Identifying Best Practices for Improvement of Pediatric Trauma Program Mass Casualty Incident Plans

Introduction: Traumatic Mass Casualty Incidents are becoming more common in the United States. Recognizing the impact of mass casualty incidents (MCI), the American College of Surgeons recommends that trauma programs be integrated into hospital disaster plans and develop a plan for surgical response to mass casualty incidents. To date, there are no guidance documents for MCI preparedness and response specific to pediatric surgical teams and pediatric perioperative hospital space. Development of a guide to creating a pediatric surgery-specific MCI response plan would improve preparedness and potentially outcomes for children affected by traumatic MCIs. Methods: Researchers conducted semi-structured focus group discussions with subject matter experts (SME) from eight Pediatric Level I Trauma Centers in the Federal Emergency Management Administration’s Region V. Subject matter expert roles included Trauma Program Director, Trauma Surgeon, Trauma Coordinator, Emergency Manager, Emergency Physician, and Operating Room Leadership from each institution. The interviews were recorded, and verbatim transcripts were created to develop a comprehensive dataset for analysis. Results: Analysis of the focus group discussions identified four key themes which—in their presence or absence—affect the effective implementation of an MCI/surge plan: (1) departmental collaboration for effective implementation; (2) identification of challenges such as resource management and coordination; (3) use of regular drills and exercises to prepare staff and refine protocols; and (4) a commitment to continuous improvement to the plans. Conclusion: As pediatric health care institutions, particularly trauma programs, confront the complexities of modern emergency response, it will be essential that they address the four key themes listed above in their MCI response plan. With a framework adapted from these focus groups, the study authors created a guidebook to create and optimize a surgical surge response plan for trauma programs to facilitate MCI preparedness and response.