P3A222: Hospital and Surgical Mass Casualty Response Lessons Learned from Structured Interviews with Nine Pediatric Level I Trauma Centers

Background: Traumatic Mass Casualty Incidents (MCIs) involving children are becoming dreadfully more common in the United States. Recent literature has elucidated the perceived deficiencies of pediatric emergency and surgical departments in preparing for and responding to an MCI involving children. Hospital system preparedness with specific plans for Emergency Medicine and Operative Services is a major area for improvement. To date, there are no guidance documents specific to trauma surgery or surgical departments from professional organizations. Despite the lack of specific guidelines, many level I pediatric trauma centers have comprehensive plans to respond to an MCI involving children. Creating a compilation of effective practices from MCI response plans of pediatric level I trauma centers would facilitate the creation and improvement of other hospitals’ disaster response plans.

Methods: The trauma workgroup of the ASPR Region V for Kids Disaster Center of Excellence conducted structured interviews with representatives from all 9 of the level I pediatric trauma centers in the FEMA V region (comprised of Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin). Members of the trauma workgroup met virtually with representatives from Pediatric Surgery, Pediatric Emergency Medicine, and Emergency Preparedness for these interviews.

Results: There were many common themes and practices ubiquitous among the trauma centers. Each hospital plan was geared toward rapid expansion of capacity and capability by focusing predominately on bolstering supplies and staff in response to an MCI affecting children. The individual trauma centers had aspects of their plans that exploited the strengths of the hospital and its surrounding partners while also accounting for deficiencies based on geography, building/campus layout, supplies, and staffing. Lessons learned from previous events prompted creation of unique additions to individual plans. A guidance document including effective practices for pediatric traumatic MCI preparedness and response was created using the information collected during the interviews.

Conclusion: Future efforts including a larger number of pediatric level I trauma centers and input from subject matter experts could lend to the creation of best practices guidelines and policy statements from professional organizations.