Pediatric Decontamination Considerations in CBRN Events: A Scoping Review.

Area of Science:

• Emergency Medicine
• Pediatric Critical Care
• Environmental Health

Background:

• Children possess unique vulnerabilities during chemical, biological, radiological, and nuclear (CBRN) events due to distinct anatomical, physiological, and psychological characteristics.
• Existing decontamination practices are largely adapted from adult protocols, failing to address specific pediatric needs.

Purpose of the Study:

• To conduct a comprehensive evaluation of current pediatric decontamination practices during CBRN events.
• To identify challenges and special considerations unique to decontaminating children in mass casualty scenarios.

Main Methods:

• A systematic scoping review was performed utilizing six databases, adhering to the PRISMA-ScR framework.
• Fourteen studies evaluating decontamination methods for children (0-18 years) in real or simulated CBRN scenarios were included.
• Data were thematically analyzed and presented in a procedural order reflecting typical decontamination sequences.

Main Results:

• Disrobing, identified in 43% of studies, is a critical initial step for contaminant removal.
• Wet decontamination (93%) was the predominant method, while dry decontamination was discussed in 21% of studies.
• Key challenges included hypothermia, psychological distress, caregiver separation, and managing non-ambulatory or special needs populations; age-specific protocols and long-term impacts were sparsely addressed.

Conclusions:

• Current decontamination guidelines are inadequate for pediatric populations, necessitating the development of standardized, age-appropriate protocols.
• Integrating caregiver support and psychosocial considerations is crucial for effective pediatric decontamination.
• A novel pediatric decontamination algorithm was developed to provide a practical framework for CBRN mass casualty incidents.