Military humanitarian efforts in pediatric surgery and ethical considerations.

Introduction: Children are often overlooked in disaster planning and response. Children are particularly vulnerable in a disaster, and their outcomes may be quite different from adults. Pediatric disaster research faces significant challenges in methodology and infrastructure, often relying on limited, non-representative, and non-generalizable data. To advance this field, there is a critical need to train future disaster scientists who can develop research-informed solutions that advance the entire spectrum of the disaster cycle. We developed a curriculum that responds to the need to increase the number of professionals trained to perform pediatric disaster science research. This program was developed in collaboration with the HRSA-funded Pediatric Pandemic Network (PPN). Methods: A consensus-driven pediatric disaster medicine research curriculum was developed using expertise from the PPN. Pediatric disaster medicine experts agreed to lead educational sessions in conjunction with program faculty. A diverse group of participants was recruited for the 2024 cohort to spend 10% of their time attending interactive Zoom educational sessions, individual mentoring sessions, developing a capstone project, and attending the PPN annual meeting to meet potential national mentors. Results: Eighteen applicants were accepted from 15 different states. 1/3rd of applicants were underrepresented in medicine. Accepted scholars represented emergency medicine, critical care medicine, surgery, hospital medicine, and epidemiology. We included a feedback loop in our curriculum that led to the addition of an implementation science session, analysis of an early-stage investigator’s disaster-specific grant proposals, sessions on QI, health services research, and other topics using disaster science research examples. Conclusion: To our knowledge, this disaster science research training program is the first of its kind in the US. To increase sustainability, we have submitted an NIH application to continue to fund this program from 2026-2031.

Introduction: Children are frequently victims of disasters. However, gaps remain in pediatric disaster preparedness. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty events that involve large numbers of children. On May 23, 2024, the NYC PDC conducted a pediatric disaster full-scale exercise testing surge, communications, and secondary transport. Participants included three NYC pediatric hospitals and the NYC Pediatric Intensivist Response Team (PIRT). Methods: The full-scale exercise was prospectively designed with specific goals: to test and improve communications with staff and city agencies; to test and improve hospitals’ pediatric surge capacity plans and response; to identify space, staffing, and equipment needs for pediatric disaster; and for hospitals to identify and triage patients requiring secondary transport to another facility. In collaboration with the DOHMH, PDC designed a Master Scenario Events List (MSEL) along with other tools to measure strengths and weaknesses to be identified at each institution at a system level. PDC created an exercise evaluation guide to assess: Communications, Emergency Operation Plans, Surge, Patient Tracking, Patient Transfer, Supplies, and Staffing, utilizing a performance rating scale from 1-4 and qualitative reporting. Results: This information was used to report lessons learned and challenges to the participants and DOHMH in an after-action report. An after-action report was written based on information from evaluation guides, site-specific and group hot-washes, and an after-action meeting. Conclusion: This presentation will highlight the strengths, challenges, and lessons learned from the exercise. Conducting a multi-hospital pediatric disaster full-scale surge exercise produced lessons learned to address exercise gaps that can improve surge capabilities during future exercises and real-time events.

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.

Summary: Children around the world are vulnerable to disasters irrespective of the local abundance or scarcity of health resources. Often, children are overlooked in healthcare systems primarily focused on adults. Creating pediatric specific strategies that are adaptable to different geographies is essential to support children, especially during surge incidents. The United States government has recently supported the initiatives, the Administration for Strategic Preparedness and Response (ASPR) Pediatric Disaster Center for Excellence (PDCOE), and the Health Resources and Services Administration (HRSA) Pediatric Pandemic Network (PPN), to improve pediatric care throughout the disaster cycle in the US healthcare system. These initiatives have created partnerships with state, regional, and local entities to promote pediatric disaster response by all healthcare systems and their communities, regardless of local pediatric resources. The PDCOE, Region 5 for Kids, created a pediatric hazard vulnerability analysis (HVA) toolkit that focuses on pediatric vulnerabilities in all disasters, a regional metrics scorecard to assist regions in understanding their pediatric strengths and gaps, and uses weekly regional hospital metrics to assist with surge mitigation. The PDCOE, Western Regional Alliance for Pediatric Emergency Management (WRAP-EM) created a Surge Toolkit as a just-in-time aid for a respiratory surge. The PPN created the Pediatric Surge All Hospital Handbook (PedSAHH), addressing community-wide needs to integrate pediatric surge planning in all hospitals. WRAPM-EM also created the “15 ‘til 50 Pediatric Mass Casualty Incident Plan Template”. These tools give critical recommendations for planning and just-in-time management of a surge of pediatric patients after a disaster or during a pandemic. While these pediatric surge support tools have been evaluated in a well-resourced country, the strategies described are applicable and adaptable to all communities, regions, and countries. The recommendations can be implemented with local surge practices to ensure that children receive optimal care within the entire disaster cycle.

