US may lack resources to treat kids in disasters

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(Reuters Health) - In the event of a natural disaster, epidemic or terrorist attack, the U.S. may not have enough medical resources to aid affected children, according to a report from the American Academy of Pediatrics.

Children are particularly vulnerable to illness and injuries during these emergency situations and their distinct needs - such as special drug formulations or dosing and pint-size medical devices - mean supplies set aside for adults may not work for them.

To start fixing the problem, the U.S. needs more investment in treatments that are appropriate for children, including research to develop age-appropriate therapies as well as investments to increase the nation's stockpile of remedies already made for kids, according to the report from AAP's Disaster Preparedness Advisory Council.

Images of non-governmental aid after Hurricane Katrina:

Katrina 10 year: Relief efforts around the country/world
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US may lack resources to treat kids in disasters
Jennifer Lamkin, right, collects a donation to the Red Cross for Hurricane Relief from Clarence Dix as she collected money in downtown Indianapolis, Thursday, Sept. 1, 2005. The Red Cross had collected $21 million, nearly $15 million of that from individual donations through its Web site, Red Cross spokeswoman Kara Bunte said. (AP Photo/Michael Conroy)
UNITED STATES - CIRCA 2002: Sean Penn (center) helps an elderly man stranded by Hurricane Katrina through the floodwaters to safety on Napoleon St. in New Orleans. The Oscar-winning actor and political activist managed to reach several people who had been trapped in their homes since the killer storm hit Monday. Penn, who was accompanied by a crew of helpers, brought the victims to dry land - and gave them cash as well. Asked what he was doing in the disaster zone, Penn said, 'Whatever I can do to help.' (Photo by Craig Warga/NY Daily News Archive via Getty Images)
Actor-Comedian Chris Rock speaks at a press conference, Thursday, Sept. 1, 2005, in New York, to announce a telethon to raise financial aid for victims of Hurricane Katrina as Marc Morial, president of the National Urban League and former New Orleans mayor, looks on. The prime-time telethon is Friday, Sept. 9 on BET which is partnering with the National Urban League, American Red Cross and Hip-Hop Summit Action Network and will feature numerous celebrities. (AP Photo/Diane Bondareff)
Marine Lance Corpral Anthony Roberts helps a young boy find his way to buses that are being used to evacuate residents in New Orleans, 01 September 2005, in the aftermath of hurricane Katrina. The Houston Astrodome in Texas was no longer accepting hurricane evacuees from New Orleans on Thursday, redirecting them instead to other cities and shelters, local police told CNN. AFP PHOTO / James NIELSEN (Photo credit should read JAMES NIELSEN/AFP/Getty Images)
WASHINGTON - SEPTEMBER 02: Tia Clark (R) of the Executive Office of Mayor Tony Williams helps to distribute supplies to the buses that will be sent to New Orleans to evacuate hurricane victims to Washington September 2, 2005 outside the DC National Guard Armory in Washington, DC. The government of Washington, DC, has sent ten buses down to New Orleans to help evacuate about 400 hurricane victims so that officials of New Orleans can focus on the city's rebuilding. The evacuees will be housed at the DC National Guard Armory with food service and shower facilities. (Photo by Alex Wong/Getty Images)
Eli Lilly & Co. employees load supplies and antibiotics onto one of the company's jets at the Indianapolis International Airport, Thursday, Sept. 1, 2005. The supplies and drugs are being flown to the Gulf Coast to aid victims of Hurricane Katrina. (AP Photo/Michael Conroy)
Wendy Bilodeau of South Burlington, Vt., helps packs aid for victims of Hurricane Katrina at the Vermont State Police Barracks, Friday, Sept. 2, 2005, in Williston, Vt. Bilodeau stopped by to drop off her donation and ended up volunteering for much of the day. (AP Photo/Alden Pellett)
U.S. Navy personel Mark Bancroft directs a crane loading bottled water on board the USNA Comfort hospital ship before it departs Friday, Sept. 2, 2005, in Baltimore. The ship will arrive in the Gulf of Mexico on Thursday to provide aid for the victims of Hurricane Katrina. (AP Photo/Gail Burton)
