Completing the Disaster Cycle for Children in CBRN Events: Introducing the Pediatric After-Action Report for Radiation and Nuclear Incidents.

OBJECTIVE: Radiation and nuclear (R/N) incidents disproportionately threaten children due to biological sensitivity and psychosocial vulnerability. No standardized tool exists for systematic evaluation of pediatric response during post-incident Recovery. This paper introduces a specialized Pediatric After-Action Report (PAAR) template to address this gap. METHOD: The Pediatric After-Action Report (PAAR) template was developed by synthesizing disaster cycle principles, pediatric disaster medicine literature, and documented operational gaps from R/N incidents. Core functional domains were identified and structured into analytical and corrective action frameworks tailored to R/N-specific pediatric challenges. RESULTS: The PAAR provides a comprehensive instrument for evaluating pediatric response across radiation-specific triage, age-appropriate medical countermeasures, prolonged sheltering, mental health interventions, family reunification, and risk communication. Each domain includes targeted questions linked to a corrective action framework assigning responsibilities and timelines to translate findings into improved preparedness. This PAAR addresses a critical omission in CBRN disaster management. CONCLUSION: By enabling rigorous pediatric-focused after-action review, it ensures children's unique needs are systematically assessed and continuously improved. Its integration into exercise cycles and real-incident recovery is essential to closing the disaster cycle for the most vulnerable population.