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Purpose:
In January, 2006, a child in Maine was placed in custody of the Maine Department of Health & Human Services due to an immediate risk of serious harm associated with the operation of a clandestine meth lab by his parents. Based on trends in other states, and a reported 42 Maine arrests associated with methamphetamines in the previous year, an immediate need exists for policy guidance for staff who may soon be faced with appropriately meeting the needs of children found in clandestine methamphetamine laboratory sites.
At present both OCFS Child Welfare Services and the Office of Substance Abuse are primarily dependant on protocols and procedures developed in other states. Communication is presently occurring between Child Welfare Services, the Office of Substance Abuse, The Maine Drug Enforcement Agency (MDEA), and the Spurwink Child Abuse clinic. Hopefully in the near future, training will be developed for child welfare staff; law enforcement, child welfare and medical protocols will be better developed and integrated; and a group of medical professionals will be trained to provide consultation to effectively examine and treat children found at clandestine meth laboratories.
Information available in current magazine articles in the media and in protocols from other states can be very alarming. One can quickly be led to believe that it is necessary for all children to be washed at the site, for them to always leave all possessions and clothes behind, to be transported in cars with disposable seat covers, and taken immediately to a medical site to be subjected to multiple tests. It is very important to keep in mind that, as articulated in Georgia methamphetamine guidelines:
Published data, as well as peer comments reviewed up to April 1, 2005, demonstrates a general lack of data on which informed decisions can be made. The available data does show clear risk of gradual pulmonary injury to individuals recurrently involved in entry, seizure and processing of methamphetamine laboratories, but provides little evidence of injury to occasional responders to sites contaminated by lab activity. There are no data available at this time that specifically addresses the acute injury to children at the time of their removal from a clandestine drug lab. It is unclear what long term effects might ensue for children residing in a methamphetamine lab. Concerns exist that neglect and/or chemical exposure may impact physical and neurodevelopmental health. – Georgia Bureau of Investigations, June 2005.
We can increase trauma to children by assuming they suffer more harm and pathology than is supported by presently published data and peer review. We share a professional responsibility to keep our heads and keep abreast of emerging literature.
Contents of Policy:
This policy incorporates in their entirety the "Georgia Guidelines for Managing Children Found in Clandestine Methamphetamine Laboratory Sites". We learned of this policy for from the Director of MDEA. Of the policies we reviewed, this was the only one with a differential response for high risk, moderate risk and low risk situations and the only one which came with references. It is the best we have found. Maine at present lacks expertise to improve upon it.
If children are cared for by parents using methamphetamines or are exposed to other adults who use methamphetamines, some experts cite an increased risk of sexual abuse. This is because parents under the influence of methamphetamines can be very negligent caretakers and because methamphetamine use can impair judgment and decrease inhibitions. Because of this possible risk, our policy includes guidance from Larry Ricci, M.D. on physical examination of children for sexual abuse in the event that case specific information from the child protective assessment indicates a need for such an examination.
Also included is a handout for foster parents who may be caring for a child coming into care from a clandestine methamphetamine drug site. This is intended to provide helpful information and to help caregivers maintain a reasonable perspective on the abuse or neglect that a child may have suffered.
Use the Northern New England Poison Center in event of questions regarding toxicity. We checked with them and have been assured that they have the needed expertise for methamphetamine related questions. Although Georgia has an out of state toll free number, we have been advised to use our own resource center.
Northern New England Poison Center
22 Bramhall Street
Portland, ME 04102
Emergency Phone: 1-800-222-1222
TTY/TDD: (877) 299-4447 (ME only) or (207) 871-2879
Administrative Phone: (207) 842-7222
Fax: (207)773-8546 or (207) 871-6226 (Poison Center)
Guidelines for Managing Children Found at
Clandestine Methamphetamine Laboratory Sites
A collaboration of
the Georgia Bureau of Investigation,
the Georgia Department of Human Resources, and
the Georgia Poison Center
June, 2005
ACKNOWLEDGEMENTS
The recommendations presented in this collaborative document are intended to serve as guidelines. It is impossible to anticipate all combinations of circumstance that may occur. The individuals at the scene should use their best judgment. At times this may require the use of a different approach than listed below. It is appropriate for those using a different approach to clearly document why they chose to follow the path they did, in the event that questions arise at a later date.