Introduction: Children are frequently victims of disasters. However, gaps remain in pediatric disaster preparedness. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty events involving children. In the fall of 2022, there was a significant increase in pediatric emergency department visits and hospitalizations due to Rhinovirus, Enterovirus, COVID-19, Influenza, and RSV throughout many areas of the United States. This, coupled with underlying staffing and other shortages, created a strain on the healthcare system. In many facilities, surge capacity was exceeded, Emergency Departments and Pediatric Intensive Care Units were closed to new patients, and inter-hospital transports were denied. Methods: In response, the NYCPDC rapidly (over four days) developed a one-hour webinar focused on: epidemiological data sharing, impacts on patient care, a review of prevention, treatment, and supply issues, and a discussion on current and future strategies to respond to the outbreak. The one-hour webinar included a total of four presenters with representation from the NYCPDC, DOHMH, as well as two major NYC children’s hospitals and a national audience. Results: Over 400 healthcare workers registered for the webinar from around the United States. Prior to the conclusion of the webinar, participants had the opportunity to ask questions and contribute to the session by sharing their firsthand surge experiences, including capacity expansion, challenges, and best practices. Following the session, a recording of the webinar as well as a curated listing of resources developed in cooperation with the National Pediatric Disaster Coalition were distributed to every participant. Conclusion: This presentation will provide a summary of the webinar and highlight effective strategies to respond to future outbreaks. This includes managing a large influx of pediatric patients in the emergency department and pediatric intensive care unit, as well as effective transfer strategies.

Introduction: The increasing frequency and severity of disasters highlight the need for robust training in disaster response, particularly for medical and public health professionals focused on pediatric care. The Center for Global Health at the Colorado School of Public Health has offered the Pediatrics in Disasters (PEDS) course since 2008 to enhance pediatric disaster preparedness in both domestic and global contexts. This study evaluates the course’s effectiveness post-COVID-19 using a mixed-methods approach to assess knowledge gains, learner satisfaction, and impressions across two diverse settings. Methods: A convergent parallel mixed-methods study design was used to evaluate the PEDS course delivered in 2023 in Nairobi, Kenya, and Aurora, Colorado, USA. Quantitative data were collected through pre- and post-course knowledge assessments, analyzed using paired t-tests and ANCOVA, and satisfaction surveys were analyzed with descriptive statistics. Qualitative data from open-ended responses were thematically analyzed to identify strengths and areas for improvement. Both data sets were integrated to comprehensively understand the course outcomes. Results: Of the 54 participants, 49 (91%) completed post-course evaluations, and 42 (78%) completed both pre- and post course assessments. Significant knowledge gains were observed, with mean scores increasing from 66% to 82% (p < 0.001). Course location did not significantly impact knowledge gains (p = 0.8). Learners expressed high satisfaction with the course, praising the interactive components. Qualitative results revealed satisfaction with course content and interactive components, particularly small group discussions and simulations, which learners found engaging and beneficial to their learning experience. Conclusion: The PEDS course significantly improved knowledge of the pediatric disaster content presented and was well received across both settings. Positive feedback emphasized the course’s relevance to disaster response roles, while learners provided valuable suggestions for refinement. Ongoing evaluation and adaptation will focus on knowledge retention and practical application after the course.

