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High-Yield Facts

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  • Children have physiologic, developmental, and behavioral differences from adults that influence their management during a mass casualty event (MCE).

  • During an MCE, emergency department (ED) staff should expect casualties to come in two waves (dual wave phenomenon): The first wave typically appears after about 15 to 30 minutes and largely consists of “the walking wounded,” and the second wave typically arrives in 30 to 60 minutes after the onset of the event and is comprised of the more critically ill or injured patients.

  • Physiological differences between adults and children make adult MCE triage protocols inappropriate for infants and children.

  • EDs should have guides with predetermined medication dosing based on weight, and equipment sizes based on age, ready for mass casualties, so that staff members do not have to perform calculations during events.

  • Decontamination of children generally takes longer than that of adults and should be done as a family unit to facilitate children's cooperation and minimize the psychological impact to children.

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Introduction
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It is critical that emergency departments (EDs) adequately prepare for mass casualty events (MCEs). EDs must not only have the capability to recognize, stabilize and care for pediatric victims of MCEs involving traumatic injuries, but also pediatric victims of biological, chemical, and radiological/nuclear agents. For any MCE, there are several unique considerations regarding pediatric victims who require differences in practices from adults such as triage and decontamination.

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Mass Casualty Events

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An MCE is defined as an event characterized by an imbalance between the needs and resources available within a healthcare system. There is no predetermined number of victims that constitutes an MCE; however, many programs consider an influx of ten or more patients as an MCE.1 The inciting event can be due to natural disasters, transportation-related failures, civil disturbances, war, terrorist-related activities, or less commonly, weapons of mass destruction that involve biological, chemical and/or radiological/nuclear agents. Whether the event is trauma related or due to a biological, chemical, or radiological/nuclear attack, children have physiologic, developmental, and behavioral differences from adults that influence their management during an MCE.2

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During an MCE, ED staff should expect casualties to come in two waves, otherwise known as a dual-wave phenomenon.2 The first wave typically appears after about 15 to 30 minutes and largely consists of “the walking wounded” who are able to get to the ED by car or on foot. The second wave of patients typically arrives in 30 to 60 minutes after the onset of the event and is composed of the more critically ill or injured patients who may have needed to be extricated and arrive by either ground or air transport.2,3

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Unique Pediatric Considerations

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Age, Size, Weight
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While there is no consensus regarding the upper limit of age that defines a child, many consider the ...

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