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Pediatric Decontamination and Prophylaxis Purpose: These recommendations are intended to assist planning for the needs of all children requiring decontamination that present to the hospital during a disaster or terrorist attack. Children require special considerations that may not be addressed in the general Hospital Decontamination Plan. These guidelines will assist hospitals to properly decontaminate infants and children in a timely manner. Pediatric and Obstetrical Emergency Preparedness Tool Kit General Guidelines: Infants and children have unique needs that require special considerations during the process of hospital-based decontamination. • Separation of families during decontamination should be avoided, especially under conditions of large number of patients in a chaotic situation but medical issues take priority. • Older children may resist or be difficult to handle out of fear, peer pressure, and modesty issues, even in front of their parents or caregivers. • If the water temperature is below 98º F, the risk of inducing hypothermia increases proportionately with the smaller, younger child. • Attention to airway management is a priority throughout decontamination showers. • It cannot be assumed that the parents or caregivers will be able to decontaminate both themselves and their children at the same time. “Hot zone” personnel should recognize the need to assist them. • Large volume, low pressure water delivery system (e.g. handheld hose sprayers) that are “child friendly” should be incorporated into the hospital decontamination showers. • Regarding considerations such as hypothermia, airway management, separation of families and the ability to effectively decontaminate a child, the smaller the child, the bigger the problem. Decontamination Recommendations Based on Age of Child: • Children are divided into three groups by age – Less than 2 years old (infants and toddlers), ages 2to 8yearsold (preschool/young children), and ages 8to18yearsold (school age). • The recommendations are based on the child’s estimated age, since asking children’s ages may be impractical due to the limitations of the PPE worn by decontamination team members or to a large influx of patients. • The recommendations are meant as general guidelines. Children Less than 2 Years of Age (Infants and Toddlers): Infants and toddlers represent the most challenging group to safely decontaminate due to their developmental stage, their dependent nature and their physical characteristics. These special needs and considerations are the most important: • All infants and toddlers should be placed on a stretcher and disrobed by either the child’s caregiver or “hot zone” personnel. Use trauma sheers, if necessary to speed the disrobing process. • A hand should be kept on the infant or toddler at all times, even when bedrails are raised. (Small children can fall through.) Some have found plastic laundry baskets to be useful in moving infants through the decontamination area. • It is not recommended that the child be carried due to the possibility of injury resulting from a fall, or from dropping a slippery and squirming child. • All clothes and items that cannot be decontaminated should be placed in appropriate containers or bags as provided by the hospital and labeled. • Ensure the temperature of the shower does not present a danger to the infant/toddler. • Each infant and toddler should then be accompanied through the decontamination shower by either their caregiver or “hot zone” personnel to ensure the entire patient is properly decontaminated. • Special attention must be given to the child’s airway while in the shower. • Children and their families (parents or caregivers) should not be separated unless critical medical issues take priority. • Once through the shower, the infant’s or toddler’s caregiver or “cold zone” personnel escort should be given a towel and sheets to dry off the child, and a hospital gown to dress the child. Immediately, the child should be given a unique identification number on a wristband and then triaged to an appropriate area for medical evaluation. • Remember that temperature regulation is a major issue for infants and toddlers. If necessary, cover the child with a blanket. Children 2 to 8 Years of Age (Preschool/Young