1. Small Victims, Big Challenges:
Refining Pediatric Disaster Triage
Algorithms and Education in the
Pre-Hospital Setting
Linda Brown MD, MSCE
lbrown8@lifespan.org
Mark Cicero, MD, Frank Overly, MD, Jorge
Yarzebski BA, Marc Auerbach MD, MS,
Antonio Riera, MD, Eric Goedecke DO, David
Cone MD, and Carl Baum MD

2. Background
• Disasters have a potentially devastating effect on
children
• Triage strategies: JumpSTART, Smart, Sacco, SALT
– Unique physiology/developmental considerations
– How best to teach pediatric disaster triage (PDT)?
– How triage strategy impacts clinical outcomes of child
disaster victims?
– No direct comparison of these strategies has yet been
completed
• Mark Cicero, MD
– PI on EMS-C targeted issues grant, 2011
– PRIDE (pediatric research in disaster education)

3. PICO Question
• Population
– Paramedics and paramedic students from CT, RI, MA
• Intervention
– Bundled: Simulated disaster scenarios followed by expert
structured debriefing and standardized pediatric disaster learning
module
• Comparison
– Participants are compared against themselves in their
performance in “pre” and two “post” disaster scenarios at 2
weeks and 6 months
• Outcome
– Accuracy and efficiency in scenarios
– Global assessment of function (videotaped performance in
scenarios with expert review)
– Results of questionnaires

4. Approach
Educational intervention
1. Each paramedic: 10 patients in simulated house fire,
utilizing state’s triage algorithm
2. Facilitated debriefing (qualitative semi-structured
interviews)
3. Brief learning module

5. Pilot Year Results
• 14 experts developed 10-patient disaster
scenarios
• 93 participants enrolled
• Accuracy best with “black” versus others
– 92-99% black versus 51-63% yellow
• Global assessment of function improved from
1st to 2nd scenario (78.1% vs 82.9% p=0.002)

6. 3 Questions
• How to best create/modify a curriculum that is
engaging and effective?
• How best to manage difficulties with
standardization of actors/SPs, simulation
environment and facilitators?
• Plans for validation and dissemination???
– Funding, manikin-based vs web-based/VR?
lbrown8@lifespan.org