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Specific Populations

Managing Specific Populations - General

  • "Specific populations" described below may have unique responses and/or needs compared to the other populations during a chemical exposure event;
  • Medical management for these specific populations may be different for reasons summarized below;
  • The appropriate management of each patient should be individualized and undertaken in light of the general principles of management reviewed below.

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Seniors

Exposure to chemical agents could be increased and the effects may be intensified in this population due to numerous factors including:

  • Reduced mobility and inability to escape (such as for those using walkers, canes, and wheelchairs) may increase exposure to chemical agent (see persons with disabilities below);
  • Aging may increase susceptibility to certain chemical agents, including lack of or diminished activity of certain enzymes for detoxification;
  • Altered skin (thinner, damaged, etc.) with increased dermal permeability;
  • Increasing number of co-existing diseases and conditions may result in altered responses, including
    • Alterations in metabolism of chemical agents and medical treatments (for example: potential for drug-drug interactions);
    • Lesser ability to tolerate aggressive antidote or decontamination treatments;
    • Reduced access to medications and treatments for treatment of underlying pre-existing diseases;
    • Weakened physiological state (for example: weakened immune system);
  • Reduced body weight leading to higher internal doses of certain chemicals, or increased body weight leading to longer duration exposure to certain chemicals.

Triage for this population could be impacted by:

  • Neurological and/or cognitive impairments (such as Alzheimer's) reducing the ability to communicate symptoms or exposures, etc., potentially affecting triage and chemical agent identification;
  • Speech and hearing difficulties inhibiting the ability to follow directions and communicate;
  • Reduced mobility and or ability to effectively cooperate with triage activities (see persons with disabilities below);
  • Lack of available or easily obtainable medical information/history.

Resources:

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Populations with Pre-existing Disease(s)/Altered Metabolism

Exposure to chemical agents could be increased and the effects may be intensified in this population due to a number of factors including:

  • Genetic polymorphisms may increase or decrease susceptibility to certain chemical agents, including lack of or diminished activity of certain enzymes for detoxification;
  • Increasing number of co-existing diseases and conditions may result in altered responses, including:
    • Alterations in metabolism of chemical agents and medical treatments;
    • Lesser ability to tolerate aggressive antidote or decontamination treatments;
    • Reduced access to medications and treatments for treatment of underlying pre-existing diseases;
  • Skin conditions that affect absorption could increase uptake of, or reactivity to, a specific chemical agent;
  • Reduced mobility and inability to escape (such as for those using walkers, canes, and wheelchairs) may increase exposure to chemical agent (see persons with disabilities below)
  • Lesser ability to tolerate aggressive antidote or decontamination treatments.

Triage for this population could be impacted by:

  • Neurological and/or cognitive impairments (such as Alzheimer's) reducing the ability to communicate symptoms or exposures, etc., potentially affecting triage and chemical agent identification;
  • Speech and hearing difficulties inhibiting the ability to follow directions and communicate;
  • Reduced mobility and or ability to effectively cooperate with triage activities (see persons with disabilities below);
  • Lack of available or easily obtainable medical information/history.
  • Need for access to required ongoing medications, treatments and medical devices, such as oxygen and dialysis, etc.;

Resources

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Infants and Young Children

Exposure to chemical agents could be increased and the effects may be intensified in this population due to a number of factors including:

  • Inability to escape;
  • Shorter stature: lower breathing zone, closer to ground contamination;
  • Increased surface area/volume ratio relative to body weight:
    • More absorptive surface;
    • More susceptible to volume loss;
  • Increased breathing rate results in a greater dose of aerosolized toxins, and smaller lungs increase the dose per unit lung;
  • Organ size and variable metabolism could increase internal exposure if excretion time is increased;
  • Potential exposure to lipophilic chemical agents via lactation;
  • Immature immune system could make more vulnerable to effects;
  • Immature blood-brain barrier;
  • Enhanced transdermal absorption, due to thinner, underkeritinized epidermis;
  • Greater propensity to dehydration and shock, especially after vomiting and diarrhea;
  • May have pre-existing conditions that may alter response;
  • Aging may increase susceptibility to certain chemical agents, including lack of or diminished activity of certain enzymes for detoxification;
  • Potential for long-term sequelae;
  • More frequent cell division during development can result in enhanced fixation of mutations due to the reduced time available for repair of DNA lesions, and colonel expansion of mutant cells gives a larger population of mutants.

Triage for this population could be impacted by:

  • Psychological immaturity, difficulty in communicating and following directions, and susceptibility to anxiety reactions in an emergency;
  • Special needs of children during decontamination procedures;
  • Availability of treatment doses, including antidotes;
  • Treatment protocols for children are different from those for adults;
  • Children can compensate and maintain heart rate during shock, and this false impression of normalcy can lead to inadequate protective measures;
  • Children loose heat faster than adults, especially during decontamination.

Resources

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Pregnant Women and Fetus

Exposure to chemical agents could be increased and the effects may be intensified in this population due to a number of factors including:

  • Pregnant Women:
    • Decreased or altered mobility;
    • Metabolic changes can increase/decrease the elimination half-life of chemical agents and/or treatment drugs;
    • Pregnancy can lead to increased amount of air breathed per minute, possible increasing exposure to chemical agent;
    • Pre-existing conditions due to pregnancy, such as gestational diabetes or high blood pressure can increase susceptibility to certain chemical agents.
  • Fetus:
    • More frequent cell division during development can result in enhanced fixation of mutations;
    • Induction of developmental abnormalities can result in a predisposition to carcinogenic effects later in life;
    • Significant developmental vulnerabilities. A number of agents have known embryo and fetal toxicity (see Types and Categories of Hazardous Chemicals);
    • Chemical agent and/or treatment effects on the mother (acidosis) can adversely affect the fetus, including fetal development and the oxygenation of the fetus.

Triage for this population could be impacted by:

  • Pregnant Women:
    • Decreased or altered mobility issues;
    • In pregnancy certain up-regulated proteins can increase/decrease the elimination half life of drugs;
    • Specific pregnancy-related concerns, such as the possibility of pre-term labor and monitoring needs/equipment.
  • Fetus:
    • Difficulty in assessing effects on developing fetus;
    • Need for monitoring equipment.

Resources

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Persons with Disabilities

Exposure to chemical agents could be increased and the effects may be intensified in this population due to a number of factors including:

  • Reduced mobility and inability to escape (such as for those using walkers, canes, and wheelchairs) may increase exposure to chemical agent;
  • Increasing number of co-existing diseases and conditions may result in altered responses, including:
    • Alterations in metabolism of chemical agents and medical treatments;
    • Lesser ability to tolerate aggressive antidote or decontamination treatments;
    • Reduced access to medications and treatments for treatment of underlying pre-existing diseases.

Triage to this population could be impacted by:

  • Neurological and/or cognitive impairments (such as Alzheimer's) reducing the ability to communicate symptoms or exposures, etc., potentially affecting triage and chemical agent identification;
  • Speech and hearing difficulties inhibiting the ability to follow directions and communicate;
  • Reduced mobility and/or ability to effectively cooperate with triage activities;
  • Lack of available or easily obtainable medical information/history;
  • Need for access to required ongoing medications, treatments and medical devices, such as oxygen and dialysis, etc.;
  • Use of service animals may inhibit mobilization in a crises, and needs to be taken into account.

Resources

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