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To assess the incidence of and risk factors for injuries in a group of bicyclists with a well-defined exposure to bicycling, we conducted a prospective study of 1638 recreational bicyclists who rode in the 6-day 339-mile Cycle Across Maryland tour in 1994. The mean age of participants was 39 years (range, 7 to 79), and two-thirds were male. All riders wore helmets. During the tour there were 85 acute traumatic injuries (15.4 per 100,000 person-miles), 76 overuse injuries (13.7 per 100,000 person-miles), and 37 other medical problems (6.7 per 100,000 person-miles). Acute traumatic injuries were associated with a history of racing versus none (relative risk = 2.2, 95% confidence limits = 1.3, 3.7) and with inexperience, no previous Cycle Across Maryland tours versus one or more (relative risk = 1.7, 95% confidence limits = 1.04, 2.8), but not with sex, training, or prior injuries. Inexperience and lack of preride conditioning were risk factors for overuse injuries. The most common overuse injuries and medical problems were knee pain, hand or wrist numbness, foot blisters, insect stings and bites, and heat and dehydration. Study results provide exposure-based incidence rates of bicyclist injuries and suggest overuse injuries may be reduced by increased preride conditioning.

Disasters have the potential to cause short-and long-term effects on the psychological functioning, emotional adjustment, health, and developmental trajectory of children. This clinical report provides practical suggestions on how to identify common adjustment difficulties in children in the aftermath of a disaster and to promote effective coping strategies to mitigate the impact of the disaster as well as any associated bereavement and secondary stressors. This information can serve as a guide to pediatricians as they offer anticipatory guidance to families or consultation to schools, child care centers, and other child congregate care sites. Knowledge of risk factors for adjustment difficulties can serve as the basis for mental health triage. The importance of basic supportive services, psychological first aid, and professional self-care are discussed. Stress is intrinsic to many major life events that children and families face, including the experience of significant illness and its treatment. The information provided in this clinical report may, therefore, be relevant for a broad range of patient encounters, even outside the context of a disaster. Most pediatricians enter the profession because of a heartfelt desire to help children and families most in need. If adequately prepared and supported, pediatricians who are able to draw on their skills to assist children, families, and communities to recover after a disaster will find the work to be particularly rewarding.

Children are the members of our population who are most vulnerable to the effects of a chemical, biological, radiological, nuclear or explosive (CBRNE) attack. It has been over 12 years since 9/11 and the majority of clinicians who would be providing care to children in the event of another attack still lack the requisite disaster preparedness training. The purpose of this report is to provide an overview of the recent developments that will enable the affordable creation of key CBRNE educational and just in time material. In 2011, the National Center for Disaster Medicine and Public Health (NCDMPH) convened a pediatric disaster preparedness conference. Much of the initial groundwork for development of a pediatric disaster preparedness curriculum, including the identification of target audiences and requisite role specific CBRNE curriculum content, was the product of this conference. Much of the needed pediatric education and training content for the diagnosis and treatment of the injurious effects of CBRNE has recently been both developed and well vetted. Bringing together these efforts in an educational program will result in a workforce that is better trained and prepared to address the needs of children impacted by these types of disasters.