An Immersive Austere Environment Pediatric Disaster Simulation to Improve Pediatric Disaster Response for a Multidisciplinary Group of Disaster Medicine Fellows

Introduction: Austere environment disaster response poses situations and challenges, many child-specific, that differ from disaster response in routine and well-resourced practice settings. Pragmatic and ethical considerations limit feasibility of including children in live disaster drills, especially in an austere environment. As part of the Beth Israel Deaconess Medical Center (BIDMC) Disaster Medicine Fellowship’s (DMF) annual 4-day immersive austere environment Pre-Deployment Course a large-scale simulation drill with pediatrics was conducted. Methods: The Pre-Deployment Course was conducted on private undeveloped property and on the adjacent State Reservation. The 4-day course focused on preparation for and response to a catastrophic flood in a rural agricultural area of a developing country with poor infrastructure. Participants stayed in tents and ate mostly MREs. The hybrid adult live actor, pediatric low fidelity manikin simulation required our multidisciplinary group of fellows to set up their pop-up field clinic; triage 40 pediatric victims; and fully evaluate and manage 6 pediatric victims. Hot wash was conducted immediately after the simulation and cold debrief 1 month after to identify strengths, gaps, and patient care and personal challenges of austere environment disaster response. Results: The simulation engaged 9 fellows and 3 guest trainees; 7 faculty ran the simulation, 8 faculty acted as adolescent patients and/or caregivers. The simulation scheduled for 2 hours was terminated at 96 minutes when predesignated endpoints were met. Hotwash and 1-month cold debrief identified austere environment pediatric disaster response considerations and challenges including: vulnerabilities; medical, psychosocial impacts; evaluation; management; logistics; and patient, caregiver, and responder ethical and moral hazards. All trainees supported inclusion of pediatric simulation in future courses. Conclusion: The experience provided team building, technical performance training, psychosocial stress preparation and management training for disaster response in the austere environment. The simulation planning, design, scenarios, and debriefs provide a toolkit for including pediatrics in other austere environment disaster training.