Lessons from the "Clean Baby 2007" pediatric decontamination drill.

Objectives: Children have unique needs and are at risk of being exposed to hazardous materials and necessitating decontamination. A drill was conducted to identify problems that arise in the decontamination of children and develop recommendations for effective age appropriate decontamination.

Methods: In a prospective, observational, multicenter, simulation exercise (drill), the authors assessed the management of patients (actors) ages 0.25-15 years and their adult guardians, who self-presented for treatment at two hospital emergency departments (EDs) (a tertiary care university hospital and an urban, municipal, level 1 trauma center) after a radiation exposure. The drill and responses of the participants were evaluated by trained observers using standardized forms and focus group interviews.

Results: Twenty children (aged 0-15 years, mean 10.7, median 12.0) and five adults presented to two EDs. Eighty-five percent of the children were successfully decontaminated in showers. Reasons for noncompletion included medical (respiratory distress, n = 1) and behavioral (n = 2) limitations. Sixty-five percent of children shivered and none were provided with appropriate sized covering immediately after showering. Forty percent were reluctant to undress and all children < 5 years (n = 4) needed assistance undressing and showering. Eighty-four percent received postdecontamination radiation screening and all had their contaminated belongings secured. Moods were described as happy 25 percent, cooperative 80 percent, consolable 35 percent, fearful 15 percent, and crying 10 percent. There was an association between children younger than 12 years of age and fearful mood or crying (p < 0.05).

Conclusions: This drill identified several key areas of concern; including the need to maintain children's warmth by using heaters and sufficient body coverings and to increase staffing to better focus on age-specific requirements such as psychosocial needs that included anxiety, modesty, and keeping families together. These needs may compromise effective decontamination. Pediatric decontamination protocols and interventions addressing all these concerns should be further studied and implemented.