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Closing the Pediatric Preparedness Gap: Building and Sustaining a Comprehensive Pediatric Mass Casualty Incident Program
Pediatric mass casualty incidents (MCIs) are high-consequence, low-frequency events that present distinct operational, clinical, and family-centered challenges. However, pediatric-specific needs are often underrepresented in hospital preparedness programs, regional and surge planning initiatives. This presentation will examine commonly overlooked pediatric MCI challenges, including family reunification, caregiver communication, surge capacity, and multiagency coordination. Drawing on the transformation of our pediatric MCI preparedness program, this presentation demonstrates how a department-focused approach evolved into a hospital-wide effort. The organization established multidisciplinary planning structures, engaged operational and clinical leaders in pediatric disaster preparedness. Attendees will learn strategies for building leadership support, fostering collaboration, and sustaining preparedness programs. The session will highlight innovative pediatric MCI exercises that extend beyond traditional discussion-based formats. Utilizing real-time Emergency Department census data, participants managed patient-surge scenarios by physically moving simulated patients throughout the hospital using interactive exercise tools. Additional exercises included HICS activation drills and regional communications exercises that tested notifications, leadership coordination, and information sharing with regional partners. These activities reinforced the importance of a system-wide approach to pediatric MCI planning. Participants will gain practical tools for after-action reporting, improvement planning, and corrective-action tracking that translate lessons learned into measurable preparedness improvements. The session will emphasize transparent approaches that foster accountability and ownership of preparedness initiatives. Through real-world examples and discussion, participants will obtain practical strategies for advancing pediatric MCI preparedness from a departmental activity to a coordinated, hospital-wide program. Attendees will receive a roadmap for securing leadership buy-in, developing progressive exercise programs, and integrating pediatric considerations into disaster planning.
Hannah Hamilton-Hurwitz, MPH
Program Manager, Emergency Management, Boston Children’s Hospital
Ashley Miller, MPH
Manager, Emergency Preparedness and Response, Boston Children's Hospital
Hannah leads emergency preparedness, downtime planning, and resilience efforts across the enterprise. She serves as the Emergency Department liaison for all-hazards preparedness, including mass casualty incidents, infectious disease, and biocontainment planning and supports citywide and regional initiatives to strengthen pediatric family reunification through planning, training, and exercises. Prior to joining Boston Children’s, she worked with the World Health Organization and the Michigan Department of Health and Human Services on public health preparedness and emergency response. She is pursuing a Doctor of Public Health (DrPH) in Public Health Preparedness and Response at Emory University. Her dissertation research focuses on monitoring and evaluation in health emergency preparedness and response, emphasizing evidence-based approaches to measuring preparedness and response capabilities.
Ashley leads Boston Children’s Hospital’s emergency preparedness training and exercise program, overseeing exercise design, evaluation, and corrective action planning. She serves as a subject matter expert in emergency management and regularly functions as Planning Section Chief during Hospital Incident Command System (HICS) activations, providing operational leadership during emergency responses. She is actively engaged in regional preparedness initiatives, participating in the Boston area HMCC, the RDHRS Region 1 Pediatric Working Group, MAPLE Regional Pediatric Disaster Center, other hospital preparedness collaboratives. Prior to joining Boston Children’s, she served with the Boston Public Health Commission’s Office of Public Health Preparedness, where she developed and delivered preparedness training across multiple learning platforms.