P3.C046: Little Footprints, Crucial Steps - Lessons Learned Creating a Community Wide Pediatric Mass Casualty Incident

Background: With increasing frequency of mass casualty incidents (MCI), prioritizing pediatric disaster preparedness is imperative. Given the concerns for inflicting psychological trauma on children with drill participation, there is a resultant inequity in disaster drills for this vulnerable population. We developed a pediatric-focused MCI drill for our community involving an active shooter, which employed a hybrid of live adult and a number of mannequin infant and toddler casualties.

Project Description: We collaborated with multiple hospital systems, EMS transport agencies, local fire departments, the 911 dispatch center, and our state, county, and city law enforcement agencies in the development of this drill. To foster engagement and collaboration, the approach focused on training and educational opportunities rather than spotlighting deficiencies. A tabletop exercise assessed our current practices and identify areas of focused opportunity for the live MCI drill. The live drill was built to allow for it to be run twice, with an opportunity to perform a hot wash between sessions. This helped identify gaps that could be immediately remediated during the repeat run of the drill. This was an effective strategy for fostering relationships, maintaining engagement, and nurturing collaboration with multidisciplinary agencies, in a pediatric disaster community response.

Discussion: Mass casualty incidents disproportionately impact the pediatric patient population. This pediatric-focused MCI drill was designed, and involved multiple hospital systems and prehospital response agencies to promote multi-agency pediatric disaster preparedness, to identify areas for improvement, and to provide prehospital education and training on MCI response specific to pediatric patients.

The importance educating and training on pediatric specific consideration in a MCI was recognized by all members of public safety in our community. However, with the current strain of limited personnel, it was challenging to find time that aligned with everyone’s availability to meet. Despite the time constraints, everyone was engaged in the table top exercise, which identified several pediatric specific considerations: 1) variable behavioral responses during the scene safety surveillance and security by law enforcement; 2) equipment modification needs, such as extra gauze packing of wounds when using standard tourniquet devices that are issued for the prehospital responders; 3) triage challenges with non-verbal and non-mobile infant survivors; 4) additional resource needs for transportation and supervision when these infants are separated from their care providers; 5) duration of the response affecting feeding needs for the infants; and 6) tracking and reunification challenges.
The preferred educational approach involved pre-drill educational modules and presentation, and running of the drill twice.

Conclusion: Pediatric disaster preparedness is essential and requires community wide engagement. Collaboration with prehospital partners is best facilitated through an “education first” approach. First responders are receptive to the strategy of repeating a drill, providing an opportunity to receive immediate feedback and the ability to immediately apply lessons learned.