PEARLINGTON, MS - SEPTEMBER 3: Justene Audler helps to deliver ice in the rural area on September 3, 2005 in Pearlington, Mississippi. Residents of Pearlington didn't receive aid for four days after Hurricane Katrina struck the region on August 29. (Photo by Ross Taylor/Getty Images)
HAVANA, CUBA: Cuban doctors listen to a speech by Cuban President Fidel Castro in Havana, 04 September 2005, as he extends his offer to send 1,100 Cuban doctors with two backpacks of medicine each to help people affected by Hurricane Katrina in the southern US. Castro earlier said in a radio and television address that some 100 doctors could board a flight to Houston, Texas, as soon as 09 September and 1,000 could arrive by the 10th and 11th. During his speech Castro said that US authorities had yet to inform the Cuban goverment of their decision yet. AFP PHOTO/Adalberto ROQUE (Photo credit should read ADALBERTO ROQUE/AFP/Getty Images)
Vernon Murphree, center, a firefighter in Kiln, Miss., hands off a case of water from one of two container trucks from Wisconsin, Monday, Sept. 5, 2005. The aid was donated by supporters of Green Bay Packers' quarterback Brett Favre. (AP Photo/Marcio Jose Sanchez)
DALLAS-SEPTEMBER 5: Several agencies came out to help the evacuees from New Orleans at Reunion Arena September 5, 2005 in Dallas, Texas. Jobs are going to be very important since most of the evacuees will be in Texas for several months if not longer. With an estimated 1.5 million people displaced due to the devastation along the Gulf Coast, Texas has been taking in evacuees from Hurricane Katrina which struck the region August 29. (Photo by Lawrence Jenkins/Getty Images)
D'IBERVILLE, MS - SEPTEMBER 06: Water is available at a relief distribution site September 6, 2005 in D'Iberville, Mississippi. The death toll stands at 160 in Mississippi in the aftermath of Hurricane Katrina, with about 400,000 still without power. (Photo by Spencer Platt/Getty Images)
BILOXI, MS - SEPTEMBER 6: In this handout provided by the U.S. Navy, Beach Master Seaman Jabril Adams, assigned to Beach Master Unit Two (BMU-2), directs a Landing Craft, Air Cushion (LCAC), loaded with Marine Corps heavy equipment onto a beach September 6, 2005 near Biloxi, Mississippi. The Marines are using multipurpose utility trucks, forklifts and front-end loaders to clean hurricane Katrina debris out of the Biloxi streets. (Photo by Michael Sandberg/U.S. Navy via Getty Images)
GULF OF MEXICO - SEPTEMBER 6: In this handout provided by the U.S. Navy, sailors aboard the Nimitz-class aircraft carrier USS Harry S. Truman (CVN 75), stage supplies, food, and water on a deck-edge elector prior to being flown ashore to aid Hurricane Katrina relief efforts September 6, 2005 in the Gulf of Mexcio. The Navy's involvement in the Hurricane Katrina humanitarian assistance operations is led by the Federal Emergency Management Agency (FEMA), in conjunction with the Department of Defense. (Photo by Eric S. Garst/U.S. Navy via Getty Images)
South Koreans donate for victims of Hurricane Katrina during a fund raising campaign near the U.S. Embassy in Seoul, Tuesday, Sept. 6, 2005. South Korea plans to send a team of rescue workers and about 100 tons of relief supplies to the United States this week to help its ally recover from the devastation caused by Hurricane Katrina, an official said Monday. The Korean letters read on the banner "Please render aid to the victims." (AP Photo/ Lee Jin-man)
BILOXI, MS - SEPTEMBER 6: In this handout from the U.S. Navy, a handmade sign stands on the beach where the U.S. Navy and Marines set up a main staging point for relief efforts in teh aftermath of Hurricane Katrina September 6, 2005 in Biloxi, Mississippi. (Photo by Michael Sandberg/U.S. Navy via Getty Images)
Ophelia Havelock, right, a volunteer with the Salvation Army, loads boxes with women's clothes that will be sent to refugees of Hurricane Katrina, while Gov. Arnold Schwarzenegger, talks to reporters at a Salvation Army warehouse in Sacramento, Calif.., Wednesday, Sept. 7, 2005. Schwarzenegger toured the facility and thanked volunteers for their work in aiding the victims of Katrina. (AP Photo/Rich Pedroncelli)
