Pediatric patients present distinct developmental, psychosocial, and clinical challenges during high-consequence infectious disease (HCID) transport. Despite these differences, national biocontainment transport systems have historically been designed around adult patients, resulting in limited pediatric-specific guidance and operational experience.

The aim of this study was to describe pediatric-specific observations from the inaugural deployment of the US Department of Health and Human Services’ (HHS) Portable Biocontainment Unit (PBCU) during a national full-scale exercise and to identify considerations relevant to pediatric-inclusive HCID transport.

A qualitative, observational evaluation was conducted during the 2025 Tranquil Passport Full-Scale Exercise. Data sources included structured interviews with pediatric actors and caregivers, evaluator observations, and facilitated multi-disciplinary debriefings. Pediatric participants simulated biocontainment transport scenarios within the PBCU across multiple sites and phases of care.

Pediatric transport within the PBCU required advance planning to address developmental, psychosocial, and physiologic needs distinct from adult care. Pediatric participants frequently described confusion or anxiety related to noise, vibration, movement, and the appearance of personnel in personal protective equipment (PPE). Communication challenges associated with masked voices were reported. Caregiver separation due to infection-control requirements was consistently described as stressful. Clinical teams identified benefits of pediatric-specific medication dosing guides and essential medication sets within the confined biocontainment environment.

This inaugural deployment of the PBCU with pediatric participants identified key operational and psychosocial considerations relevant to pediatric-inclusive HCID transport. Findings supported the need for deliberate integration of pediatric-specific planning, communication strategies, and resources within biocontainment transport systems. These observations may also inform pediatric HCID transport planning in international settings where similar challenges are encountered.