Pediatric Prehospital Medicine in Mass Casualty Incidents

Abstract

The prehospital provider is met with unique challenges when responding to a call and finding a pediatric aged patient that requires evaluation, treatment, and transfer to a medical facility. Many mass causality incidents secondary to natural disaster, man-made disasters, or acts of terrorisms have exposed the vulnerabilities of prehospital emergency medical services personnel in the evaluation, treatment, and transport of the pediatric population. Many lessons learned from past events have been published with agendas to incorporate the needs of the transport of pediatric patients. This article will review the issues and recommendations of the prehospital personnel's role with expectations that pediatric aged victims are rendered optimal care.

A Scoping Review of the Essential Components of Emergency Medical Response Systems for Mass Casualty Incidents

“…At the local level, a physical emergency operations center (EOC) with well-defined jurisdictional responsibility is mandated for MCI management. 13,21,22,28,31,34,36,47,50,[55][56][57][58][59]61,62,[64][65][66]73,82,88,89,99,110,111,118,119,129,135,142,145,149,[151][152][153][154][155][156][157][158] EOCs play an important role by coordinating amongst organizations that need medical resources with those that can provide medical resources and delegating various emergent tasks among different entities. 39,50,54,118,151,152,155,157...…”

“…39,50,54,118,151,152,155,157,159,160 EOCs follow the framework of a centralized and hierarchical incident command system (ICS) in directing all response activities. 13,21,22,28,36,47,50,[56][57][58][59]61,62,[64][65][66]73,82,88,89,91,99,110,118,119,129,135,142,149,[151][152][153][154][155]157,158,[161][162][163] Based on the extent and duration of the MCI, the ICS system can be lean or more expansive, requiring additional command and support roles to facilitate the operations of care delivery for at least 10 days with...…”

Major Accident Disasters and Their Management

“…Recently, most rescue services have developed detailed plans for preclinical disaster management, but only 17% involve special plans for the pediatric care. Sufficient triage should ensure the correct therapy for each patient at the appropriate time (Lowe 2009b). Currently, most of the usually used triage algorithms are based on physiological parameters.…”

Managing mass casualty events is just the application of normal activity on a grander scale for the emergency health services. Or is it?

“…38,64,65 Triage Disaster triage is the process of allocating treatment and evacuation priorities to patients based on the severity of their injuries. 10,[66][67][68][69][70] This course of action is usually outside the normal daily experience of most emergency healthcare providers 13 and can be very difficult. 71 Patients may present with injuries different from normal emergency department presentations.…”

“…59,73 Compared to routine practice, triage principles during a disaster require an entirely different approach to evaluation and care and often run counter to training and ethical values. 3,74,75 Due to potential resource limitations, 34,75 mass casualty triage is aimed at ensuring that medical resources are directed at achieving the greatest good for the greatest number of people, 3,19,33,45,66,67,69,70,[76][77][78] in an attempt to reduce mortality and morbidity. 3,67,75,79 Regardless of the triage method used, during a mass casualty event, patients requiring triage are sorted into four categories: immediate, delayed, ambulatory and expectant.…”