Overlooked and Under protected: Addressing the Pediatric Gap in Venue Bags for Mass Casualty Response

Building a Culture of Total Preparedness

We train. We equip. We prepare. But somewhere in the rush to be ready, a critical population is too often left out—children. In the world of tactical medicine and mass casualty response, the pediatric patient remains underrepresented in training curricula, gear design, and venue bag contents. The assumption that “children aren’t likely victims” is not only flawed—it’s dangerous.

Recent active shooter events and mass casualty incidents have made one thing painfully clear: preparedness must include everyone, especially those least capable of saving themselves. The phrase “if it’s bleeding, plug it” has no age bracket. And yet, our venue bags—the primary gear resource for Medical Rescue Teams (MRTs) operating in hot and warm zones—are often packed with adult-centric tools that offer little utility when a child is the one bleeding.

This isn’t just a clinical oversight. It’s an ethical failure. If our response system doesn’t account for pediatric care in high-threat environments, then our readiness is incomplete. MRT leaders and agencies must take responsibility: audit your gear, update your protocols, and advocate for inclusive preparedness. Because the next casualty may not be six feet tall—it may be three.

The Pediatric Blind Spot in Mass Casualty Planning

Most venue bags are designed by adults, for adults. They’re optimized for high-volume trauma to adult limbs, torsos, and airways. Tourniquets are sized for standard extremities. NPA sizes rarely drop below 26–28 French. Chest seals are built for broad rib cages. The assumption, often unstated, is that these tools will be “good enough” for everyone.

But pediatric patients aren’t just smaller—they’re different. Their physiology, psychology, and treatment priorities diverge significantly from adults. A tourniquet that fits a 30-year-old male will slide uselessly over a five-year-old’s thigh. A needle decompression kit meant for a broad chest wall may cause more harm than good in a small child.

These gaps aren’t academic—they are lethal in a mass casualty environment, where chaos, resource limits, and time constraints amplify every weakness in our planning.

What the Data Tells Us

School shootings, daycare violence, and public events involving children are no longer anomalies. From Sandy Hook to Uvalde, the data is heartbreaking and indisputable: children are targeted, and when they are injured, their chances of survival hinge on immediate, skilled care delivered with age-appropriate tools.

According to the Committee on Tactical Combat Casualty Care (CoT-CCC), uncontrolled hemorrhage remains the leading cause of preventable death in both adult and pediatric trauma. And yet, few venue bags are equipped with even the simplest solutions for pediatric hemorrhage control.

ACE Wraps: The $1 Solution That Saves Pediatric Lives

One of the simplest and most overlooked tools for pediatric bleeding is the ACE wrap. This common elastic bandage, when combined with focused pressure, can function as an effective hasty tourniquet for children—especially for those under age 10 whose limbs are too small for standard TQs.

Here’s what makes the ACE wrap indispensable in pediatric trauma care:

• Low Cost: Around $1 per unit, making bulk stocking affordable.

• Lightweight and Compact: Easy to store in any venue bag without compromising space.

• Highly Versatile: Can be used for pressure dressings, joint immobilization, and securing splints.

• Meets 1.5-inch Compression Standard: When applied correctly, it can generate sufficient pressure (30–50 mmHg) to stop bleeding without causing tissue necrosis.

• No FDA Expiration Date: Unlike many trauma tools, ACE wraps do not carry an FDA-imposed shelf life, allowing them to remain in kits indefinitely without routine replacement—reducing waste and saving money.

Every MRT venue bag should carry at least 10–12 ACE wraps. They’re not a substitute for commercial pediatric tourniquets—but they’re a reliable stopgap when seconds matter and the right-sized gear is unavailable.

Gear Audit: What’s Missing in Most MRT Venue Bags

To address the pediatric gap, MRT leaders must conduct a purposeful gear audit. Start with this checklist and ask: “If I had to treat five children under the age of 10 right now, could I?”

Critical Pediatric-Supportive Gear to Include:

• Pediatric-sized airway adjuncts (OPA small/medium)

• ACE wraps or 1.5-inch elastic bandages

• Small-sized chest seals or adaptable occlusive dressings

• Pediatric-Decompression Needles (Standard 20g/18g angios)

Pediatric Training: Not Just Gear, But Mindset

Gear alone won’t save a child. The responders using it must be trained, mentally prepared, and emotionally grounded in pediatric trauma care. MRT teams must include pediatric modules in their ongoing training cycles:

• Pediatric TECC integration: Focused on adapting MARCH to younger patients.

• Child casualty simulations: Use high-fidelity pediatric manikins or volunteers to simulate bleeding control, airway emergencies, and triage.

• Psychological prep: Address the emotional impact of treating children in mass casualty settings—a reality that can rattle even seasoned medics.

• MRT-family communication drills: Train on how to handle parent/caregiver interaction during an evolving crisis scene.

Preparedness isn’t just about what’s in the bag. It’s also about what’s in your head.

Updating Stop the Bleed for All Ages

The national Stop the Bleed program has made tremendous strides in public awareness and layperson empowerment. But the curriculum and associated kits often fail to account for pediatric application.

MRTs and public safety leaders must advocate for updates to Stop the Bleed training that reflect real-world needs:

• Include pediatric-specific bleeding control demonstrations.

• Provide ACE wrap demonstrations as a child-appropriate tool.

• Partner with school systems to educate staff on bleeding control in students.

• Offer pediatric-centric Stop the Bleed kits as part of school preparedness initiatives.

This isn’t about criticizing a program—it’s about evolving it. Children deserve more than a generic tourniquet tossed into a classroom cabinet.

Leadership Matters: MRTs Set the Tone

MRT leaders are more than just medics in charge—they are culture drivers. If pediatric readiness isn’t on the agenda, it won’t make it into the bags, the training, or the scene.

Leaders must:

• Review inventory every quarter with pediatric inclusion as a checklist item.

• Advocate to command staff for funding and policy updates.

• Assign pediatric response liaisons in training cells.

• Partner with pediatric specialists and trauma centers for feedback and best practices.

Because when the unthinkable happens—and we know it will again—your team’s readiness to treat children isn’t just about response. It’s about responsibility.

Conclusion: Total Preparedness Includes Every Life Stage

Pediatric readiness in mass casualty response is not a special add-on. It’s not a luxury. It’s a foundational requirement of any system claiming to be fully prepared. Children are not small adults. They have unique needs, vulnerabilities, and survivability profiles. If MRTs and public safety systems ignore that, they’re not prepared—they’re hoping.

From ACE wraps to airway adjuncts, from training protocols to trauma psychology, we must close the pediatric gap. MRTs are the frontline of bleeding control. Let’s make sure they’re equipped to treat the smallest and most vulnerable among us—not just the ones who fit adult gear.

Preparedness that excludes children is not preparedness at all. And in the moment that matters most, the difference between “we did our best” and “we weren’t ready” will come down to whether your venue bag was packed with everyone in mind.