Telemedicine-supported pediatric burn mass casualty response in a rural emergency department

Mass casualty incidents (MCIs) involving pediatric burn patients are rare, high-impact events that can rapidly overwhelm rural emergency departments (EDs), particularly critical access hospitals with limited pediatric and subspecialty resources. We report a pediatric burn MCI involving three critically injured children presenting within minutes of each other to a rural ED following an enclosed structural fire.

Pre-arrival EMS notification enabled early activation of institutional MCI protocols and immediate telemedicine consultation with regional pediatric and burn specialists. This facilitated rapid mobilization of multidisciplinary personnel, anticipatory airway planning, and coordination of critical care transport. Upon arrival, patients required simultaneous resuscitation under conditions of limited staffing and constrained transport availability. All three patients were stabilized and transferred to a regional pediatric burn center. Two patients survived to hospital discharge while the third was compassionately extubated at the receiving facility days later.

To our knowledge, this is among the first descriptions of telemedicine-supported simultaneous pediatric burn MCI resuscitations in a critical access ED. This case highlights the importance of early MCI activation, and telemedicine-enabled operational and clinical coordination in rural disaster response systems.