We acknowledge the leadership and expertise of Robert Geller, M.D. in launching these guidelines. We would also like to acknowledge the contributions of Rosalyn K. Bacon M.P.H., Claudia Barthold M.D., Consuelo Campbell M.S.P.H., Wilfred Hamm M.S.S.W., Janet Oliva Ph.D., Phil Price, Janice Saturday, and Carla Simms, as well as many other members of the Georgia Department of Human Resources, Division of Public Health, Meth Workgroup too numerous to mention.
Airborne Chemical Exposure: Contact in the air with one or more chemicals in either gas or droplet form.
Clandestine Drug Lab/Laboratory: Facilities equipped and used in the production of illegal drugs. For the manufacture of methamphetamines, these can be located in a variety of locations such as homes, hotel rooms, fields, abandoned buildings, and even automobiles.
Cook/Cooking: The process of preparing individual chemicals to react with other substances to produce a new product with the ultimate goal of producing an illicit drug. A cook is "active" when chemicals are in the process of being heated or mixed or are otherwise in use.
Entry Team: The individuals, most often public safety or hazardous material technicians, who are designated to make the first entrance into a suspected meth lab.
Gross Contamination: Clearly visible evidence of chemicals on an individual or item. Examples include but are not limited to, large fresh stains or obvious odor. Since there is a wide variety of substances and chemicals used in the production of methamphetamine, there is no single type of odor or stain that implies contamination. An odor is not always detectible. Gross contamination should be clear to an untrained observer in close proximity to an individual or item.
Personal Protective Equipment (PPE): Items of clothing or tools that may be used to insulate a worker from chemical, thermal or other hazards encountered while he or she is working. PPE commonly includes goggles, masks, gloves, suits, hoods, respirators or boots. The type of equipment used depends on the suspected hazards to be encountered.
Reasonable Observation Period: A span of time deemed by a medical professional to be adequate to see signs or symptoms of a toxic exposure. This decision can be made based on a medical professional’s personal knowledge or in concert with a medical toxicologist or the Georgia Poison Center. Knowledge of the type and amount of potentially toxic exposure is helpful in determining an adequate amount of time needed for this purpose.
Visible Contamination: Clearly apparent evidence of the presence of chemicals on an individual or item. (see Gross Contamination).
ITEMS LISTED IN THIS GLOSSARY ARE MARKED IN BOLD IN THE FOLLOWING GUIDELINES
Georgia Guidelines for Managing Children Found at Clandestine Methamphetamine Laboratory Sites
Methamphetamine production and use appear to be growing problems in the state of Georgia. The manufacture of methamphetamine and related compounds may occur in hidden or clandestine laboratories. These can be located in virtually any location including houses, trailers, cars, or hotels. There are a variety of methods used to make methamphetamine, each utilizing different chemicals. Many of the chemicals used are potentially hazardous, not only to those directly involved in the manufacture of the drugs, but also to those who live in or around the laboratories. The desired final methamphetamine product is potentially dangerous as well. Children living in or around such laboratories are at risk of exposure to hazardous chemicals by inhalation, ingestion and/or direct skin contact.
This document presents guidelines for the handling of children found in and around clandestine drug laboratories after law enforcement entry into these facilities. The overriding goals of these guidelines are:
| 1. | To assure the safety of the children found at meth laboratories; To assure the safety of law enforcement, health care providers, state agency personnel and the general public interacting with and caring for children found at meth laboratories; and |
| 2. | To minimize the psychosocial trauma to the children while protecting their health and safety. |
These guidelines address the situation where children have been found at a site believed to be a
clandestine drug laboratory and where concern exists that the children may have been exposed to the chemicals used in that process. It is recommended that law enforcement personnel contact the Division of Family and Children Services (DFCS) and obtain their assistance either prior to entering a site if it is known that children are present or once children have been found at a site. These guidelines do not address the long-term management of children found in or around clandestine drug laboratories, lab site remediation, recommendations for PPE (personal protective equipment) for law enforcement, or specific hazardous-materials protocols for decontamination, though they are important issues.
