Pediatric Mass Casualty Care in Resource-Limited Emergency Departments: A Narrative Review

Background Pediatric MCIs across prehospital, field, and emergency department settings in resource-limited environments pose grave risks due to children’s physiological vulnerabilities compounded by systemic shortages of equipment, medications, and specialized staff. Objective To evaluate evidence-based strategies for pediatric mass casualty management in resource-limited environments, encompassing triage protocols, crisis standards of care, field-adapted innovations, and psychosocial support. Methods This synthesis integrates evidence from PubMed literature (2010–2025), WHO/ICRC guidelines, and field data from 17 disaster responses (Nepal earthquake, Syrian refugee crises, Gaza conflict). We evaluated: triage protocols (JumpSTART, ETAT+), CSC, improvised medical devices, psychosocial and family-centered interventions. Results JumpSTART triage reduced pediatric errors by 40% versus START in simulations. ETAT+ implementation in Sierra Leone lowered mortality by 33.1%. CSC protocols prioritizing survivability increased overall pediatric survival but triggered ethical conflicts in of Syrian deployments. Improvised tools proved critical: manual suction devices achieved efficacy in airway management, while solar-powered oxygen concentrators reduced hypoxemia deaths in Uganda. Culturally adapted PFA cut acute stress symptoms by 65% in Thai tsunami survivors. Critical gaps persisted: 50% of MCIs lacked family reunification protocols, prolonging separations. Conclusion Effective pediatric MCI management requires context-adapted triage, ethically grounded CSC, field-validated innovations, and integrated psychosocial support. Standardizing protocols, scaling low-cost technologies (e.g., DripAssist IV regulators), and strengthening reunification systems are urgent priorities.