Hospital preparedness exercises for paediatric mass casualty incidents: a systematic review

Introduction: Mass casualty incidents (MCIs) present a global threat to civilians, with children often being affected and sometimes even targeted; however, there is little research regarding the preparedness exercises of healthcare professionals for such events.

Methods: A systematic search of PubMed, Web of Science and Embase from inception up to July 2025, was conducted. Risk of bias was also assessed using the risk of bias in non-randomised studies of interventions exposure (ROBINS E) tool.

Results: The initial search generated 223 results, and following double screening and manual citation searching, 17 observational studies were selected for narrative synthesis, since numerical data to perform meta-analysis were unavailable. The review identified a broad range of training interventions tailored for paediatric MCIs. Both brief, frequent drills and longer, mixed methods training schemes were effective, yielding gains in specific skills and a holistic sense of preparedness, including teamwork and communication. These improvements were often sustained for up to 6 months, despite a common limitation of lost to follow-up. However, the overall risk of bias in the included studies were high to very high.

Discussion: MCI educational schemes appear to improve all aspects of preparedness. However, the evidence is heterogeneous, lacked standardisation in the outcome measures and contained high to very high risk of bias, suggesting that the current evidence cannot support definitive recommendations. Future research should aim to conduct high-quality studies with standardised outcome assessment tools to optimise paediatric MCI preparedness.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251084048.