Introduction: Social media has become a crucial source of information for families, particularly during disasters when parents seek quick updates regarding loved ones and after a disaster for future planning. In response, Region V for Kids, a Pediatric Disaster Center of Excellence funded by the United States Administration for Strategic Preparedness and Response, formed a Communications Workgroup to disseminate disaster-related content via social media. This study evaluated whether the Region V for kids’ website user engagement with hospitals and families improved after leveraging social media for disaster content. Methods: This retrospective study, conducted from January to August 2024, analyzed user engagement metrics from the Region V for Kids website. Metrics included landing page views, active users, average engagement time, and bounce rates. These were compared against benchmarks from significant events, such as forming a dedicated communications team, hiring a communications specialist, and posting educational resources during disasters. Results: After establishing the Communications Workgroup and hiring a communications specialist, user engagement improved significantly. Average engagement time increased from 5 to 26 seconds, while bounce rates decreased from 49% to 15%, indicating greater user interest. Although overall views and active user counts showed variability, there were notable increases following the Ohio Tornado Outbreaks in May 2024, demonstrating responsive engagement during critical events. Targeted social media posts also positively impacted engagement. A May 2024 social media post on disaster preparedness for individuals with disabilities resulted in a six-fold increase in relevant webpage views. Similar trends were observed for family reunification, hazard vulnerability analysis, and pediatric medical operations coordination cell. Conclusion: Social media has emerged as a vital tool for efficiently disseminating critical information, particularly during disasters. Region V for kids successfully utilized these platforms to enhance engagement and promote pediatric disaster preparedness best practices among families and hospitals.

Introduction: Children in the United States are disproportionately impacted by disasters. Fourteen million children live in high risk areas for natural disasters, and over 4,300 were affected by gun violence in 2022 alone. Children have unique vulnerabilities, leading to higher morbidity and mortality compared to adults. Despite these distinctive traits, research addressing pediatric-specific needs in disaster medicine remains limited, underscoring an urgent need for a focused pediatric disaster medicine research agenda for the United States to improve outcomes and preparedness for future events. Methods: A consensus-driven pediatric disaster medicine research agenda was developed using a scoping review followed by a modified Delphi process to identify research questions. The Delphi process leverages expert input, enabling participants to refine their responses based on expert feedback until consensus is achieved. Forty-eight pediatric healthcare and disaster medicine subject matter experts participated in three rounds of surveys, discussions, and voting. The process aimed to identify key research areas and determine a prioritized consensus research agenda for pediatric disaster medicine. Results: One hundred six research questions were generated from the gaps in the literature, and an additional 155 research questions were generated by the Delphi panelists, for a total of 261 research questions generated and categorized into 20 subtopics across five main topics: Response, Recovery, Mitigation/Prevention, Preparedness, and Education. Of these, 10 subtopics were prioritized as consensus for high priority, including capacity and capability, community involvement, and health equity considerations. Critical research areas were highlighted as mental health needs, technology, and disaster-specific metrics. Conclusion: This consensus-driven research agenda is the first of its kind for pediatric disaster medicine, offering a roadmap for future research initiatives. By addressing identified gaps in disaster preparedness and response for children, this US-based agenda aims to enhance evidence-based practices, guide future research, and improve the health and safety of pediatric populations during disasters.

Introduction: Pediatric reunification is a critical component of hospital disaster planning. Timely reunification has shown improved outcomes for children, yet many hospitals fail to have a plan. The U.S. Administration for Strategic Preparedness and Response funded Region V for Kids, a Pediatric Center of Excellence for standardizing pediatric disaster preparedness. A Reunification Workgroup was formed within this center to determine if an educational series would improve pediatric reunification plans for U.S. hospitals. Methods: This pilot project is a mixed-methods study including nine children’s hospitals from six states. Hospitals were pre-surveyed in May 2023 and post-surveyed after completion of the educational series in July 2024. The series comprises five modules: Patient Tracking, Facility Logistics, Information Sharing, Plan Activation, and Recovery. Modules were developed from deficits revealed via a gap analysis from the presurvey and virtually presented each month from January through May 2024 to emergency managers and physicians. Sessions were also recorded for self-guided learning. The audience was polled live for immediate feedback during each virtual session. Results: Live polling questions included presentation helpfulness, speaker knowledge, presentation content, and session expectations. The post-survey solicited information on reunification knowledge enhancement, relevancy, and changes to clinical practice, the virtual experience, independent learning opportunities, and ease of the online learning platform. Using a scale from 1 to 5, with 1 being strongly disagree and 5 being strongly agree, all modules averaged above 4, with a range of 3 to 5 in both polling and post-survey questions. Descriptive results indicated that modules were concise, informative, relevant, and practical. Conclusion: This pilot is the first educational series developed for standardizing and improving pediatric reunification plans in the U.S. The project used knowledge deficits to improve education, strategy, and guidance for reunification planning. Similar educational series should be considered in pediatric reunification development for hospitals globally.

