Disaster management among pediatric surgeons: Preparedness, training and involvement


  • Nikunj K. Chokshi, MD
  • Solomon Behar, MD
  • Alan L. Nager, MD, FAAP
  • Fred Dorey, PhD
  • Jeffrey S. Upperman, MD, FAAP, FACS




disaster training, pediatric surgery, mass casualty, trauma


Introduction: Contemporary events in the United States (eg, September 2001, school shootings), Europe (eg, Madrid train bombings), and the Middle East have raised awareness of mass casualty events and the need for a capable disaster response. Recent natural disasters have highlighted the poor preparation and infrastructure in place to respond to mass casualty events. In response, public health policy makers and emergency planners developed plans and prepared emergency response systems. Emergency response providers include first responders, a subset of emergency professionals, including firemen, law enforcement, paramedics, who respond to the incident scene and first receivers, a set of healthcare workers who receive the disaster victims at hospital facilities. The role of pediatric surgeons in mass casualty emergency response plans remains undefined. The authors hypothesize that pediatric surgeons’ training and experience will predict their willingness and ability to be activated first receivers. The objective of our study was to determine the baseline experience, preparedness, willingness, and availability of pediatric surgeons to participate as activated first receivers.
Methods: After institutional review board approval, the authors conducted an anonymous online survey of members of the American Pediatric Surgical Association in 2007. The authors explored four domains in this survey: (1) demographics, (2) disaster experience and perceived preparedness, (3) attitudes regarding responsibility and willingness to participate in a disaster response, and (4) availability to participate in a disaster response. The authors performed univariate and bivariate analyses to determine significance. Finally, the authors conducted a logistic regression to determine whether experience or preparedness factors affected the respondent’s availability or willingness to respond to a disaster as a first receiver.
Results: The authors sent 725 invitations and received 265 (36.6 percent) completed surveys. Overall, the authors found that 77 percent of the respondents felt “definitely” responsible for helping out during a disaster but only 24 percent of respondents felt “definitely” prepared to respond to a disaster. Most felt they needed additional training, with 74 percent stating that they definitely or probably needed to do more training. Among experiential factors, the authors found that attendance at a national conference was associated with the highest sense of preparedness. The authors determined that subjects with actual disaster experience were about four times more likely to feel prepared than those with no disaster experience (p < 0.001). The authors also demonstrated that individuals with a defined leadership position in a disaster response plan are twice as likely to feel prepared (p _ 0.002) and nearly five times more willing to respond to a disaster than those without a leadership role. The authors found other factors that predicted willingness including the following: a contractual agreement to respond (OR 2.3); combat experience (OR 2.1); and prior disaster experience (OR 2.0). Finally, the authors found that no experiential variables or training types were associated with an increased availability to respond to a disaster.
Conclusions: A minority of pediatric surgeons feel prepared, and most feel they require more training. Current training methods may be ineffectual in building a prepared and willing pool of first receivers. Disaster planners must plan for healthcare worker related issues, such as transportation and communication. Further work and emphasis is needed to bolster participation in disaster preparedness training.

Author Biographies

Nikunj K. Chokshi, MD

Research Fellow, Pediatric Surgery, Department of Pediatric Surgery, Childrens Hospital Los Angeles, Los Angeles, California.

Solomon Behar, MD

Assistant Professor of Pediatrics, Division of Emergency Medicine, Childrens Hospital Los Angeles, Los Angeles, California.

Alan L. Nager, MD, FAAP

Clinical Associate Professor of Pediatrics, Division of Emergency Medicine, Childrens Hospital Los Angeles, Los Angeles, California.

Fred Dorey, PhD

Director of Biostatistics Core, Department of Pediatrics, Childrens Hospital Los Angeles, Los Angeles, California.

Jeffrey S. Upperman, MD, FAAP, FACS

Associate Professor of Surgery, Department of Pediatric Surgery, Childrens Hospital Los Angeles, Los Angeles, California.


Wise RA: The creation of emergency health care standards for catastrophic events. Acad Emerg Med. 2006; 13: 1150-1152.

Koenig KL: Strip and shower: The duck and cover for the 21st century. Ann Emerg Med. 2003; 42: 391-394.