Published data, as well as peer comments reviewed up to April 1, 2005, demonstrates a general lack of data on which informed decisions can be made. The available data does show clear risk of gradual pulmonary injury to individuals recurrently involved in entry, seizure and processing of methamphetamine laboratories, but provides little evidence of injury to occasional responders to sites contaminated by lab activity. There are no data available at this time that specifically address the acute injury to children at the time of their removal from a clandestine drug lab. It is unclear what long term effects might ensue for children residing in a methamphetamine lab. Concerns exist that neglect and/or chemical exposure may impact physical and neurodevelopmental health.
For information about the toxicology of chemicals encountered at a scene, the Georgia Poison Center may be contacted 24 hours a day, 7 days a week at 1-800-222-1222 within Georgia, or
at 404-616-9000 from outside Georgia.
| III. | PROTOCOLS FOR HIGH RISK SITUATIONS |
| 1. | Definition of a High Risk Situation: |
| a. | Lab entered while drug cooking in progress, AND/ OR |
| b. | Lab found with evidence of recent cooking (e.g. warm vessels or odor present) in an area with shared ventilation (The area in which the child is residing.). |
| a. | Police or other members of entry team in appropriate PPE (personal protective equipment) bring children to the Division of Family and Children Services (DFCS) or Emergency Medical Services (EMS) staff waiting at a safe distance outside the house. |
| b. | Unless grossly contaminated, possessions immediately brought with the child should include: |
| iii. | Durable medical equipment attached to the child (such as feeding tubes or IV access ports entering the skin) |
| iv. | Prescription medications |
| (1) | It may be appropriate to validate that contents are compatible with the label. This can be done by comparing the contents with those expected. The Georgia Poison Center will assist in deciphering the codes imprinted on tablets or capsules, if contacted. |
| c. | No cloth or paper possessions should be brought with the child at the time of the evacuation from the site. |
| i. | It may be appropriate to claim items important to the child at a later time once reentry into the home is deemed safe. See "Moderate Risk Situation" section on possessions (Section 12, a through e) for guidance. |
| a. | If the patient is visibly contaminated, remove clothes immediately and decontaminate as appropriate for specific chemicals in use at that site. |
| b. | Decontamination should be performed by the agency responsible for this task at the scene and should follow appropriate procedures as defined by that agency. |
| c. | With issues of gender sensitivity, appropriate attention should be given to changing, and related issues. Maintenance of appropriate protection from cold weather should be taken into account as well, especially when decontaminating infants and small children. Infants and small children are at increased risk of cold stress due to their smaller size and disproportionately large body surface area. Care must be taken not to wash infants or young children with cold water. Even when washed with warm water, care should be taken to promptly dress them after washing. |
| d. | If the patient is not visibly contaminated, have the patient change into clean clothes and leave contaminated clothing behind at the site. Additional steps may be necessary, depending on the specific chemicals in use at that site. This decision should be made by the agency or team members tasked with decontamination decisions. |
| e. | Eye glasses, hearing aids or durable medical equipment attached to the child who was evacuated should be cleansed or wiped down thoroughly (i.e. every surface needs to be cleaned). Items in this category that have no visible contamination can generally be cleaned by use of typically available household multi-surface cleaners (such as Fantastik., Formula 409., or similar agents) while wearing household rubber gloves. |
However, best practices should be determined in consultation with decontamination staff, hazardous materials experts and/or the Georgia Poison Center.