Summary: This presentation will report on medical evacuation challenges involving pediatric specialty hospitals and the capabilities and challenges identified during the October 2022 National Pediatric Disaster Conference Significant Event Readiness Forum (SERF). The event drew pediatric subject matter experts and entities from across the nation to explore opportunities along the disaster response continuum addressing the multi-state and federal capability in the event of a catastrophic earthquake. Over 351 coalition, pediatric, EMS, air-medical state, regional, and national disaster response partners participated in this hybrid event. The purpose of a SERF is to foster information sharing and relationship development with a targeted group of stakeholders who do not always plan together. The presentation will discuss how a Significant Event Readiness Forum provided a framework for stakeholders to understand command structures and situational awareness on the first responder and private sector level is needed to operationally manage military, and private sector medical transportation staging, triage, and deployment of ground and air transport associated with a no-notice catastrophic event. In the event of massive infrastructure disruptions, facilities will be faced with decisions to self-evacuate or shelter in place. Prolonged staging will necessitate going “old school,” informed by lessons learned from our colleagues in war and austere settings. Lessons learned: 1. Facilitated discussions are needed across disciplines and sectors before community planning for pediatrics and other special populations. 2. SERF format results in improved communication and consensus planning across disciplines and private public partnerships. 3. Improvements are needed in developing and testing plans for interoperable interstate communication, coordination, and response. 4. Addressing the “basic” needs of the workforce and community in the first 24 hours for food, water, restrooms, shelter, and emotional support may be one of the most important factors in resilience and recovery.

Summary: A coordinated and effective response is critical in disaster scenarios, particularly when addressing pediatric patients’ unique health care needs. This abstract presents a collaborative approach between nurses and pharmacists to enhance pediatric care during disasters, emphasizing the importance of interdisciplinary teamwork in ensuring optimal outcomes for children. Nurses play a pivotal role in the initial assessment and management of pediatric patients, providing direct care and identifying the specific needs of children affected by disasters. Their expertise in pediatric assessment allows for the timely recognition of injuries and medical conditions requiring immediate attention. Meanwhile, pediatric pharmacists bring specialized knowledge in medication management, ensuring that appropriate dosing and therapeutic options are available for young patients, especially given the physiological differences between children and adults. This presentation will highlight key strategies for fostering collaboration between nurses and pharmacists during disaster response. We will explore effective communication techniques, shared protocols for medication administration, and joint training exercises to enhance preparedness. Case studies will illustrate successful nurse pharmacist partnerships in disaster settings, showcasing how their collaborative efforts can streamline patient care, improve medication safety, and reduce errors in drug administration. Moreover, we will discuss the importance of establishing clear roles and responsibilities, facilitating real-time consultation, and leveraging the strengths of each discipline to create a comprehensive care plan tailored to the pediatric population. By promoting a unified approach, we aim to address the unique challenges faced by children during disasters, ultimately improving health outcomes and ensuring that their specific medical and emotional needs are met. This collaborative model not only enhances the quality of care delivered during emergencies but also sets a precedent for future interdisciplinary practices in pediatric disaster management.

Measuring Pediatric Disaster Readiness of United States Emergency Departments.

