Hospital Disaster Preparedness and Response to a Pediatric Mass Casualty Incident in Central India: A Retrospective Quality Improvement Analysis

Background Mass casualty incidents (MCIs) place extreme demands on health systems, and pediatric victims introduce additional physiological and psychosocial challenges. Although disaster preparedness principles are well described, reports of coordinated pediatric MCI responses from India remain limited. On 26 November 2024, a school bus accident near Nagpur led to the simultaneous arrival of 49 casualties at a tertiary trauma center. This study uses retrospective operational data to evaluate hospital surge capacity, triage, imaging workflow, and clinical outcomes and interprets these findings in relation to selected published reports on MCI response. Methods A retrospective observational analysis was conducted using hospital operational logs, emergency department triage records, and electronic medical data for all 49 patients. Variables included notification time, arrival pattern, triage categories, resource utilization, imaging volumes, operative interventions, and clinical outcomes. Categorical data are presented as frequencies and percentages. Findings were interpreted descriptively in relation to selected published MCI reports; no formal statistical benchmark comparison was performed. Results The hospital received the alert at 10:15 AM and immediately activated its MCI protocol. Forty-nine casualties (46 students, two volunteers, and one teacher) arrived in rapid succession. A 50-bed surge ward was established, and multidisciplinary teams were mobilized. Baseline imaging evaluation was performed for 48 patients, excluding one patient who was brought dead; 26 patients required computed tomography. One emergency laparotomy for bladder rupture and two operative reductions with internal fixation were performed. Minor procedures included 22 wound dressings, seven sutures, three splint applications, and one foreign body removal (33 minor procedures in total). Within 24 hours, 42 patients (85.7%) were discharged, including one patient discharged against medical advice; six patients (12.2%) required hospital admission, including one pediatric intensive care unit admission following emergency bladder rupture repair, and one patient (2.0%) was brought dead. No in-hospital deaths occurred. Conclusion Early activation of a structured disaster plan, rapid surge expansion, coordinated triage with pediatric adaptations, prioritized imaging, and multidisciplinary collaboration were observed during this pediatric MCI response. The high same-day discharge rate and absence of in-hospital mortality among patients arriving alive suggest that institutional preparedness and surge strategies may support MCI response, although causal attribution is limited by the descriptive design and lack of severity-adjusted comparison.