PC3041: A Modified Table Top Exercise via Group Email to Promote and Assess Community Pediatric Mass Casualty Preparedness

Background: Table top exercise is an invaluable tool that is defined by United States federal emergency management agency as a facilitated analysis of an emergency situation. There is great variability in the design and conduction of table top exercises. During the pandemic, with workforce challenges, it was more challenging to organize times for in-person or virtual discussions. This abstract explores the feasibility of a modified table top exercise through group email discussion of the readiness of our local frontline providers to a mass casualty event involving infants and toddlers.

Methods: A scenario involving a shooting event at a daycare was designed by a pediatric emergency medicine physician with limited experience and knowledge in pediatric disaster preparedness for our urban community with a population of 120,000. The scenario was emailed to a state emergency medical service (EMS) medical director, two EMS managers, three EMS medical director, and an EMS educator at two level 1 trauma hospitals to solicit their knowledge of what the initial responses would be from police, fire and paramedics for our community. This form of communication was required since it occurred during the shelter-at-home phase of the SARS-CoV-2 pandemic.

Results: Group email was effective in soliciting input from a state EMS medical director, EMS managers and EMS medical directors from two different community hospital systems. Individual responses and comments were more likely to occur when the scenario was sent to one person at a time, as opposed to the whole group. Some suggestions that improved response rate involved adding diagrams of the floor plans and putting the victims and their injuries in a table format. Areas of opportunities to improve pediatric disaster awareness and preparedness fell into categories of 1. Communication between first responders (dispatch, police, fire, ambulance, and hospital liaisons), 2. Pediatric management (medical and non-medical such as behavioral or transport issues) and supplies, 3. Tracking and Reunification of the non-verbal pediatric patients, and 4. Mental health support for patients and their families, frontline responders, and daycare staff.

Conclusion: Our modified table top exercise, via group email, for a mass casualty incident involving infants and toddlers was successful in identifying numerous issues and questions in our community pediatric disaster response. A level of trust is required for a successful table top exercise. In our modified strategy of emailing individuals directly and collating people’s responses, an interactive discussion ensued and issues were identified. Future directions include further building of relationships and collaborating with these other entities, with a focus on education about pediatric specific issues during a disaster, and organizing of a full scale exercise to further promote and identify pediatric disaster preparedness needs.