Background: Children represent 25% of the population, have special needs and are often over-represented in disasters. The New York City Pediatric Disaster Coalition (NYC PDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve NYC’s pediatric disaster preparedness and response. PDC worked with a network of pediatric intensivists to create the Pediatric Intensive-Care Response Team (PIRT). PIRT consists of volunteer pediatric intensivists that currently practice throughout New York City. Methods: The purpose of the PIRT in the draft NYC Pediatric Disaster Plan is to provide prioritization triage services to the agency responsible for inter-facility secondary transport of patients during large-scale disasters. Secondary transport may be requested by hospitals due to a mismatch of resources to needs for patients requiring critical and or subspecialty care. The team is activated when a disaster involves a significant number of pediatric patients. In the proposed plan, the PIRT physician on-call will triage/prioritize the patients based on acuity and need for services and relay the necessary information to the transport agency. PIRT is designated to provide subject matter expertise and resources during real-world events. PIRT maintains a 24/7 on-call schedule with backup. Results: The PIRT system was tested in four call-down communications drills that demonstrated the ability to contact the on call and backup physicians by e-mail or text within 20 minutes and others within one hour. Text was the preferred method of communications. PIRT conducted a tabletop exercise for pediatric mass casualty incidents. The objective was to demonstrate PIRT’s ability to prioritize pediatric patients for secondary transport. The PIRT team members were given 15 patient profiles based on the scenario and asked to sort patients based on their injuries and medical needs. This was accomplished in less than 30 minutes, followed by a review and discussion of the rank order. Outcomes included: • The cases forced the team to make difficult decisions, which were beneficial for preparing for a real incident. • PIRT physicians were successfully able to receive the patient information in a timely manner and efficiently triaged each case by category and special needs. Lessons learned include: • Real time situational awareness, knowledge of resource availability, and ethical considerations should be utilized for prioritization decision making. • A PIRT communications list serve/rapid access group communications tool would benefit the response, providing backup assistance, member input and issue resolution • Telemedicine interaction between PIRT physicians and transferring and receiving hospitals would facilitate patient transfer Conclusion: In conclusion, the NYCPDC has developed a PIRT that is available 24/7 to prioritize patients for secondary transport and offer subject matter expertise during Pediatric Mass Casualty Events. This model can be utilized to enhance pediatric disaster preparedness.