, provides incentives for drug research and is expected to produce a child's version of an anti-radiation pill.
And federal officials are buying stocks of a new "pediatric auto-injector" that would help emergency workers quickly deliver antidotes to children caught in a chemical gas attack.
But Dr. Louis Cooper, a Columbia University pediatrics professor, said such efforts have been plodding since the Sept. 11 attacks. "It's been three years, right?" said Cooper, past president of the American Academy of Pediatrics. "To the best of my knowledge, no one has tracked to see if the 4,000 hospitals have surge capacity to include kids."
The American Academy of Pediatrics, which formed a task force shortly after the attacks, has urged federal officials to do more. Last year, an expert panel created by Congress -- the National Advisory Committee on Children and Terrorism -- delivered dozens of recommendations to HHS Secretary Tommy Thompson. A spokesman said Thompson told HHS divisions to use the items in planning, but critics said the impact has been modest.
"Many of these things have minimal cost implications," said Dr. David Markenson, deputy director of Columbia University's National Center for Disaster Preparedness. "The majority have not been implemented."
Dr. Michael Shannon, Harvard University associate professor and chief of emergency medicine at Children's Hospital in Boston, said child health specialists are still absent from too many state and local planning groups.
"I get e-mail after e-mail from pediatricians in various parts of the country who are concerned about kids in their community. (They) feel vulnerable to a public health emergency. No one is listening to (them) when (they) say, `What are you going to if you have multiple pediatric emergencies?"'
To boost the nation's ability to detect and respond to a crisis, Congress earmarked more funding over the past three years -- about $1.3 billion annually -- for improvements in hospital and state and local health departments, though none is reserved specifically for children.
Shannon believes federal grants should come with line-item mandates for spending on children. "The money is not flowing that way," he said.
The $1.3 billion is about what Congress spends each year for the Patent and Trademark Office or the Animal and Plant Health Inspection Service.
President Bush has proposed a $130 million reduction of the allotment in 2005. Even if funding goes down, recent federal support of public health has been "extraordinary," said William Raub, a deputy assistant secretary at HHS.
"This was a sea change," said Raub, noting that public health has traditionally been a state and local responsibility. "Every state is far better off than where they were three years ago."
Raub agreed more could be done to protect children, but said federal policy makers have adopted a "community-wide" preparedness philosophy so that no group is neglected.
"Children are one set of the population. But there's an equally strong case for the disabled. The elderly are an equally formidable challenge, especially the handicapped and frail elderly."
Public health analysts, meanwhile, say current federal investments will not rescue a public health system that had atrophied before the attacks, let alone ensure protections for children.
Cash-poor local and state health departments in recent years have been forced to curtail immunizations, restaurant inspections and school health programs that could be the first line of surveillance and treatment in a public health crisis, said Shelley Hearne, executive director of Trust for America's Health, a nonpartisan Washington health promotion group.
"The cities and states, and the medical facilities, have a complete understanding of where they need to be," said Greenberger, a former Clinton administration official. "But cities and states are facing the greatest financial crunch since the Great Depression. The federal government has been so busy cutting taxes and focusing on things like the war in Iraq, the resources just aren't available."
James Carafano, a senior fellow for homeland security at the Heritage Foundation, a conservative Washington think tank, said protections for children are inadequate: "If you look at any kind of dangerous environment, casualties are typically disproportionate among the elderly and children. They are the least resilient and most vulnerable."
Doctors have long recognized that children share inherent vulnerabilities. A 2003 article in the journal Advances in Pediatrics summarized concerns:
-- Children dehydrate easily, leaving them at high risk to agents causing vomiting or diarrhea. A biological or chemical attack that causes mild symptoms in adults may send an infant into shock.
-- Because they breathe faster than adults, children would be exposed to greater doses of inhaled agents and die faster.
-- Children might easily be trapped in plumes of chlorine, sarin or other chemical gases because the poisons settle near the ground.
-- Children have more permeable skin than adults, meaning they receive relatively higher doses of agents. They also lose heat fast and could suffer hypothermia after decontamination showers.
-- Their immaturity makes children less likely to understand and escape a crisis. They may even run toward the danger.
In testimony to Congress shortly after the Sept. 11 attacks, Dr. Joseph Wright, a pediatric emergency medicine specialist at Children's National Medical Center in Washington, D.C., provided a bleak assessment: Fewer than half of hospital emergency departments had equipment to stabilize ill and injured children, and fewer than four in 10 maintained formal agreements to transfer children for more advanced care.
Progress has not been dramatic, Wright said in a recent interview.
"I can tell you that states have sought to formally mandate that all ambulances have pediatric equipment," he said. "It sounds like a no-brainer. But it costs money."
Dr. Fred Henretig, a pediatrician at the Children's Hospital of Philadelphia, said he worries about not only equipment but also training for emergency workers.
"Would they feel as competent to take care of 150 kids as opposed to 150 adults?" Henretig said. "To give them ventilation support? The right dose of drugs? To get the IVs into critical pediatric patients?"
Dr. Marianne Gausche-Hill, a Torrance, Calif., emergency physician, said she is occasionally confronted with a child who has shrunken pupils, lips coated in saliva, and clothes soaked with urine.
In most cases, the diagnosis is accidental fertilizer poisoning. But these days she can't help but wonder: Could this signal a chemical attack? Are more sick children on the way?
"You typically don't look at children as targets," said Gausche-Hill, a medical professor at UCLA. "But you have to think they could be."
Source: http://www.newhousenews.com/archive/seeman091504.html