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Published on: March 29, 2019
Hospital preparedness exercises for paediatric mass casualty incidents: a systematic review
Elizabeth Baxter1, Zubair Ahmed1,2,3, Justine J Lee2,3
1Department of Inflammation and Ageing, School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom.
Insights
Healthcare professional training for mass casualty incidents (MCIs) involving children shows promise. While educational schemes improve preparedness, evidence quality is limited, necessitating further high-quality research for definitive recommendations.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Public Health Preparedness
Background:
- Mass casualty incidents (MCIs) pose a significant global threat, disproportionately affecting children.
- There is a notable lack of research on healthcare professional preparedness for pediatric MCIs.
Purpose of the Study:
- To systematically review existing literature on preparedness exercises for healthcare professionals responding to pediatric mass casualty incidents.
- To identify effective training interventions and assess the quality of evidence.
Main Methods:
- A systematic literature search was conducted across PubMed, Web of Science, and Embase.
- Seventeen observational studies were included for narrative synthesis following rigorous screening.
- Risk of bias was assessed using the ROBINS-E tool.
Main Results:
- A variety of training interventions were identified for pediatric MCIs, including drills and mixed-methods schemes.
- Training demonstrated effectiveness in improving specific skills, teamwork, and communication, with sustained effects up to 6 months.
- A significant limitation was the high to very high overall risk of bias across included studies.
Conclusions:
- MCI educational schemes show potential for enhancing preparedness across various domains.
- The current evidence is characterized by heterogeneity and high risk of bias, precluding definitive recommendations.
- Future research should prioritize high-quality studies with standardized outcome measures to optimize pediatric MCI preparedness.
Introduction:
Mass casualty incidents (MCIs) present a global threat to civilians, with children often being affected and sometimes even targeted; however, there is little research regarding the preparedness exercises of healthcare professionals for such events.
Methods:
A systematic search of PubMed, Web of Science and Embase from inception up to July 2025, was conducted. Risk of bias was also assessed using the risk of bias in non-randomised studies of interventions exposure (ROBINS E) tool.
Results:
The initial search generated 223 results, and following double screening and manual citation searching, 17 observational studies were selected for narrative synthesis, since numerical data to perform meta-analysis were unavailable. The review identified a broad range of training interventions tailored for paediatric MCIs. Both brief, frequent drills and longer, mixed methods training schemes were effective, yielding gains in specific skills and a holistic sense of preparedness, including teamwork and communication. These improvements were often sustained for up to 6 months, despite a common limitation of lost to follow-up. However, the overall risk of bias in the included studies were high to very high.
Discussion:
MCI educational schemes appear to improve all aspects of preparedness. However, the evidence is heterogeneous, lacked standardisation in the outcome measures and contained high to very high risk of bias, suggesting that the current evidence cannot support definitive recommendations. Future research should aim to conduct high-quality studies with standardised outcome assessment tools to optimise paediatric MCI preparedness.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251084048.
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