A classroom of 23 6- to 7-year-old children and their teacher quickly developed eye irritation, coughing, and increased secretions. They are en route to your facility with concern for exposure to an infectious, biological, or chemical agent. They will require effective and immediate triage to determine the need for isolation or decontamination.
This triage, infection control, and decontamination guide addresses preparedness and response considerations for pediatric patients impacted by a chemical or biological exposure or an infectious disease. Treatment strategies and considerations for decontaminating and preventing infection in children, including those with access and functional needs or complex medical conditions, will be a priority. Triage of infected patients and prevention and containment of infectious disease within the hospital setting is critical (as it may impact pediatric patients and personnel who treat these individuals).
Triage
Many different pediatric triage algorithms exist worldwide. There is no clear consensus as to one system’s superiority over another. The goal of effective triage is that it is easily utilized both in the prehospital setting during primary triage and in the hospital during secondary triage (while limiting under or over assessment of the injuries or scope of contamination). Triage tools have the following principles in common: assignment of resources based on the initial patient assessment, consideration of available resources/transport needs, and an understanding of the physiologic differences in the pediatric population (all while being performed under pressure due to the scale and urgency of the problem).
Infection Prevention and Control
Healthcare infection prevention and control strategies provide a framework for preventing transmission of infectious agents, including any “special pathogens” that are considered to be highly transmissible and capable of causing severe disease. Hospital personnel must be prepared to quickly identify patients possibly infected with a special pathogen, isolate the patient to minimize transmission, and inform key clinical, infection prevention, and public health stakeholders. Effective preparedness requires attention to education, policies and procedures, drills and training, and supplies. Successful preparation for special pathogens is an important measure to keep communities, healthcare personnel, and patients and families safe and healthy.
Radiation Exposures
Critically injured or ill patients contaminated with radioactive solids or liquids require lifesaving procedures prior to decontamination because contamination with radioisotopes is not immediately life threatening, whereas serious trauma, burns, and illnesses are, and require time-critical interventions to preserve life, limb, and/or eyesight.
Decontamination
Children have physiologic and developmental characteristics that increase their susceptibility to injury from a chemical, biological, or nuclear/radiological (CBRN) exposure compared to adults. Younger children rely on parents or caregivers for protection and guidance. In their absence, children may need special assistance from hospital staff for decontamination and to address family separation issues.
Rapid, life-saving, clinical care for patients with chemical, biological, radiological, or nuclear (CBRN) exposures is essential. Children manifest several unique vulnerabilities to CBRN exposures and pose corresponding management challenges. Hospital preparedness requires emergency departments to have a plan for providing timely, effective decontamination for pediatric patients. Decontamination might be set up at a scene, outside of the hospital, or in the hospital. Pediatric patient decontamination (skin, hair, eyes, and wounds) is necessary to minimize risk of contact injury, reduce the dose of absorbed chemicals, and decrease morbidity and mortality. Effective decontamination also reduces the risk of secondary contamination of other patients and hospital staff.
Meeting Schedule
Meetings are held the first Tuesday of each month 1:00-2:15 pm CT.
| Session Date | Links | Session Details |
|---|---|---|
| 2025 | ||
| March 4 | Details | Recording and Slides |
| April 1 | Details | Recording and Slides |
| May 6 (Full Collaborative) | Register | |
| June 3 | ||
| July 1 | ||
| August 5 (Full Collaborative) | Register | |
| September 2 | ||
| October 7 | ||
| November 4 (Full Collaborative) | Register | |
| December 9 (Office Hours) | ||
| 2026 | ||
| January 6 | ||
| February 3 (Full Collaborative) | Register | |
| March 3 | ||
| April 7 | ||
| May 5 (Full Collaborative) | Register | |
| June 2 | ||
Planning
For triage, infection control, and decontamination, advanced planning through optimization of protocols within the hospital’s disaster plan, and development of reference cards/posters, and knowledge reinforcement tools or just-in-time training modules can help support staff and improve outcomes for children.
All four DRC intervention bundle guides are based on information and recommended strategies within the Checklist of Essential Pediatric Domains and Considerations for Every Hospital’s Disaster Preparedness Policies (also known as “The Disaster Checklist”). Triage, infection control, and decontamination, domain 4 includes recommended activities at foundational, intermediate, and advanced levels and can be found on page 11.
