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Background <p>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.</p> Objective <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月23日

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  • Amira A. Aboali,
  • Abdulrahman Khaldoon Hamid,
  • Karim Fahmy,
  • Yousef Hawas,
  • Joseph Alhaddad,
  • Salma Tamer Abdelrahman,
  • Marina Ramzy Mourid,
  • Bethany Bucciarelli,
  • Eric Lusinski,
  • Mohammed Alsabri

摘要

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.