Children): From ages two to eight, children should be able to walk and speak, yet will still look like a child with considerable variations in physiology and anatomy. • Ambulatory children should be assisted in disrobing by either the child’s caregiver or “hot zone” personnel. • All clothes and items that cannot be decontaminated should be placed in appropriate containers or bags as provided by the hospital and labeled. • Each child should be directly accompanied through the shower by either the child’s caregiver or “hot zone” personnel to ensure the entire patient is properly decontaminated. • It is recommended that the child not be separated from family member(s) or the adult caregiver unless serious medical conditions dictate otherwise. • In the case of children with special health care needs or injured children who are non-ambulatory: • • Non-ambulatory children should be placed on a stretcher by “hot zone” personnel and disrobed (using trauma shears if necessary). Again, all clothes and items that cannot be decontaminated should be placed in appropriate containers or bags as provided by the hospital and labeled. • Each non-ambulatory child on a stretcher is escorted through the decontamination shower and assisted with decontamination to ensure the entire patient is properly decontaminated. • Children of this age may find the showering of their face to be aversive. Care should be taken to keep their airway open during the showering procedure. • Once through the shower, each child should be given a towel and sheets to dry, and a hospital gown. Immediately, the child should be given a unique identification number on a wristband and then triaged to an appropriate area for medical evaluation. Ask if they would like a blanket. Children 8 to 18 Years of Age (School-Age Children): At the age of 8 years and upward, the airway anatomy approximates that of an adult. Although it is tempting to regard this age group as “small adults,” there are special needs unique to this age group. First, privacy is likely to be a bigger issue with this age group than with younger children, so steps should be taken to protect modesty of the patient and limit the number of people to which the child appears to be exposed. Second, this group will be more likely to want explanations about procedures. The child is likely to be more cooperative if age-appropriate explanations are given. • Ambulatory children should be instructed to disrobe by “hot zone” personnel. • All clothes and items that cannot be decontaminated should be placed in appropriate containers or bags as provided by the hospital and labeled. Children this age should able to accomplish this themselves. • Each ambulatory child should then walk through the decontamination shower, preferably in succession with their parent or caregiver, and essentially decontaminate him/herself. • Non-ambulatory children should be placed on a stretcher by “hot zone” personnel and disrobed (using trauma shears, if necessary). This may include children with mobility impairments, children with special health care needs or injured children. Clothing should be placed in appropriate containers or bags provided and labeled. Then, each non-ambulatory child is escorted through the decontamination shower and assisted with decontamination to ensure the entire patient is properly decontaminated. • Once through the shower, each child will be given a towel and sheets to dry, and a hospital gown. Immediately, the child should be given a unique identification number on a wristband and then triaged to an appropriate area for medical evaluation. • Children and their families (parents or caregivers) should not be separated unless critical medical issues take priority. Home Preparation for Emergency Doses of Doxycycline for Infants and Children Exposed to Anthrax Once you have been notified by your federal, state, or local authorities that you have been exposed to anthrax, you may need to prepare emergency doses of doxycycline for infants and children using doxycycline tablets. You will need: • One 100 milligram (mg.) doxycycline tablet • Metal teaspoon • 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.) measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.] • 1 small bowl • One of these foods: – chocolate syrup – maple syrup – caramel syrup – applesauce – unsweetened – applesauce – jarred pureed baby – fruit Directions: 1. Put one (1) 100mg doxycycline tablet into a small bowl. Crush the tablet with the back of the metal spoon until no large pieces are seen. 2. Add four (4) level teaspoons (tsp) of a food to the crushed doxycycline. Stir them together until the drug looks evenly mixed with the food. 3. Use the chart on the following page to find out how much of the mixture to give the child. How Much of the Doxycycline Mixture to Give a Child: • The number of teaspoons of the doxycycline mixture to give a child depends on the child’s weight. • If child’s weight is unknown, weigh child before giving the first dose. • The chart below tells you how much to give a child for one dose. • You should give the child two doses each day for 10 days. (One dose is given in the morning and one dose is given in the evening.) If the child weighs: 4 – 11 pounds (lbs.) 12 – 22 pounds (lbs.) 23 – 33 pounds (lbs.) 34 45 pounds (lbs.) 46 55 pounds (lbs.) 56 65 pounds (lbs.) 66 77 pounds (lbs.) 78 88 pounds (lbs.) Over 88 pounds (lbs.) Give the child: One half (1⁄2) teaspoon (tsp) (2.5mL) of the doxycycline mixture One (1) teaspoon (5mL) of the doxycycline mixture One and one half (1 1⁄2) teaspoons (7.5mL) of the doxycycline mixture Two (2) teaspoons (10mL) of the doxycycline mixture Two and one half (2 1⁄2) teaspoons (12.5mL) of the doxycycline mixture Three (3) teaspoons (15mL) of the doxycycline mixture Three and one half (3 1⁄2) teaspoons (17.5mL) of the doxycycline mixture Four (4) teaspoons (20mL) of the doxycycline mixture (or 1 tablet) Children heavier than 88 pounds who are exposed to anthrax should take one (1) 100mg tablet of doxycycline two times a day (at the same time each day if possible) for 10 days. If the child cannot swallow tablets, use the directions for preparing a mixture and give 4 teaspoons twice a day. How already prepared Doxycycline mixture should be stored: • Doxycycline mixed with any of the recommended foods will keep for at least 24 hours. • Store the mixture in a covered container and refrigerate. • Prepare the doxycycline mixture daily; unused portions should be thrown away. Note: Children receiving doxycycline for brucellosis prophylaxis should also receive rifampin. See additional sheets for instructions and dosing. How To Prepare Emergency Dosages Of Rifampin For Children and Adults Exposed To Brucellosis Once you have been notified by your federal, state, or local authorities that you have been exposed to brucellosis, it may be necessary to prepare emergency doses of rifampin for infants and children using rifampin capsules. You will need: • Two (2) 300 milligram (mg.) rifampin capsules • Metal teaspoon • 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.) measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.] • 1 small bowl • One of these foods: – chocolate syrup – unsweetened applesauce – maple syrup – jarred pureed baby fruit – caramel syrup – ketchup Directions: 1. Open two (2) 300mg rifampin capsules into a small bowl. Put the contents of the capsules into a small bowl and discard the empty capsule. Crush the contents with the back of the metal spoon until no large pieces are seen 2. Add six (6) level teaspoons (tsp) of a food to the crushed rifampin. Stir them together until the drug looks evenly mixed with the food. 1. Use the chart on the following page to find out how much of the mixture to give the child. How Much of the Rifampin Mixture to Give a Child: • The number of teaspoons of the rifampin mixture to give a child depends on the child’s weight. • If child’s weight is unknown, weigh child before giving the first dose. • The chart tells you how much to give the child for one dose. • You should give the child one dose each day for 3 to 6 weeks. If the child weighs: Less than 10 pounds (lbs.) 10 – 17 pounds (lbs.) 18 – 30 pounds (lbs.) 31 – 44 pounds (lbs.) 45 – 55 pounds (lbs.) 56 – 70 pounds (lbs.) 71 88 pounds (lbs.) Over 88 pounds (lbs.) Give the child: One half (1/2) teaspoon (tsp) (2.5mL) of the rifampin mixture One (1) teaspoon (5mL) of the rifampin mixture Two (2) teaspoons (10mL) of the rifampin mixture Three (3) teaspoons (15mL) of the rifampin mixture Four (4) teaspoons (20mL) of the rifampin mixture Five (5) teaspoons (25mL) of the rifampin mixture Six (6) teaspoons (30mL) of the rifampin mixture Children heavier than 88 pounds who are exposed to brucellosis should take two (2) 300mg capsules of rifampin once a day (at the same time each day if possible) for 3 to 6 weeks. If the child cannot swallow capsules, use the directions for preparing a mixture and give 6 teaspoons once a day. How already prepared Rifampin mixture should be stored: • Prepare the rifampin mixture daily and throw away any unused portions. • Rifampin mixed with any of the recommended foods will keep for at least 24 hours in the refrigerator. Note: Children 8 years or older should also receive Doxycycline. Children less than 8 years should also receive Cotrimoxazole. Please see additional sheets for directions and dosing of those drugs. How To Prepare Emergency Dosages of Tamiflu For Infants and Children Exposed to Influenza Once you have been notified by your federal, state, or local authorities that you have been exposed to influenza, it may be necessary to prepare emergency doses of Tamiflu (oseltamivir) for infants and children using Tamiflu capsules . You will need: • One (1) 75 milligram (mg.) tamiflu (oseltamivir) capsule • Metal teaspoon • 1 teaspoon (tsp.) measuring spoon [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.] • 1 small bowl • One of these foods: – chocolate syrup – maple syrup – caramel syrup – applesauce – unsweetened applesauce – jarred pureed baby fruit – apple juice – strawberry jam Directions: 1. Put one (1) 75mg Tamiflu capsule contents into a small bowl, discarding empty capsule. Add two (2) level teaspoons (tsp) of water. Stir the water and capsule contents for 1 minute 2. Add three (3) level teaspoons (tsp) of a food or drink to the Tamiflu and water mixture. Stir them together until the drug looks evenly mixed with the food or drink. The final concentration is 3 mg/ml (2 tsp = 30 mg). 3. Use the chart on the following page to find out how much of the mixture to give the child. How Much of the Tamiflu Mixture to Give a Child: • The number of teaspoons of the Tamiflu mixture to give a child depends on the child’s weight. • If child’s weight is unknown, weigh child before giving the first dose. • The chart tells you how much to give a child for one dose. • You should give child one dose each day (once in the morning). If the child weighs: Less than 33 pounds (lbs.) 33 – 51 pounds (lbs.) 51 – 88 pounds (lbs.) Over 88 pounds (lbs.) Adults and adolescents 13 years and older Give the child: Two (2) teaspoons (tsp) or 30 mg of the Tamiflu solution Three (3) teaspoons (tsp) or45 mg of the Tamiflu solution Four (4) teaspoons (tsp) or 60 mg of the Tamiflu solution Five (5) teaspoons (tsp) or 75 mg of the Tamiflu solution The recommended oral dose of Tamiflu prophylaxis of influenza in adults and adolescents 13 years and older is 75 mg once daily for 10 days. Treatment should begin within 2 days of exposure. How already prepared Tamiflu solution should be stored: • Tamiflu mixed with any of the recommended foods and drinks will keep for at least 24 hours. • If mixed with food, store the mixture in a covered container and refrigerate. • Mixtures made with juice can be stored at room temperature. How To Prepare Emergency Dosages of Doxycycline For Infants and Children Exposed to Plague Once you have been notified by your federal, state, or local authorities that you have been exposed to plague, it may be necessary to prepare emergency doses of doxycycline for infants and children using doxycycline tablets . You will need: • One 100 milligram (mg.) doxycycline tablet • Metal teaspoon • 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.) measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.] • 1 small bowl • One of these foods: – chocolate syrup – maple syrup – caramel syrup – applesauce – unsweetened applesauce – jarred pureed baby fruit Directions: 1. Put one (1) 100mg doxycycline tablet into a small bowl. Crush the tablet with the back of the metal spoon until no large pieces are seen. 2. Add four (4) level teaspoons (tsp) of a food to the crushed doxycycline. Stir them together until the drug looks evenly mixed with the food. 3. Use the chart on the following page to find out how much of the mixture to give the child. How Much of the Doxycycline Mixture to Give a Child: • The number of teaspoons of the doxycycline