This study aimed to evaluate a dissemination strategy for an online pediatric disaster learning module to reach pediatric residents in programs participating in nationally funded disaster networks. A secondary aim measured the educational impacts among learners. The module included case-based scenarios, videos, interactive questions and answers with experts, and resource links. The dissemination strategy involved identifying a local champion at each of the disaster network institutions to recruit a targeted group of pediatric residents during a clinical rotation. Dissemination was evaluated using surveys of site champions and learners. The educational impact of the module was measured using retrospective pre/postsurveys. Twenty-eight residency programs within the funded disaster networks were approached, and 6 additional residency programs requested to participate after learning about this project. Twenty-five programs participated with a total of 252 residents initially engaging with the module over the 2 designated dissemination weeks. Of residents, 75% started the module and completed it. Most site champions expressed interest in continuing to engage in dissemination of future modules in the curricula. A statistically significant improvement in self-reported knowledge, attitudes, and behaviors was noted for all 6 learning objectives. The mean Net Promoter Score reported by the learners was 11/100. Overall, the strategy of disseminating disaster curricula through the funded disaster networks with local site champions was effective, though barriers were identified for future efforts to reach all programs interested. Completion of the module was associated with self-reported achievement of all learning objectives.

Major weather and climate disasters are increasing in frequency and severity. How often these events result in child deaths is unknown. We assessed temporal and regional trends in pediatric fatalities due to weather events in the United States over the last 21years. We conducted an ecological study of weather-related pediatric fatalities between 2001 and 2021 using the National Centers for Environmental Information Storm Events Database. Weather-related fatalities were compared with pediatric fatalities included in the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database. The change in the proportion of all-cause pediatric fatalities associated with weather events was assessed over time. The frequency of events occurring in regions with Pediatric Disaster Care Centers of Excellence (COE) was examined. Between 2001 and 2021, weather events were associated with 1423 pediatric fatalities. Sixty percent of fatalities occurred in male children, with a bimodal distribution in age. Flood/currents accounted for the largest proportion of fatalities (37%, n = 524), followed by cold/ice/winter weather (13%, n = 192), tornadoes (13%, n = 183), heat (12%, n = 168), and hurricanes/storms (11%, n = 155). Although no significant difference was noted in the absolute number of fatalities over time (P = .18), the proportion of all-cause pediatric fatalities associated with weather events increased (P = .006) over the course of the study. Forty-six percent of pediatric fatalities occurred in areas with an associated COE. Pediatric fatalities from weather events make up an increasing proportion of childhood deaths. Expansion of health-system infrastructure for pediatric disaster planning and response may mitigate childhood deaths from weather-related disasters.

Evaluate and improve the accuracy of disaster triage decisions for pediatric patients among clinicians of various training levels using the Sort, Assess, Life-Saving Intervention, Treatment/Transport (SALT) triage system. We used an online pediatric disaster triage module to evaluate and improve accuracy of triage decisions. During a pre- and post-test activity, participants triaged 20 fictional patients. Between activities, participants completed a didactic covering concepts of disaster triage, SALT triage, and pediatric limitations of triage systems. We assessed accuracy and improvement with non-parametric tests. There were 48 participants: 27 pediatric emergency medicine attendings (56%), 9 pediatric emergency medicine fellows (19%), 12 pediatric residents (25%). The median (interquartile range [IQR]) pre-test percent accuracy across all participants was 75 (IQR 65-85). Attendings scored higher than residents 80 (IQR 73-88) compared to 60 (IQR 55-65, P < 0.01) but not significantly higher than fellows 75 (IQR 70-85, P = 0.6). For the 44 participants who completed both the pre- and post-test, median score significantly improved from 75 (65-85) to 80 (75-90), P < 0.01. The accuracy of triage decisions varies at different training levels. An online module can deliver just-in-time triage training and improve accuracy of triage decisions for pediatric patients, especially among pediatric residents.

Public health emergencies, including climate-related and manmade disasters such as active shooter incidents, occur regularly in the United States. A comprehensive approach is needed to ensure that children's mental health needs are adequately addressed following disasters. This article summarizes the latest evidence on how health systems can effectively address children's unique developmental, social, emotional, and behavioral needs in the context of disasters. To do so requires the integration of mental health considerations throughout all disaster phases, including preparedness, response, and recovery. We discuss the role of traditional emergency response systems and emerging models for responding to mental health crises. These include the national children's disaster mental health concept of operations and specific resources such as crisis lines, mobile crisis units, and telemental health. To achieve a broader reach in addressing children's mental health needs during disasters, health systems can foster a "pediatric disaster system of care" by partnering with community touch points such as schools, faith-based organizations, public health, and law enforcement. Unique considerations during disasters are required to maintain access to care for children with preexisting behavioral health conditions. During disasters, attention is needed to promote equitable identification of mental health needs and linkage to services, particularly for minoritized groups and children living in rural, frontier, and high-poverty areas. Strategies to address children's mental health needs during disasters include the provision of psychological first aid, screening for and triaging mental health needs, and stepped care approaches that progressively allocate higher-intensity evidence-based treatments to children with greater and enduring needs.

