Improving Mass Casualty Incident Preparedness of Pediatric Emergency Medicine Fellows: A Quality Improvement Initiative.

Abstract

Objective: Mass casualty incidents (MCI) overwhelm health care systems; however, MCIs are infrequent and require ongoing preparatory efforts. Although there is dedicated disaster medicine education in emergency medicine, most pediatric emergency medicine (PEM) fellows complete pediatric residencies. Pediatric residents have variable exposure to disaster training as part of their curriculum. To improve this, a quality improvement (QI) initiative was implemented to increase MCI comfort and knowledge amongst PEM fellows.

Methods: This study took place in a single-center tertiary pediatric hospital, amongst 1 cohort of PEM fellows. Following a baseline survey, a key driver diagram was developed to guide Plan-Do-Study-Act (PDSA) cycles. A focused disaster curriculum was provided to fellows and specific quick references were developed. Knowledge application interventions included mock triage, response scavenger hunt, and tabletop MCI exercise.

Results: PEM fellow comfort and knowledge of MCI response improved from an average of 2.93 to 6.56 on a 10-point Likert scale, and 3.71 to 6.58 on 10-point Likert scale respectively following the active intervention cycle and showed sustained results over a 6-month period without further interventions.

Conclusions: Utilizing QI methodology, PEM fellow comfort with MCI response, and knowledge of MCI response increased. As MCIs are a rare occurrence, ongoing assessment is necessary to evaluate the need for further interventions to maintain knowledge and comfort levels.