mixture to give a child depends on the child’s weight. • If child’s weight is unknown, weigh child before giving the first dose. • The chart tells you how much to give the child for one dose. • You should give the child two doses each day (one in the morning and one in the afternoon) for 7 days. If the child weighs: Give the child: 4 – 11 pounds (lbs.) 12 – 22 pounds (lbs.) 23 – 33 pounds (lbs.) 34 45 pounds (lbs.) 46 55 pounds (lbs.) 56 65 pounds (lbs.) 66 77 pounds (lbs.) 78 88 pounds (lbs.) Over 88 pounds (lbs.) One half (1/2) teaspoon (tsp) (2.5mL) of the doxycycline mixture One (1) teaspoon (5mL) of the doxycycline mixture One and one half (1 1⁄2) teaspoons (7.5mL) of the doxycycline mixture Two (2) teaspoons (10mL) of the doxycycline mixture Two and one half (2 1⁄2) teaspoons (12.5mL) of the doxycycline mixture Three (3) teaspoons (15mL) of the doxycycline mixture Three and one half (3 1⁄2) teaspoons (17.5mL) of the doxycycline mixture Four (4) teaspoons (20mL) of the doxycycline mixture (or 1 tablet) Children heavier than 88 pounds who are exposed to plague should take one (1) 100mg tablet of doxycycline two times a day (at the same time each day if possible) for 7 days. If the child cannot swallow tablets, use the directions for preparing a mixture and give 4 teaspoons twice a day. How already prepared Doxycycline mixture should be stored: • Prepare the doxycycline mixture daily and store it in a covered container, refrigerated. • Doxcycline mixed with any of the recommended foods will keep for at least 24 hours. • Throw away any unused portions. How To Prepare Emergency Dosages of Ciprofloxacin For Infants and Children Exposed to Plague Once you have been notified by your federal, state, or local authorities that you have been exposed to plague, it may be necessary to prepare emergency doses of ciprofloxacin for infants and children using ciprofloxacin tablets. You will need: • One (1) 500 milligram (mg.) ciprofloxacin tablet • Metal teaspoon • 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.) measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.] • 1 small bowl • One of these foods: – chocolate syrup – maple syrup – caramel syrup – unsweetened applesauce – jarred pureed baby fruit – ketchup Directions: 1. Put one (1) 500mg ciprofloxacin tablet into a small bowl. Crush the tablet with the back of the metal spoon until no large pieces are seen 2. Add six (6) level teaspoons (tsp) of a food to the crushed ciprofloxacin. Stir them together until the drug looks evenly mixed with the food. 3. Use the chart on the following page to find out how much of the mixture to give the child. How Much of the Ciprofloxacin Mixture to Give a Child: • The number of teaspoons of the ciprofloxacin mixture to give a child depends on the child’s weight. • If child’s weight is unknown, weigh child before giving the first dose. • The chart tells you how much to give a child for one dose. • You should give child two doses each day (one in the morning and one in the evening) for 7 days. If the child weighs: 4 – 5 pounds (lbs.) 5.5 10 pounds (lbs.) 11 – 15 pounds (lbs.) 16 20 pounds (lbs.) 21 – 25 pounds (lbs.) 26 30 pounds (lbs.) 31 – 35 pounds (lbs.) 36 – 40 pounds (lbs.) 41 – 45 pounds (lbs.) 46 – 50 pounds (lbs.) 51 – 55 pounds (lbs.) 56 60 pounds (lbs.) Over 60 pounds (lbs.) Give the child: One half (1⁄2) teaspoon (tsp) (2.5mL) of the ciprofloxacin mixture One (1) teaspoon (5mL) of the ciprofloxacin mixture One and one half (1 1⁄2) teaspoons (7.5mL) of the ciprofloxacin mixture Two (2) teaspoons (10mL) of the ciprofloxacin mixture Two and one half (2 1⁄2) teaspoons (12.5mL) of the ciprofloxacin mixture Three (3) teaspoons (15mL) of the ciprofloxacin mixture Three and one half (3 1⁄2) teaspoons (17.5mL) of the ciprofloxacin mixture Four (4) teaspoons (20mL) of the ciprofloxacin mixture Four and one half (4 1⁄2) teaspoons (22.5mL) of the ciprofloxacin mixture Five (5) teaspoons (25mL) of the ciprofloxacin mixture Five and one half (5 1⁄2) teaspoons (27.5mL) of the ciprofloxacin mixture Six (6) teaspoons (30mL) of the ciprofloxacin mixture (or 1 tablet) Children heavier than 60 pounds who are exposed to plague should take one (1) 500mg tablet of ciprofloxacin two times a day (at the same time each day if possible) for 7 days. If the child cannot swallow tablets, use