Key considerations for your facility’s pediatric triage, infection control, and decontamination plan:
- Identify local CBRN and infectious disease experts/consultants available to you in response to key topics.
- Prioritize triage options to identify and isolate patients likely to be infectious or exposed to CBRN contamination and in need of decontamination.
- Address staff awareness of infection prevention and control practices (every day and in an emergency), specifically think about:
- Isolation practices and designated areas
- Personal protective equipment (PPE): Availability, accessibility, and training on donning/doffing
- Outline the decontamination process for infants, children, and adolescents, including those with special or complex health care needs and any service animals with the patient.
- Ensure protocols promote keeping family units, who were likely exposed or infected at the same time, together.
Tabletop Exercises and Drills
The DRC teams will be offered an opportunity to review/test their disaster plans during a 3-hour virtual tabletop exercise (VTTX) in 2025. An After-action report completed by exercise participants will help identify gaps and steps for improvement that the facility can consider and follow up on. The gaps and process measures can be tested in two follow-up drills to be conducted in 2026. See the VTTX Checklist and the DRC Tabletop Exercises and Drills webpage.
Quality Improvement and Intervention Strategies
Global AIM
Support children’s hospitals to develop robust plans for pediatric disaster response to events that require triage, infection control, and/or decontamination strategies at their individual facility.
AIM Statement
By June 2026, 50% of children’s hospitals in the DRC choosing to focus on triage, infection control, and decontamination will have taken steps to improve performance on at least one of the following process measures:
Quality Measures
Select one or more measures from the list below to test and improve on in the two drills:
- Time from notification that decontamination is needed until the decontamination area is ready to receive the first patient (improvement: decrease in time)
- Intervention Strategies:
- Establish a clear notification process for the occurrence of a decontamination event and activation of incident command, including who will communicate, how the communication occurs, and who must receive the information, and all applicable community partners.
- Incorporate a list of areas available to use for decontamination area(s) into the plan, supplies need to set up an area, and who will be involved in the set up.
- Develop a list of supplies needed during a decontamination event and where they can be found. Incorporate the list into the disaster plan.
- Create a poster for staff that suggests signs or symptoms that should lead to a concern that decontamination might need to occur. Alternatively, post reminder cards in triage areas to help staff remember to think about decontamination needs.
- Intervention Strategies:
- Percent of staff who demonstrate competency in adhering to the Standard Operating Procedures (SOP) for infection control or decontamination (improvement: increase in staff competency)
- Intervention Strategies:
- Create knowledge reinforcement tools and/or badge buddies to assist staff with following the SOP.
- Develop a clear list of criteria for which staff should be able to show competency when performing/following SOPs for infection control and decontamination.
- Develop a process or plan for training staff on performing SOPs during an infection control or decontamination event, including frequency.
- Develop a process for evaluating staff on performing SOPs during an infection control or decontamination event.
- Intervention Strategies:
- Time from identifying a concern that someone is infected with a special pathogen until the hospital infection prevention and control team is notified (improvement: decrease in time it takes for notification)
- Intervention Strategies:
- Establish a clear notification process for the occurrence of a person identified as being infected with a special pathogen and activation of incident command, including who will communicate, how the communication occurs, and who must receive the information.
- Develop a plan for tracking patients identified as being infected with a special pathogen or at risk of being infected.
- Intervention Strategies:
If you have identified other objectives or measures because of an exercise after-action report or state/organizational requirements (CMS, Joint Commission, ACS Trauma Level 1, etc.), you can use those.
Resources
- Chemical Hazards Emergency Medical Management (CHEMM): Decontamination
- Radiation Emergency Medical Management (REMM): Guidance on Diagnosis and Treatment for Healthcare Providers
- Pediatric Medical Countermeasures: Antidotes and Cytokines for Radiological and Nuclear Incidents and Terrorism
- Infection Prevention and Control Implications of Special Pathogens in Children
- Chemical-Biological Terrorism and Its Impact on Children
- Hazardous Chemical Emergencies and Poisonings
- Principles of Pediatric Decontamination