Rapid Response Teams in Mass Casualty Incidents

A mass casualty incident (MCI) is an event that temporarily overwhelms the local healthcare system due to the number of casualties vastly exceeding available resources. Management of pediatric patients during an MCI is especially challenging given the anatomical, physiological, and psychosocial vulnerabilities of children combined with the specific skill set required to diagnose and treat pediatric trauma and children with unstable cardiorespiratory status. The mainstay of the initial hospital response to an MCI is rapid and accurate triaging of patients. When done effectively, it enables the streaming of patients to appropriate management care team and to progress them throughout the MCI “pipeline,” which includes the emergency department, diagnostic imaging, operating room, and intensive care unit. Rapid response teams (RRTs) are dedicated care teams with expertise in the management of in-hospital emergency response. RRTs may primarily be adult oriented in their knowledge, and their ability to support pediatric casualties during an MCI may require specific preparation. The use of RRTs in any MCI response requires a balanced approach and consideration to the risks and benefits of their involvement in MCI patient care versus availability to respond to urgent in-hospital events where patients incidentally deteriorate during the ongoing MCI response. This judicious consideration will be further evaluated in this chapter together with the considerations specific to the management of pediatric MCI casualties combined with appropriate ways to prepare and practice for these events.