BATON ROUGE - SEPTEMBER 7: Orlando Magic Assistant General Manager Otis Smith and Tamia Hill unload relief supplies at the airport September 7, 2005 in Baton Rouge, Louisiana. The Magic arrived to deliver supplies and lend disaster relief for the victims of Hurricane Katrina. NOTE TO USER: User expressly acknowledges and agrees that, by downloading and/or using this Photograph, user is consenting to the terms and conditions of the Getty Images License Agreement. Mandatory Copyright Notice: Copyright 2005 NBAE (Photo by Fernando Medina/NBAE via Getty Images)
HOUSTON - SEPTEMBER 7: Houston Rockets player Tracy McGrady helps unload a van full of supplies for the hurricane Katrina victims at the Houston Rockets Hopefest September 7, 2005 in Houston, Texas. NOTE TO USER: User expressly acknowledges and agrees that, by downloading and or using this photograph, User is consenting to the terms and conditions of the Getty Images License Agreement. Mandatory Copyright Notice: Copyright 2005 NBAE (Photo by Bill Baptist/NBAE via Getty Images)
**FILE** Salvation Army volunteer Shirley Garreth, left, of Villa Rica, Ga. helps prepare ravioli and green beans to feed victims of Hurricane Katrina in Biloxi, Miss., Wednesday, Sept. 7, 2005. Where the government stumbled, churches rushed in. That's the message religious disaster relief groups already are bringing to Capitol Hill, hoping the example of how they sped aid to Hurricane Katrina survivors along the Gulf Coast will build new momentum for President Bush's drive to expand federal funding for faith-based groups. (AP Photo/Darron Cumming, File)
Rosa Hall, seated, hands out aid supplies to victims of Hurricane Katrina outside of the Grace Temple Baptist in Gulfport, Miss., on Thursday Sept. 8, 2005. (AP Photo/Marcio Jose Sanchez)
** ADVANCE FOR SUNDAY SEPT. 11 ** Student Council officers from left, Justin Scheibe, Paul Whittington, Tony Brellinger and Travis Clayton show one of the many ways that students at Valmeyer High School are pitching in to aid the survivors of Hurricane Katrina on Friday, Sept. 9, 2005, in Valmeyer, Ill. The people of the town, which was obliterated by floods from the Mississippiu River 1993 and eventually relocated to higher ground, sympathize with the displaced victims of Katrina. Folks in Valmeyer believe their story of rebirth should offer hope to New Orleans and other communities caught in Katrina's fury, even though they're well aware that it's easier to pick up and move a rural town of thousands than to rebuild a city of hundreds of thousands. (AP Photo/Tom Gannam)
WASHINGTON - SEPTEMBER 9: (L-R) Murriel Page, Kaayla Chones and Delisha Milton-Jones of the Washington Mystics help collect money for the Team Up DC/Hurricane Relief efforts September 9, 2005 outside RFK Stadium in Washington, DC. All donations will be donated to the American Red Cross. NOTE TO USER: User expressly acknowledges and agrees that, by downloading and or using this photograph, User is consenting to the terms and conditions of the Getty Images License Agreement. Mandatory Copyright Notice: Copyright 2005 NBAE (Photo by Mitchell Layton/NBAE via Getty Images)
NEW YORK - SEPTEMBER 09: Def Jam President Jay-Z (L) and Sean 'P. Diddy' Combs hold a check for one million dollars that they will donate to the American Red Cross backstage during 'S.O.S. (Saving OurSelves): The BET Relief Telethon' to benefit the victims of hurricane Katrina at the BET Studios September 9, 2005 in New York City. (Photo by Scott Gries/Getty Images)
Local residents wait in line for aid from the American Red Cross in Gulfport, Miss., on Friday, Sept. 9, 2005. Food and medicine is being distributed throughout the region affected by Hurricane Katrina. (AP Photo/Marcio Jose Sanchez)
U.S. Air Force personnel unload a donation of 30 tons of relief supplies for the hurricane Katrina relief effort received from the country of Thailand at the Little Rock Air Force Base in Little Rock, Ark., Sunday, Sept. 11, 2005. The supplies include flour, rice, canned tuna, blankets and ready to eat meals. (AP Photo/Brian Chilson)