the directions for preparing a mixture and give 6 teaspoons twice a day How already prepared Ciprofloxacin mixture should be stored: • • • • Prepare the Ciprofloxacin mixture daily. Store the mixture in a covered container and refrigerate. Mixture will keep for at least 24 hours refrigerated. Throw away any unused portions. Home Preparation for Emergency Doses of Doxycycline for Infants and Children Exposed to Tularemia Once you have been notified by your federal, state, or local authorities that you have been exposed to tularemia, it may be necessary to prepare emergency doses of doxycycline for infants and children using doxycycline tablets. You will need: • One 100 milligram (mg.) doxycycline tablet • Metal teaspoon • 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.) measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.] • 1 small bowl • One of these foods: – chocolate syrup – maple syrup – caramel syrup – applesauce – unsweetened applesauce – jarred pureed baby fruit Directions: 1. Put one (1) 100mg doxycycline tablet into a small bowl. Crush the tablet with the back of the metal spoon until no large pieces are seen. 1. Add four (4) level teaspoons (tsp) of a food to the crushed doxycycline. Stir them together until the drug looks evenly mixed with the food. 1. Use the chart on the following page to find out how much of the mixture to give the child. How Much of the Doxycycline Mixture to Give a Child: • The number of teaspoons of the doxycycline mixture to give a child depends on the child’s weight. • If child’s weight is unknown, weigh child before giving the first dose. • The chart tells you how much to give the child for one dose. • You should give the child two doses each day (one in the morning and one in the afternoon) for 14 days. If the child weighs: Give the child: 4 – 11 pounds (lbs.) 12 – 22 pounds (lbs.) 23 – 33 pounds (lbs.) 34 45 pounds (lbs.) 46 55 pounds (lbs.) 56 65 pounds (lbs.) 66 77 pounds (lbs.) 78 88 pounds (lbs.) Over 88 pounds (lbs.) One half (1⁄2) teaspoon (tsp) (2.5mL) of the doxycycline mixture One (1) teaspoon (5mL) of the doxycycline mixture One and one half (1 1⁄2) teaspoons (7.5mL) of the doxycycline mixture Two (2) teaspoons (10mL) of the doxycycline mixture Two and one half (2 1⁄2) teaspoons (12.5mL) of the doxycycline mixture Three (3) teaspoons (15mL) of the doxycycline mixture Three and one half (3 1⁄2) teaspoons (17.5mL) of the doxycycline mixture Four (4) teaspoons (20mL) of the doxycycline mixture (or 1 tablet) Children heavier than 88 pounds who are exposed to tularemia should take one (1) 100mg tablet of doxycycline two times a day (at the same time each day if possible) for 14 days. If the child cannot swallow tablets, use the directions for preparing a mixture and give 4 teaspoons twice a day How already prepared Doxycycline mixture should be stored: • Prepare the doxycycline mixture daily. • Store in a covered container and refrigerate. • Doxycycline mixed with any of the recommended foods will keep for at least 24 hours. • Throw away any unused portions. How to Prepare Emergency Dosages of Ciprofloxacin for Infants And Children Exposed to Tularemia Once you have been notified by your federal, state, or local authorities that you have been exposed to tularemia, it may be necessary to prepare emergency doses of ciprofloxacin for infants and children using ciprofloxacin tablets . You will need: • One (1) 500 milligram (mg.) ciprofloxacin tablet • Metal teaspoon • 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.) measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.] • 1 small bowl • One of these foods: – chocolate syrup – maple syrup – caramel syrup – unsweetened applesauce – jarred pureed baby fruit – ketchup Directions: 1. Put one (1) 500mg ciprofloxacin tablet into a small bowl. Crush the tablet with the back of the metal spoon until no large pieces are seen 1. Add six (6) level teaspoons (tsp) of a food to the crushed ciprofloxacin. Stir them together until the drug looks evenly mixed with the food. 1. Use the chart on the following page to find out how much of the mixture to give the child. How much of the Ciprofloxacin Mixture to Give a Child: • The number of teaspoons of the ciprofloxacin mixture to give a child depends on the child’s weight. • If child’s weight is unknown, weigh child