| f. | Children should be bathed at the earliest possible opportunity that protects their privacy and health, unless on-scene decontamination was necessary as per section 3.a. above. |
| a. | Change the child’s clothes on scene. Given that prompt clothing change is in the best interest of the child, this should be done as soon as is feasible. |
| b. | If the child is able to independently undress and dress without assistance, the child should be offered an appropriate area to do so. |
| c. | In the event that the child requires assistance, DFCS or any other agency’s staff capable of doing so should assist the child. |
| d. | Consultation with hazardous materials/decontamination staff is encouraged in case of questions regarding proper procedures and disposition of the removed clothing. |
| e. | It is preferable to use clean clothes from outside the home (e.g. newly purchased items or items from neighbors or family). |
| i. | If not available, use paper scrubs, |
| ii. | If none of the above are available wrap child in a clean blanket from outside the home after decontamination, |
| f. | Do not dress the children in clothing from inside the home in which a cook is active at the time of evacuation until they have been laundered. Clothing from inside the home should be laundered before children wear them. Rationale: The concern is that any cloth material taken from the home during a "cook" or shortly after a "cook" may expose clothing to airborne chemicals, which would contaminate previously clean porous items. |
| a. | If possible, initial evaluation should take place on scene to identify immediate threats to life. If there are any questions regarding the presence of such threats, rapid consultation with EMS or other medical personnel should be performed. |
| b. | Even if an on-scene examination takes place, the child should be taken to the most appropriate emergency department for evaluation prior to placement. Rationale: The medical examination in the emergency department should be geared to find and treat acute toxicity, and rule out delayed toxicity during a reasonable observation period from exposure to airborne chemicals from the cook. It is neither intended to be a comprehensive physical or neurodevelopmental examination nor is it intended to diagnose chronic condition that pose no acute danger to the health or well being of the child. |
| i. | The emergency department physician should be informed of what chemicals were at the scene (if known) and be informed that a cook was apparently in progress or apparently had recently been in progress prior to the evacuation of the child. (see also the GBI Clandestine Laboratory Guideline document for cross referencing and coordination, section 4.B.8) |
| ii. | While the extent of evaluation and disposition is the choice of the treating physician, it is recommended that the emergency department (ED) evaluation include at least the following: |
| (1) | Measurement of vital signs including heart rate, blood pressure, respiratory rate, oxygen saturation and temperature; |
| (2) | Physical examination with specific attention paid to the cardio-pulmonary systems and skin examinations; and |
| (3) | Observation for development of delayed toxicity for approximately 6 hours. |
| iii. | No specific laboratory or radiological testing is recommended to be performed at the time of the ED evaluation unless medically indicated. |
| (1) | Urine or blood toxicological testing does not need to be sent unless the clinician feels it is medically indicated. In general urine toxicology screens do not add much clinical information in this setting. |
| iv. | If a forensic sample is desired by law enforcement agencies, standard forensic sample handling, including chain of custody procedures, should be followed. |
| c. | Once released from the initial evaluation, follow-up of the child should be arranged by DFCS for full medical examination including laboratory work and neurodevelopmental evaluation. |
| i. | The first choice should be to arrange follow-up with the child’s own pediatrician, possibly in through referral to with a neurodevelopmental specialist. |
| ii. | If the child’s pediatrician or neurodevelopment specialist is not available, a clinic or hospital practice should evaluate the child within 72-96 hours for follow-up examination and laboratory testing to assess for chronic toxicity. |
| (1) | Laboratory evaluation should generally include a Complete Metabolic Panel, including sodium, potassium, chloride, CO2, BUN, creatinine, and liver function tests. |
| iii. | Given the child’s toxicological exposure, it may be beneficial to consider the following tests as the clinician deems them to be indicated: |
| (3) | Pulmonary Function Tests as appropriate for age |
| a. | During evacuation from a site in which a cook is in progress or believed to be recently completed, no items should be removed from the home, except for those items in section 2.b. above in compliance with forensic protocols. |
| b. | Consideration should be given to claiming items potentially important to the child once investigation of or evaluation of the scene has been processed and is deemed safe. This decision should be made by those local officials responsible for scene clean-up. |