Gracie Brandt, 10, holds a sign "When Life Gives You Hurricanes ... Make Lemonade," as she and her friends sell lemonade to raise money for victims of Hurricane Katrina at a park Saturday, Sept. 10, 2005, in Chicago. Dubbing themselves "Kids Who Care," they raised more than $1,300 with a lemonade stand the first weekend after the hurricane and this past weekend added another $560. The same group of kids also raised about $6,000 in tsunami aid last winter. All the funds they've raised have gone to the Red Cross. (AP Photo/Nam Y. Huh)
Dr. Carolyn Heron, right, donates $20 for a brownie and lemonade to Keaton Bubala, 5, as Bubala and friends were raising money for victims of Hurricane Katrina at a park Saturday, Sept. 10, 2005 in Chicago. Bubala and his friends, who have dubbed themselves "Kids Who Care," raised more than $1,300 with a lemonade stand the first weekend after the hurricane and this past weekend added another $560. The same group of kids also raised about $6,000 in tsunami aid last winter. All the funds they've raised have gone to the Red Cross. (AP Photo/Nam Y. Huh)
HOUSTON - SEPTEMBER 11: Former NBA player and current co-host of the 'Best Damn Sport Show Period' John Salley holds up signage for Kenny Smith's Hurricane Katrina relief NBA charity game, September 11, 2005 in Houston, Texas. NOTE TO USER:User expressly acknowleges and agrees that, by downloading and/or using this Photograph, user is consenting to the terms and conditions of the Getty Images License Agreement. Mandatory Copyright Notice: Copyright 2005 NBAE (Photo by Chris Graythen/NBAE/Getty Images)
SACRAMENTO, CA - SEPTEMBER 12: Former Sacramento Kings, Vlade Divac (L), helps load donated canned food along with whatever anyone wanted to donate to aid victims of Hurricane Katrina at his restaurant, L'Image, on September 12, 2005 in the Pavilions shopping center in Sacramento, California. NOTE TO USER: User expressly aknowledges and agrees that, by downloading and/or using this Photograph, User is consenting to the terms and conditions of the Getty Images License Agreement. Mandatory Copyright Notice: Copyright 2005 NBAE (Photo by Rocky Widner/NBAE via Getty Images)
NEW YORK - SEPTEMBER 16: Singer Kelly Osbourne, Sean 'Diddy' Combs and Nicole Richie attend the 'Fashion For Relief' fashion show, with proceeds going to aid Hurricane Katrina victims, during Olympus Fashion Week at Bryant Park September 16, 2005 in New York City. (Photo by Thos Robinson/Getty Images)
UNITED STATES - SEPTEMBER 17: Professional mile runner, Alan Webb from Reston Va., and Rep. Jim Moran, D-Va., wait for the start of the Gulf Coast Relief 5k in Alexandria, Va., Saturday. The race attracted nearly 4,000 participants and raised over $150,000 for Hurricane Katrina victims. (Photo By Tom Williams/Roll Call/Getty Images)
NEW ORLEANS - SEPTEMBER 19: Domino's Pizza worker Lyle Landry puts a pizza into an oven inside a small tralier September 19, 2005 in the French Quarter of New Orleans, Louisiana. Mike Schlater, a Domino's Pizza franchise owner, came down from Indiana to hand out free pizzas to law enforcement officials, relief worker and clean up crews in appreciation of all the work they have done during the aftermath of Hurrican Katrina. (Photo by Justin Sullivan/Getty Images)
NEW ORLEANS - SEPTEMBER 26: American Red Cross volunteer Mary Breslin of Michigan helps New Orleans resident Earl Davis carry food and cleaning supplies back to his car after he returned to his home in the Algiers District for the first time since Hurricane Katrina September 26, 2005 in New Orleans, Louisiana. New Orleans Mayor Ray Nagin on Monday reopened Algiers to residents. Business owners were allowed into Algiers and several other districts to resume cleanup from Hurricane Katrina that was interrupted when Hurricane Rita passed by the area. (Photo by Ethan Miller/Getty Images)
LAS VEGAS - OCTOBER 15: Actor Ashton Kutcher (L) bids on an item as his wife, actress Demi Moore, looks on at the launch of the 'uBid for Hurricane Relief' charity auction and benefit at the Empire Ballroom October 15, 2005 in Las Vegas, Nevada. All of the proceeds from the auction will be split evenly between the Brett Favre Fourward Foundation, the RockWorks Foundation (in association with Kutcher) and the Child Welfare League of America. The organizations will use money raised to help areas in the Gulf Coast devastated by Hurricane Katrina and Hurricane Rita. The online part of the auction continues on through November 1, 2005. (Photo by Ethan Miller/Getty Images)
