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Pediatric Mass Casualty Care in Resource-Limited Emergency Departments: A Narrative Review
Journal article   Open access   Peer reviewed

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

Amira A. Aboali, Abdulrahman Khaldoon Hamid, Karim Fahmy, Yousef Hawas, Joseph Alhaddad, Salma Tamer Abdelrahman, Marina Ramzy Mourid, Bethany Bucciarelli, Eric Lusinski and Mohammed Alsabri
Current emergency and hospital medicine reports, v 14(1), 16
23 Jun 2026
DOI: https://doi.org/10.1007/s40138-026-00351-3
Featured in Collection :   Research Supported by Drexel Libraries' OA Programs
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https://doi.org/10.1007/s40138-026-00351-3View
Published, Version of Record (VoR) Open Access via Drexel Libraries Read and Publish Program 2026 Open CC BY V4.0

Abstract

Emergency Medicine Medicine Medicine & Public Health Review
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.

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