| IV. | PROTOCOLS FOR MODERATE RISK SITUATIONS |
| 1. | Definition of Moderate Risk Situation: |
| a. | No cook in progress and no evidence of recent cook, BUT chemicals and cook apparatus were found in an area where children share ventilation (area in which child resides). |
| a. | Police or other members of entry team, in appropriate PPE, bring children to DFCS or EMS staff waiting at a safe distance outside the house. |
| b. | Unless grossly contaminated, possessions immediately brought with child should include: |
| iii. | Durable medical equipment attached to the child (such as feeding tubes or IV access ports entering the skin) |
| iv. | Prescription medications |
| (1) | It may be appropriate to validate that contents are compatible with the label. This can be done by comparing the contents with those expected. The Georgia Poison Center will assist in deciphering the codes imprinted on tablets or capsules, if contacted. |
| a. | If the patient is visibly contaminated, remove clothes immediately and decontaminate as appropriate for specific chemicals in use at that site. |
| b. | Decontamination should be performed by the agency responsible for this task at the scene and should follow appropriate procedures as defined by that agency. |
| c. | Appropriate attention should be given to issues of gender sensitivity, including appropriate cover while changing and related issues. Maintenance of appropriate protection from cold weather should be taken into account as well, especially when decontaminating infants and small children. Infants and small children are at increased risk of cold stress due to their smaller size and disproportionately large body surface area. Care must be taken not to wash infants or young children with cold water. Even when washed with warm water, care should be taken to promptly dress them after washing. |
| d. | Eyeglasses, hearing aids or durable medical equipment attached to the child who was evacuated should be wiped down thoroughly (i.e. every surface needs to be cleaned). Items in this category that have no visible contamination can generally be cleaned by use of typically available household multi-surface cleaners (such as Fantastik., Formula 409., or similar agents) while wearing household rubber gloves. However, best practices should be determined in consultation with decontamination staff, hazardous materials experts and/or the Georgia Poison Center. |
| e. | Children should be bathed at the earliest possible opportunity that protects their privacy and health, unless on-scene decontamination was necessary as per section (3.a) above. |
| a. | Change the child’s clothes on scene. Given that prompt clothing change is in the best interest of the child, this should be done as soon as is feasible. |
| b. | If the child is able to independently undress and dress without assistance, the child should be offered an appropriate area to do so. |
| c. | In the event that the child requires assistance, DFCS or any other agency’s staff capable of doing so should assist the child. |
| d. | Consultation with hazardous materials/decontamination staff is encouraged in case of questions regarding proper procedures and disposition of the removed clothing. |
| e. | It is preferable to use clean clothes from outside the home (e.g. newly purchased items or items from neighbors or family). |
| i. | If not available, use paper scrubs, |
| ii. | If none of the above are available wrap child in a clean blanket from outside the home after decontamination, |
| f. | Do not dress the children in clothing from inside the home in which a cook is active at the time of evacuation until they have been laundered. Clothing from inside the home should be laundered before children wear them. Rationale: The concern is that any cloth material taken from the home during a "cook" or shortly after a "cook" may expose clothing to airborne chemicals, which would contaminate previously clean porous items. |
| a. | If the child has ANY acute health complaints or there are concerns regarding the child’s acute health, or if the child was rescued from a burning structure, the child should be evaluated before placement. |
| i. | i. If possible initial evaluation should take place on scene to identify immediate threats to life. If there are any questions regarding the presence of such threats, rapid consultation with EMS or other medical personnel should be performed. |
| ii. | Even if an on-scene examination takes place, the child should be taken to the most appropriate emergency department for evaluation prior to placement. Rationale: The medical examination in the emergency department should be geared to find and treat acute toxicity and rule out delayed toxicity during a reasonable observation period in the symptomatic child. It is neither intended to be a comprehensive physical or neurodevelopmental examination nor is it intended to diagnose chronic condition that pose no acute danger to the health or well being of the child. |
| iii. | The emergency department physician should be informed of what chemicals were at the scene (if known) and be informed that no evidence of a recent cook, but chemicals and cook apparatus were found during evacuation of the child (see the GBI Clandestine Lab Guidelines 4.B.8.). |