Zach Cooper, left, from Houston, Texas tosses a case of bottled water to Mark Bassett of West Hartford, Conn., to be placed in the trunk of a car at a food, water and ice distribution center on Newton Street in New Orleans Thursday afternoon Nov. 10, 2005. Both men are firefighters sent to New Orleans by their companies as volunteer aid workers in the wake of Hurricane Katrina and both have been on station in New Orleans for more than two months. (AP Photos/Stephan Savoia)
LOS ANGELES, CA - JANUARY 22: Musical artist Gwen Stefani records her contribution to the disaster relief charity single, a cover of the Sir Eric Clapton ballad 'Tears In Heaven', at a Los Angeles studio on January 22, 2005 in Los Angeles, California. Other stars contributing to the single include Sir Elton John, Velvet Revolver, Andrea Bocelli, Robbie Williams, Rod Stewart, Pink, Ozzie and Kelly Osbourne, Gavin Rossdale, Robert Downey Jr., Phil Collins, Josh Groban and Aerosmith's Steve Tyler. The single - which was released on October 18, 2005 for download exclusively on 7 Digital, is an initiative of Sharon Osbourne, and proceeds will go to benefit victims of Hurricane Katrina, survivors of the devastating tsunami in southeast Asia last December and children affected by emergencies throughout the world. (Photo by Getty Images)
A group of women from Louisiana carry blue umbrella's as they walk to a news conference on Capitol Hill, Monday, Jan. 30, 2006, to bring attention to the lack of funding in the rebuilding effort after Hurricane Katrina. Five months after the hurricane made landfall, 55 representatives and 30 senators have visited New Orleans. The women argue that delays in federal aid to New Orleans are the result of so few lawmakers seeing the destruction up close. (AP Photo/Susan Walsh)
Billy Crystal, right, presents former President Bill Clinton, and U.S. Ambassador to the Hurricane Katrina relief effort, with a check for $549,000 to aid the Hurrican Katrina relief fund on stage at the Wilshire Theater prior to one of his performaces of "700 Sundays" Thursday, Feb. 9, 2006, in Los Angeles. A portion of ticket sales from Crystal's "700 Sundays" tour along with donations from patrons, which Crystal matches, are being donated to the fund. (AP Photo/Danny Moloshok)
Dana Hansel, left, and Marjorie McKeithen help organize tools that the members of KATRINA -- the Krewe Aiding in Trash Removal In the New Orleans Area -- will use while picking up debris left behind by Hurricane Katrina in New Orleans Saturday morning April 29, 2006. The volunteers target a different section of the city each time they go out and remove litter, debris and plain old dirt. They also mow medians and even yards. (AP Photo/Bill Haber)
BILOXI, MS - AUGUST 29: Volunteers assist in the rebuilding of Beck Park to commemorate the one year anniversary of Hurricane Katrina on August 29, 2006 in Biloxi, Mississippi. NOTE TO USER: User expressly acknowledges and agrees that, by downloading and or using this photograph, user is consenting to the term and conditions of the Getty Images License Agreement. Mandatory Copyright Notice: Copyright 2006 NBAE (Photo by Layne Murdoch/NBAE via Getty Images)
Tammy Pescatelli during OPERATION DOGGY DROP Benefit to Aid the Pets Devastated by Hurricanes Katrina and Rita at House Of Blues in Los Angeles, California, United States. (Photo by Rebecca Sapp/WireImage for MRC PR)
Steve Nash of the Phoenix Suns scrapes paint off of a house in the East Section of New Orleans as players help participate in the NBA Cares Project during the 2008 NBA All-Star Weekend February 15, 2008 in New Orleans, Louisiana. The one-day project is to help rebuild homes that were damaged by Hurricane Katrina. AFP PHOTO/TIMOTHY A. CLARY (Photo credit should read TIMOTHY A. CLARY/AFP/Getty Images)
NEW ORLEANS, LA - DECEMBER 17: Taye Diggs helps a woman carry her clean laundry to her car after folding and packing laundry at Tide?s Mobile Laundromat in New Orleans December 17, 2007. The Tide CleanStart truck is a mobile laundromat created in 2005 to provide much needed, free laundry services to families in areas affected by Hurricane Katrina. Over the past two years, Tide has visited the area four times and washed more than 20,000 loads of laundry for Gulf Coast families. (Photo by Skip Bolen/