The National Academies of Sciences, Engineering, and Medicine (NASEM) Symposium on Pediatric Disaster Science, which was led by the Action Collaborative for Disaster Research, was held August 1st and 2nd, 2022, in Washington, DC. The meeting convened a broad representation of subject matter experts, including federal and nonfederal partners, with the goal of presenting the scope of perspectives, information, and scientific needs related to disasters affecting children. Meeting goals were achieved through formal presentations and facilitated discussions that identified high level pediatric disaster research priorities, opportunities for synergistic scientific efforts, and considerations and strategies to effectively advance pediatric disaster science to improve outcomes for children in disasters. This three-part discussion paper is part of the Symposium collection of works as a compilation of perspectives, ideas, and discussions shared during the Symposium, with follow-on considerations for the field. Part 1 focuses on pediatric disaster science throughout the disaster cycle; Part 2 addresses the scope of translational science in pediatric disaster management; and Part 3 addresses opportunities for building the infrastructure and workforce to support current and future pediatric disaster science efforts. Associated articles in this Symposium collection of works were submitted after the meeting by experts in the field; these pieces augment some of the themes and key concepts identified throughout the Symposium.

Children comprise up to 30-50 percent of all disaster victims. Pediatric disaster medicine is a poorly established field, and most protocols are designed without adequate emphasis on the special needs of the pediatric population. During the 2021 Shavuot holiday in Israel, the collapse of temporary steel bleachers in a partially constructed synagogue resulted in a mass casualty incident (MCI) with a majority of pediatric casualties. This study analyzed the differences in post-incident casualty management, treatment, and outcomes in three Jerusalem medical centers. Multicenter retrospective data were collected from two tertiary level 1 trauma centers and one secondary hospital in Jerusalem. The data included demographics, triage scores, injury mechanisms, medical workups, and the management of the pediatric patients. A total of 171 children and adolescents aged 9-18 years presented to three centers. In two institutions, the triage was performed by a senior emergency medicine physician, and in the third institution, by a senior trauma physician. Different protocols were applied, resulting in significant differences in triage, identification and documentation, admission strategies, adherence, and analgesic treatment. Most patients presented with orthopedic injuries (115/171, 67 percent). A small number had head, chest, abdominal, and multisystem injuries (11, 5, 2, and 2 percent, respectively). Pediatric MCI management presents specific challenges. The lack of consistency in triage, registry, and management highlights the need for robust pediatric MCI training programs.

To assess pediatric disaster medicine (PDM) instruction in emergency medicine (EM) residency programs and to identify barriers to integrating these skills into EM training. National survey study of United States EM Residency Program Directors (PDs) and Assistant PDs during the 2021-2022 academic year. Of the 186 EM residency programs identified, a total of 24 responses were recorded with a response rate of 12.9 percent. Importance of training was rated 5.79 (standard deviation 2.51) using the Likert scale ranging from 1 to 10. Out of 24 programs, 17 (70.8 percent) do not have any PDM training as part of residency training. Live drill, simulation, and tabletop were identified as most effective methods to deliver PDM training with the Likert scale score of 4.78, 4.6, and 4.47, respectively. Senior trainees' level of -knowledge/skills with family reunification (Likert 2.09/5; chemical-biological-radiological-nuclear explosive 2.95/5) and mass casualty preparation of the emergency department (3.3/5) as assessed by the respondents. The main barrier to education included logistics, eg, space and costs (Likert 3.7/5), lack of didactic time (3.7/5), and limited faculty knowledge, skill, or experience (3.3/5). PDM training is lacking and requires standardization. This study highlights the opportunity for the creation of a model for EM resident education in PDM.