| iv. | While the extent of evaluation and disposition is the choice of the treating physician, it is recommended that the ED evaluation of the symptomatic child include at least the following: |
| (4) | Measurement of vital signs including heart rate, blood pressure, respiratory rate, oxygen saturation and temperature; |
| (5) | Physical examination with specific attention paid to the cardiac, pulmonary and skin examinations; and |
| (6) | Observation for development of delayed toxicity for approximately 6 hours. |
| v. | No specific laboratory or radiological testing is recommended to be performed at the time of the ED evaluation unless medically indicated. |
| 6. | Urine or blood toxicological testing does not need to be sent unless the clinician feels it is medically indicated. In general urine toxicology screens do not add much clinical information in this setting. |
| vi. | If a forensic sample is desired by law enforcement agencies, standard forensic sample handling including chain of custody procedures should be followed. |
| b. | If the child does NOT have any acute health complaints and there are NO concerns regarding the child’s acute health DFCS should follow the standard procedure for any child taken into DFCS custody. The temporary custodian should be given a written and verbal explanation of any warning signs, and when to call the physician. |
| c. | Follow up should be arranged for all children in coordination with DFCS for full medical examination, including laboratory work and neurodevelopmental evaluation. |
| i. | The first choice should be to arrange follow up with the child’s own pediatrician, possibly through referral to a neurodevelopmental specialist. |
| ii. | If the child’s pediatrician or neurodevelopment specialist is not available, a clinic or hospital practice should evaluate the child within 72-96 hours for follow-up examination and laboratory testing to assess for chronic toxicity. |
| (1) | Laboratory evaluation should generally include a Complete Metabolic Panel, including sodium, potassium, chloride, CO2, BUN, creatinine, and liver function tests. |
| iii. | Given the child’s toxicological exposure, it may be beneficial to consider the following tests as the clinician deems them to be indicated: |
| (3) | Pulmonary Function Tests as appropriate for age |
| i. | At the time of the child’s removal from site, AND/OR |
| ii. | Once the site has been processed and deemed safe for entry by law enforcement personnel in compliance with forensic protocols. |
| b. | Items that are grossly contaminated should be left at the scene for later assessment and possible handling as contaminated goods. |
| c. | Unless grossly contaminated, solid surface items should be thoroughly cleansed or wiped down (i.e. each side of the object should be cleaned) after which the item may be given to the child (e.g. plastic toys, Nintendo. type game systems, computers and other electronics). Items in this category that have no visible contamination can generally be cleaned by use of typically available household multi-surface cleaners (such as Fantastik., Formula 409., or similar agents) while wearing household rubber gloves. However, best practices should be determined in consultation with decontamination staff, hazardous materials experts and/or the Georgia Poison Center. |
| d. | Clothes or stuffed items housed in covered or enclosed areas (i.e. dresser drawers or boxes) that do not have visible contamination can be sent with the child to the foster family, where they can be washed safely using the following guidelines: |
| i. | i. Items should be transported in plastic bags that can be tied closed in transit. |
| ii. | Each bag should contain no more than several items (about 3 to 5 pounds per bag maximum). |
| iii. | The foster family should be notified that each bag of clothes should be washed alone as a single wash load, using hot water and warm rinse, and generous amounts of detergent. |
| e. | If there is uncertainty as to whether an item is contaminated or not, leave it at the scene for later assessment. |
V. PROTOCOLS FOR MINOR RISK SITUATIONS
| 1. | Definition of Minor Risk |
| a. | No cook in progress and no evidence of recent cook. |
| b. | No chemicals or cook apparatus or evidence of contamination found in an area with shared ventilation with the area in which the children were residing (e.g., children are found in a house without any immediately evident contamination and the house does not share any ventilation [i.e. ducts or doors or windows] with a trailer in which chemicals and cooking vessels were housed.). ] |
| a. | Police or other members of entry team in appropriate PPE bring children to DFCS or EMS. |
| b. | Possessions immediately brought with child should include: |
| iii. | Durable medical equipment attached to the child (such as feeding tubes or IV access ports entering the skin). |
| (2) | If any of these possessions are visibly contaminated the "moderate risk" guidelines should be followed (Section 3.d). |
| iv. | Prescription medications |
