Addressing the Pediatric Gap in Venue Bags for Mass Casualty Response

In the world of tactical and mass casualty response, Medical Response Teams (MRTs) pride themselves on readiness. They train hard, gear up, and prepare to move toward danger when others are moving away. Venue or casualty bags—built to treat 10 to 15 critically injured victims—are becoming more common across EMS, fire, and law enforcement integrations. These bags are designed to deliver rapid point-of-care treatment in chaotic, high-threat environments.

But amid the tourniquets, hemostatic agents, and chest seals, there’s a glaring omission that few MRTs are addressing:

Where is the pediatric gear?

A Dangerous Oversight

Whether the mass casualty incident unfolds in a school, a mall, a church, or a sports venue, the probability of pediatric casualties is not theoretical—it’s real. Yet most venue bags are designed entirely around adult trauma care, with very little consideration for treating children under 14.

Even many of the “Stop the Bleed” kits deployed in schools are built to support victims aged 14 and up, following adult sizing standards. That leaves a significant portion of the population—children in elementary and early middle school—without appropriately sized hemorrhage control tools in an emergency.

And here's the hard truth: there is no such thing as a commercially available pediatric tourniquet. None currently exist that are FDA-approved or field-tested for small limbs in children under 8 years old.

So, what do we do when the smallest victims need the same life-saving care?

The Myth of the “Universal” Tourniquet

Most tactical tourniquets on the market today—including CATs and SOFT-Ts—are excellent tools for adult limb hemorrhage. They’re built to be applied with one hand under stress, and they perform well when used correctly. But even the best tourniquet can fail if it's the wrong size for the patient.

For smaller children—especially those under 60 pounds—adult tourniquets often cannot achieve circumferential compression. They slip. They require awkward wrapping. They take longer to apply. In the worst-case scenarios, they don’t work at all.

Simply packing more CATs in the bag doesn’t solve the problem. We need a pediatric-capable alternative for hemorrhage control that’s practical, scalable, and proven in austere care environments.

The Field Solution: 1.5-Inch ACE Wraps

ACE wraps offer a lightweight, compact, and highly effective hasty tourniquet solution for pediatric extremity hemorrhage. In children, effective control of brachial or femoral artery bleeding typically requires only 30–50 mmHg of pressure—a significantly lower threshold than that needed for adults. Unfortunately, most commercial tourniquets are too large to effectively compress small pediatric limbs and are not designed to accommodate their anatomy.

A 1.5-inch elastic ACE wrap provides a proven alternative. When applied correctly, it delivers adequate pressure to stop life-threatening bleeding and, critically, meets the minimum recommended tourniquet width to help reduce the risk of tissue necrosis, nerve injury, and arterial damage. Narrower materials or improvised solutions can cause focal pressure points, increasing the chance of permanent harm to the limb. The 1.5-inch width helps distribute pressure evenly, making it safer for pediatric application during prolonged field use.

The application is simple and effective:

1.      Wrap the limb high and tight or 2–3 inches above the wound, placement is no different than a commercial tourniquet.

2.      Continue with firm, overlapping layers, tightening until visible bleeding is controlled.

3.      Reassess to confirm the absence of a distal pulse and ensure hemorrhage has stopped.

This technique is quick, intuitive, and employs tools already familiar to MRTs. Most importantly, it addresses a significant capability gap in pediatric trauma care where no commercial pediatric tourniquet currently exists.

In every venue bag I assemble, I carry 10 to 12 ACE wraps, clearly marked for pediatric use. They’re lightweight, inexpensive, and highly reliable under real-world conditions. Until a dedicated pediatric tourniquet is developed and widely available, the 1.5-inch ACE wrap remains the most practical and clinically appropriate tool for controlling life-threatening bleeding in children—without introducing the added risks of tissue necrosis, nerve damage, or arterial injury caused by improperly sized or overly narrow devices.

Why It Matters

If MRTs are going to be inserted into schools, youth venues, and public spaces where children are present, we must be equipped to treat them. Ignoring pediatric casualties during preplanning is not just an oversight, it’s a failure of mission.

Hemorrhage is the leading cause of preventable death in trauma, and this applies just as much to children as it does to adults. If we can’t stop the bleeding in the field, our chances of saving pediatric lives drop to near zero—regardless of how fast the transport or how advanced the hospital care.

This isn't about building a pediatric-specific bag. It's about integrating pediatric-capable tools into the standard loadout, so MRTs don’t have to think twice in the middle of a crisis. A small stack of ACE wraps in a labeled pouch can make all the difference—without increasing the weight or cost of your kit in any significant way.

Action Steps for MRT Leaders and Instructors

If you're responsible for developing MRT capability, updating your agency’s venue bags, or teaching tactical medicine, now is the time to act. Here are some immediate changes to consider:

• Audit Your Venue Bags: Do they contain tools capable of treating small children? If not, revise your packing list.

• Add ACE Wraps (1.5-inch): Include at least 5–10 wraps, clearly marked for pediatric use.

• Train on Pediatric Hemorrhage Control: Include pediatric-focused wound packing and ACE wrap application in TECC training scenarios.

• Label Pediatric Capable Kits: Use color-coded pouches or labels so responders can find them quickly under stress.

• Push for Pediatric Inclusion in “Stop the Bleed” Programs: Advocate for gear and training updates in schools and public buildings.

Conclusion: Prepared Means Everyone

We cannot call ourselves “prepared” if we fail to account for our most vulnerable patients. In every school shooting, every large-scale event involving families, the reality is the same: children will be among the casualties. And when they are, we must be ready.

A venue bag is more than a collection of trauma supplies—it’s a lifeline for multiple people in the worst moments of their lives. If we exclude pediatric considerations from our planning, we’re writing off those who most depend on our protection.

There may not be a pediatric tourniquet on the market yet—but that doesn't mean we are without options. A $1 ACE wrap could be the tool that saves a child’s life—if we’re smart enough to carry it, and trained enough to use it.

Preparedness is not about checking a box. It’s about anticipating what could happen—and building our systems around the people we may have to save. That includes kids.