EXPERTS WARN THAT doctors aren't getting the education they need to treat children in the event of a bioterrorism attack — and that medical facilities may be overrun with pediatric emergencies unless CME activities step up their focus on the impact of terrorism on children.

“Unless planners specifically prepare for [child victims], we may be at risk for an adverse outcome,” says Steve Baldwin, MD, a pediatric emergency physician at the University of Alabama School of Medicine in Birmingham.

Even family physicians and pediatricians who may never treat a child victim of terrorism need to be educated so they can relay accurate information to worried parents during a crisis, such as the anthrax scare following 9/11, said David Markenson, MD, medical director of the program for pediatric preparedness at Montefiore Hospital, Bronx, N.Y., speaking at the Pediatric Preparedness for Disasters and Terrorism conference held in Washington, D.C., this winter, as reported by The New York Times.

But CME providers say few doctors have requested such education. In fact, “the further out we get from 9/11, frankly the less interest there has been” in terrorism in general, notes Nancy Davis, PhD, the CME director at the American Academy of Family Physicians, Leawood, Kan.

Children are especially vulnerable to the threat of bioterrorism, medical experts say. They breathe faster, which makes them more vulnerable to a gas attack; they can bleed to death or become dehydrated more quickly than adults because they have smaller volumes of body fluids; and, in the case of infants, they cannot extricate themselves in the wake of an accident. They need child-sized neck braces and other emergency equipment, as well as pediatric doses of medication — which must be in liquid form, not pills.

Yet, pediatric doses of medicines to counter threats such as nerve gas and anthrax have not been standardized, and emergency medical personnel are not getting trained in such techniques as recognizing skin anthrax in infants and children. At the pediatric preparedness conference, 78 percent of attendees said the country was not ready to take care of children if terrorists struck, according to an article in The New York Times.

Baldwin believes CME activities should address a full range of clinical and administrative issues that reach well behind emergency medical care. In a crisis, for example, children will have to be paired with caregivers.

“Adult answers cannot be scaled down to take care of pediatric problems,” Baldwin says. “Trying to do this is a recipe for problems. Specific funding for such endeavors may be needed. This requires education techniques beyond the general overview lecture.”

Thomas Terndrup, director of the University of Alabama's Center for Disaster Preparedness, says that CME providers should work both to raise awareness of the problem among doctors and to increase the readiness of medical professionals to deal with actual emergencies. “Awareness may be achieved by distance education and self-study, while true operational competency, in my opinion, requires live-exercise training,” he says.

One challenge for educators, however, is the United States has relatively few experts with specialized knowledge of treating child victims of terrorism. American trainers sometimes look to Israel for expertise, where many bombing victims have been youngsters.