| (1) | It may be appropriate to validate that contents are compatible with the label. This can be done by comparing the contents with those expected. The Georgia Poison Center will assist in deciphering the codes imprinted on tablets or capsules, if contacted. |
| a. | If the patient is visibly contaminated, the "moderate risk" guidelines should be followed (see Moderate Risk Guidelines in Section 4). |
| b. | The child does not need decontamination at the scene. |
| c. | Children should be bathed at the earliest possible opportunity that protects their privacy and health. This should occur in a setting that is appropriately heated, in order to minimize the risk of cold stress. |
| d. | Eyeglasses, hearing aids or durable medical equipment attached to the child who was evacuated should be wiped down to remove household dirt and other potential debris. Items in this category that have no visible contamination can generally be cleaned by use of typically available household multi-surface cleaners (such as Fantastik, Formula 409., or similar agents) while wearing household rubber gloves. However, best practices should be determined in consultation with decontamination staff, hazardous materials experts and/or the Georgia Poison Center. |
| a. | The child should change clothes in this situation, as follows: |
| i. | Clothing from outside the home (e.g. newly purchased items or items from neighbors or family), or paper scrubs can be used. |
| ii. | Clothes from inside the site can be used as long as the clothes are not visibly contaminated (by visual inspection or smell). |
| a. | If the child has ANY acute health complaints, or there are ANY concerns regarding the child’s acute health, or if the child was rescued from a burning structure, the child should be evaluated by a physician before placement. |
| b. | If the child does NOT have any acute health complaints and there are NO concerns regarding the child’s acute health, DFCS should follow the standard procedure for any child taken into DFCS. |
| c. | Once released from the initial evaluation, follow up of the child should be arranged by DFCS for full medical examination including laboratory work and neurodevelopmental evaluation. |
| i. | The first choice should be to arrange follow up with the child’s own pediatrician, possibly in conjunction with a neurodevelopmental specialist. |
| ii. | If the child’s pediatrician or neurodevelopment specialist is not available, a clinic or hospital practice should evaluate the child within 72-96 hours for follow-up examination and laboratory testing to assess for chronic toxicity. |
| (1) | Laboratory evaluation should generally include a Complete Metabolic Panel (including sodium, potassium, chloride, CO2, BUN, creatinine, liver function tests). |
| iii. | Given the child’s toxicological exposure it may be beneficial to consider the following tests as the clinician deems them to be indicated: |
(2) Chest Radiograph
(3) Pulmonary Function Tests as appropriate for age
| a. | Items can be removed at the time of the child’s removal from the site AND/ OR once the site has been processed and deemed safe for entry by law enforcement personnel in compliance with forensic protocols. |
| b. | Items that are grossly contaminated should be left at the scene for later assessment and possible handling as contaminated goods. |
| c. | Unless grossly contaminated, solid surface items should be thoroughly be cleansed or wiped down (i.e. each side of the object should be cleaned), after which the item may be given to the child (e.g. plastic toys, Nintendo. type game systems, computers and other electronics). Items in this category that have no visible contamination can generally be cleaned by use of typically available household multi-surface cleaners (such as Fantastik., Formula 409., or similar agents) while wearing household rubber gloves. However, best practices should be determined in consultation with decontamination staff, hazardous materials experts and/or the Georgia Poison Center. |
| d. | Clothes or stuffed items that do not have visible contamination can be sent to the foster family to be washed. |
| i. | Items should be transported in plastic bags that can be tied closed in transit. |
| ii. | The foster family should be notified that clothes should be washed, using hot water and warm rinse, and generous amounts of detergent, prior to wearing. |
| e. | If there is uncertainty as to whether an item is contaminated or not, leave it at the scene for later assessment. |
VI. REFERENCES
Bay West Inc. Methamphetamine Decontamination Study February 2002. Produced by Bay West
Inc. St. Paul, MN 55103
Burgess, JL. Phosphine exposure from a methamphetamine laboratory investigation. Journal of
Toxicology – Clinical Toxicology 2001; 39(2): 165-168.
Burgess, JL, Barnhart, S, Checkoway, H. Investigating clandestine drug laboratories: adverse
medical effects in law enforcement personnel. American Journal of Industrial Medicine. October
1996; 30(4): 488-494.
Burgess JL, Kovalchick DF, Siegel EM, Hysong TA, McCurdy SA. Medical surveillance of
clandestine drug laboratory investigators. Journal of Occupational and Environmental Medicine.
February 2002; 44(2): 184-9
CDC. Acute public health consequences of methamphetamine laboratories --- 16 States, January
2000 – June 2004. MMWR. April 15, 2005; 54(1): 356-359.
