Introduction: Following a disaster, up to 50% of mass casualties are
children. The number of disaster increases worldwide, including in
Switzerland. Following national order, the mapping of the various
risks of disaster in Switzerland will be completed by the end of 2012.
Pre-hospital disaster drills and plans are well established and regularly
tested. In-hospital disaster plans are much less frequently tested, if
only available. Pediatric in-hospital full scale disaster exercises have
never been reported in Switzerland. Based on our local constraints, we
set up and evaluated a disaster plan during two full scale exercises.
Methods: In a university hospital treating more than 35 000 pediatric
emergencies per year, two exercises involving mock victims of a
disaster aged 9 to 14 years old were successively set up over a period
of 3 years. The exercises were planned during the day, without
modification of the normal emergency room activities. The hospital
staff was informed and trained in advance. Variables such as the alarm
timing and transmission, triage set-up and function, special disaster
medical records utilization, communication and victims' identification
were assessed. Family members participated in the second exercise.
An evaluation team observed and record exercises activities,
identifying strength and weaknesses.
Results: On two separate occasions, a total of 44 mock patients
participated, were triaged, admitted and treated in the hospital
according to usual standards of care. Alarm transmission was not
appropriate during the first exercise. Triage overload occurred on one
occasion. In-hospital communication needed readjustment.
Identification and in-hospital tracking of the children remained
problematic. Hospital employees showed great enthusiasm and
stressed the positive effect of full scale exercises on their knowledge
of the hospital disaster plan.
Conclusions: Performing real life disaster exercises in a pediatric
hospital was very beneficial. The disaster plan was adapted to local
needs and updated accordingly. An alarm transmission protocol was
elaborated and tested. Triage set-up was adapted and tested. A
hospital identification plan for injured children was created and tested.
Full scale hospital exercises evaluating disaster plans revealed several
weaknesses in the system. Practice readjustments based on local
experience were made. A tested pediatric disaster plan adapted to
local constraints could minimize chaos, optimize care and support in
the event of a real disaster. Children's identification and family
reunification following a disaster remains a challenge.