before giving the first dose. • The chart tells you how much to give a child for one dose. • You should give the child two doses each day (one in the morning and one in the evening) for 14 days. If the child weighs: 4 6.5 pounds (lbs.) 7 12.5 pounds (lbs.) 13 18 pounds (lbs.) 19 24 pounds (lbs.) 25 30 pounds (lbs.) 31 37 pounds (lbs.) 38 43 pounds (lbs.) 44 49 pounds (lbs.) 50 55 pounds (lbs.) 56 61 pounds (lbs.) 62 67 pounds (lbs.) 68 73 pounds (lbs.) Over 73 pounds (lbs) Give the child: One half (1/2) teaspoon (tsp) (2.5mL) of the ciprofloxacin mixture One (1) teaspoon (5mL) of the ciprofloxacin mixture One and one half (1 1⁄2) teaspoons (7.5mL) of the ciprofloxacin mixture Two (2) teaspoons (10mL) of the ciprofloxacin mixture Two and one half (2 1⁄2) teaspoons (12.5mL) of the ciprofloxacin mixture Three (3) teaspoons (15mL) of the ciprofloxacin mixture Three and one half (3 1⁄2) teaspoons (17.5mL) of the ciprofloxacin mixture Four (4) teaspoons (20mL) of the ciprofloxacin mixture Four and one half (4 1⁄2) teaspoons (22.5mL) of the ciprofloxacin mixture Five (5) teaspoons (25mL) of the ciprofloxacin mixture Five and one half (5 1⁄2) teaspoons (27.5mL) of the ciprofloxacin mixture Six (6) teaspoons (30mL) of the ciprofloxacin mixture (or 1 tablet) Children heavier than 73 pounds who are exposed to tularemia should take one (1) 500mg tablet of ciprofloxacin two times a day (at the same time each day if possible) for 14 days. If the child cannot swallow tablets, use the directions for preparing a mixture and give 6 teaspoons twice a day. How already prepared Ciprofloxacin mixture should be stored: • • • • Prepare the Ciprofloxacin mixture daily. Store the mixture in a covered container and refrigerate. Mixture will keep for at least 24 hours refrigerated. Throw away any unused portions. References: 1) Occupational Safety and Health Administration (OSHA), 29 CFR 1910.120, Hazardous Materials Incident Response Curriculum Guidelines (HAZWOPER), last updated Directive 11/05/2003. http://www.oshasic.gov/pls/oshaweb/owadisp.show_document?p_table=ST ANDARDS&P_id=9765 2) OSHA Best Practices for Hospitalbased First Receivers of Victims form Mass Casualty incidents Involving the Release of Hazardous Substances, December 2004. http://www.osha.gov/dts/osta/bestpractice/firstreceivers_hospital.html 3) U.S. Department of Health and Human Service: Concept of Operations Plan (CONOPS) for Public Health and Medical Emergencies, March 2004, Tommy G. Thompson, Secretary Dept. HHS. http://www.dhhs.gov/nypo/pandemicplan/hhs_conops.pdf 4) Okumura T, Takasu N, Ishimatsu S, Miyanoki S, Mitsuhashi A, Kumada K, Tanaka K, Hinohara S. Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med 1996 Aug;28(2):12935 5)Macintyre AG, Christopher GW, Eitsen E, Hum R,Weir S, DeAtley C, Tonat K, Barbera JA. Weapons of mass destruction events with contaminated casualties. JAMA 2000; 283:242249. 6) Barbera JA, Macintyre AG. Mass Casualty Handbook: Hospital, Emergency Preparedness and Response, First edition 2003: Jane’s Information Group, Ltd. 7) Hick JL, Hanfling D, Burnstein J, Markham A, Mclntyre G, and Barbera JA. Protective equipment for health care facility decontamination personnel: regulations, risks, and recommendations. Ann Emerg Med Sept 2003 Sept;42(3):370380 8) Hick JL, Penn P, Hanfling D, Lapp MA, O’Laughlin D, Bunstein JL. Establishing and training health care facility decontamination teams. Ann Emerg Med 2003 Sept; 42(3):381390 9)Markenson D. Redlener I. Pediatric Preparedness for Disasters and Terrorism: A National Consensus Conference. Executive Summary 2003. National Center for Disaster Preparedness. Columbia University, Mailman School of Public Health http://www.bt.cdc.gov/children /pdf/working/execsumm03.pdf 10) Testimony before the Senate Committee on Health, Education, Labor, and Pensions Subcommittee on Children and Families Presented by Joseph L.Wright, MD, MPH, FAAP on Behalf of the American Academy of Pediatrics. Senate Committee on Health, Education, Labor, and Pensions Subcommittee on Children and Families. Washington, DC: American Academy of Pediatrics, 2001 of the United States Senate http://www.aap.org/terrorism/resources/academy_recources.htm. 11) Oklahoma University College of Pharmacy and Oklahoma CityCounty Public Health Department. How to prepare medication for children.