CDC. Public health consequences among first responders to emergency events associated with
illicit methamphetamine laboratories --- Selected states, 1996 – 1999. MMWR. November 17,
2000; 49(45): 1021-4
Horton DK, Berkowitz Z, Kaye WE. Acute Health Consequences to Children Exposed to
Hazardous Substances Used in Illicit Methamphetamine Production, 1996-2001. J Children’s
Health 2003; 1(1) 99-108.
Martyny, JW, Arbuckle, SL, McCammon, CS, Esswein, EJ, Erb, N. Chemical exposures
associated with clandestine methamphetamine laboratories. Online:
http://nationaljewish.org/pdf/chemical_exposures.pdf
Martyny, JW, Arbuckle, SL, McCammon, CS, Erb, N. Chemical exposures associated with
clandestine methamphetamine laboratories using the anhydrous ammonia method of production.
March 2004. Online at: http://nationaljewish.org/news/meth_research_results.html
Minnesota Department of Health. Clandestine drug labs general cleanup guidelines. September
2003. Online at: http://www.health.state.mn.us/divs/eh/meth/lab/cleanup0903.pdf
Olmsted County, Minnesota Community Task Force. Medical protocols for children found at
methamphetamine lab sites. October 2003. Online at:
http://www.health.state.mn.us/divs/eh/meth/ordinance/olmstedchild.pdf
Swetlow, K. Children at clandestine methamphetamine labs: Helping meth’s youngest victims.
OVC Bulletin Office for Victims of Crime, Office of Justice Programs, US Department of
Justice, June 2003. Online at:
http://www.ojp.usdoj.giv/ovc/publications/bulletins/children/197590.pdf
Guidelines for Care Givers of Children who have been exposed to Methamphetamine
Summary
It is important that caregivers be trained to recognize and respond appropriately to the special needs of the children exposed to methamphetamine.
These children usually come from an environment where there has been no consistent parenting routine and may demonstrate learning skills and behaviors that are not age appropriate.
Behavior often displayed by children exposed to methamphetamine
| • | Feeding and eating habits
Due to the lack of parental control or involvement, these children, by necessity, become self-sufficient. In the absence of a regular meal time, their eating habits can best be described as grazing through whatever is available to eat, whenever it is available. Foods that require little or no preparation like cereals, chips or microwaveable fare are usually the norm. Toddlers may not know how to use eating utensils and will lack the discipline to sit at the dinner table for a complete meal. When presented with access to a regular family meal, a child may gorge with multiple portions and still want more. Eating, even to the point of overeating, triggers the release of feel-good endorphins through the brain and is a comforting and pleasurable experience for the child. |
Caregivers are advised to place reasonable limits on food portions to prevent overeating and be vigilant in access to food to mitigate hoarding. It is also recommended that a meal-time schedule be established and preparations be made to teach basic table manners and eating skills.
| • | Social Skills/Psyche
These children may feel a responsibility for actions taken against their parents. Their social skills will mimic those of their parents and may include paranoia, poor hygiene, irritability, insomnia and hyperactivity. In many cases, these children may lack the anticipated age-appropriate cognitive and social skills but will display the survival skills of a much older child, even taking on responsibilities normally resigned to a parent. |
Caregivers should comfort the child at their current emotional level. Huffman advises that the first 48 hours of care be focused on observation and providing a safe, comfortable family environment for the child.
| • | Sleep Patterns
Following the haphazard sleep cycles and all-night activity displayed by their parents, these children often have distorted sleep patterns and may become nocturnal, displaying little association with normal bedtime routines. They may also have an enuresis condition of involuntary bed-wetting as a result of the poor sleep patterns and nighttime activities. Caregivers are advised to establish a regular bedtime routine of dinner, bath, story time and bed. |
| • | Elimination
The lack of a proper diet combined with the inconsistent family routine and poor sleep patterns can create a personal elimination problem for a these children. They may not be able to eliminate regularly and may resort to hiding their stool due to habit and embarrassment. Caregivers are reminded to be patient and understanding of this delicate situation, which may self-correct with the establishment of a proper diet and normal family routine. |
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