"Without research and development the pipeline of new and innovative medical countermeasures will not be achieved or sustained," said lead report author Dr. Daniel Fagbuyi of George Washington University in Washington, D.C.

"Life or death is what's at stake," Fagbuyi, a retired infantry veteran with expertise in disaster and terror response, added by email.

While significant strides have been made in recent decades to improve the U.S. stockpile of supplies needed for children in emergencies, there's still a lot to be done, Fagbuyi and colleagues write in the journal Pediatrics.

To meet the needs of children, the nation's disaster stockpile should include life-saving equipment, devices, supplies and medications that are appropriate for children.

With medicines and vaccines in particular, the stockpile should have pediatric formulations such as liquid alternatives to pills adults might swallow, as well as age-based or weight-based dosing instructions, the report authors say.

One considerable challenge to adding more pediatric treatments to the stockpile is the paucity of research done in kids, which is due in part to difficulties getting consent from parents to include children in clinical trials and meeting clinical trial requirements that are more stringent for kids than adults, Dr. Laura Faherty of the University of Pennsylvania and the Children's Hospital of Philadelphia noted in an accompanying editorial.

Doing more research as public health disasters unfold may help scientists better understand how to help children in these emergency situations, Faherty said by email.

The goal is to rapidly learn what works and what doesn't, and to get this information quickly, Faherty said, adding, "The systems to do good research must be set up in advance to more quickly figure out what's going on during an outbreak or similar public health emergency, and respond accordingly."

Cost can also be an obstacle, particularly because many pediatric versions of drugs are liquids that may have a shorter shelf life than pills for adults and be harder to transport and store, noted report co-author Dr. David Schonfeld of the University of Southern California.

"Yes, there are limited resources available for preventive and treatment services, and we always need to balance the likely benefit against the cost," Schonfeld said by email. "But if as a country we decide to create a national stockpile of medical countermeasures, I feel we have an obligation to ensure that children are protected at least to the same extent as adults - which is not the current situation."

The need for better pediatric emergency supplies has also become more pressing as the perceived domestic risk for exposure to chemical, biologic and radiologic agents has increased, noted Dr. Steven Krug, a researcher at Northwestern University Feinberg School of Medicine in Chicago and chair of the AAP Disaster Preparedness Advisory Council.

"Disasters will continue to occur," Krug said by email. "We therefore need to be prepared and we need to be able to better weather the storm."

SOURCE: Pediatrics, online January 4, 2016.

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