Markenson D, Reynolds S: The pediatrician and disaster preparedness. Pediatrics. 2006; 117: e340-e362.

Sterling DA, Clements B, Rebmann T, et al.: Occupational physician perceptions of bioterrorism. Int J Hyg Environ Health. 2005; 208(1/2): 127-134.

Qureshi K, Gershon RR, Sherman MF, et al.: Health care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005; 82: 378-388.

Potoka DA, Schall LC, Gardner MJ, et al.: Impact of pediatric trauma centers on mortality in a statewide system. J Trauma. 2000; 49: 237-245.

Potoka DA, Schall LC, Ford HR: Improved functional outcome for severely injured children treated at pediatric trauma centers. J Trauma. 2001; 51: 824-832; discussion 832-824.

Graham J, Shirm S, Liggin R, et al.: Mass-casualty events at schools: A national preparedness survey. Pediatrics. 2006; 117: e8-e15.

Martin SD, Bush AC, Lynch JA: A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs. Pediatrics. 2006; 118: e620-e626.

Qureshi KA, Gershon RR, Merrill JA, et al.: Effectiveness of an emergency preparedness training program for public health nurses in New York City. Fam Community Health. 2004; 27: 242-249.

Balicer RD, Omer SB, Barnett DJ, et al.: Local public health workers’ perceptions toward responding to an influenza pandemic. BMC Public Health. 2006; 6: 99.

Qureshi KA, Merrill JA, Gershon RR, et al.: Emergency preparedness training for public health nurses: A pilot study. J Urban Health. 2002; 79: 413-416.

Rivara FP, Nathens AB, Jurkovich GJ, et al.: Do trauma centers have the capacity to respond to disasters? J Trauma. 2006; 61: 949-953.

Kyle RR,Via DK, Lowy RJ, et al.: A multidisciplinary approach to teach responses to weapons of mass destruction and terrorism using combined simulation modalities. J Clin Anesth. 2004; 16: 152-158.

Hirshberg A, Holcomb JB, Mattox KL: Hospital trauma care in multiple-casualty incidents: A critical view. Ann Emerg Med. 2001; 37: 647-652.

Syrett JI, Benitez JG, Livingston WH III, et al.:Will emergency health care providers respond to mass casualty incidents? Prehosp Emerg Care. 2007; 11: 49-54.

Alexander GC, Larkin GL,Wynia MK: Physicians’ preparedness for bioterrorism and other public health priorities. Acad Emerg Med. 2006; 13: 1238-1241.

Conway-Welch C: Educational competencies for registered nurses responding to mass casualty incidents. In Colleen Conway- Welch P (ed.): Nursing Curriculum Plan for Emergency Preparedness. Nashville:Vanderbilt University School of Nursing, 2007.

Gebbie K, Merrill J: Public health worker competencies for emergency response. J Public Health Manag Pract. 2002; 8: 73-81.

Hsu EB, Thomas TL, Bass EB,Whyne D, et al.: Healthcare worker competencies for disaster training. BMC Med Educ. 2006; 6: 19.

Markenson D, DiMaggio C, Redlener I: Preparing health professions students for terrorism, disaster, and public health emergencies: Core competencies. Acad Med. 2005; 80: 517-526.

Psoter WJ, Herman NG, More FG, et al.: Proposed educational objectives for hospital-based dentists during catastrophic events and disaster response. J Dent Educ. 2006; 70: 835-843.

Hsu EB, Jenckes MW, Catlett CL, et al.: Effectiveness of hospital staff mass-casualty incident training methods: A systematic literature review. Prehosp Disaster Med. 2004; 19: 191-199.

Adini B, Goldberg A, Laor D, et al.: Assessing levels of hospital emergency preparedness. Prehosp Disaster Med. 2006; 21: 451-457.




How to Cite

Chokshi, MD, N. K., S. Behar, MD, A. L. Nager, MD, FAAP, F. Dorey, PhD, and J. S. Upperman, MD, FAAP, FACS. “Disaster Management Among Pediatric Surgeons: Preparedness, Training and Involvement”. American Journal of Disaster Medicine, vol. 3, no. 1, Jan. 2008, pp. 5-14, doi:10.5055/ajdm.2008.0001.

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