Emergency drills and exercises in healthcare organizations: Assessment of pediatric population involvement using after-action reports


  • Rizaldy R. Ferrer, PhD
  • Marizen Ramirez, PhD, MPH
  • Kori Sauser, MD
  • Ellen Iverson, MPH
  • Jeffrey S. Upperman, MD, FACS, FAAP




pediatric population, drills, emergency, disaster preparedness, after-action reports


Background: Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires healthcare organizations to demonstrate disaster preparedness through the use of disaster exercises, the evaluation of pediatric preparations is often lacking. Our investigation identified, described, and assessed pediatric victim involvement in healthcare organizations’ disaster drills and exercises using data from after-action reports.
Methods: Following the IRB approval, the authors reviewed the after-action reports generated by healthcare organizations after a disaster drill and exercise, as a self-assessed reporting tool for JCAHO regulations. Forty-nine of these reports that were voluntarily supplied to the emergency medical services agency were collected. The authors analyzed the data using quantitative and qualitative analytic approaches.
Results: Only nine reports suggested pediatric involvement. Hospitals with large bed capacity (M = 465.6) tended to include children in exercises compared with smaller facilities (M = 350.8). Qualitative content analysis revealed themes such as lack of parent–child identification and family reunification systems, ineffective communication strategies, lack of pediatric resources and specific training, and unfamiliarity with altering standards of pediatric care during a disaster.
Conclusions: Although many organizations are performing disaster exercises, most are not including pediatric concerns. Further work is needed to understand the basis for this gap in emergency preparedness. Overall, pediatric emergency planning should be a high priority for this vulnerable population.

Author Biographies

Rizaldy R. Ferrer, PhD

Research Analyst, Pediatric Disaster Resource and Training Center, Department of Pediatric Surgery, Childrens Hospital Los Angeles, Los Angeles, California.

Marizen Ramirez, PhD, MPH

Assistant Professor, Injury Prevention Research Center, Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa.

Kori Sauser, MD

Emergency Medicine, Northwestern Memorial Hospital, Chicago, Illinois.

Ellen Iverson, MPH

Associate Director, Community Health Outcomes and Intervention Research Program, The Saban Research Institute, Childrens Hospital Los Angeles, Los Angeles, California.

Jeffrey S. Upperman, MD, FACS, FAAP

Associate Professor, Department of Surgery, Childrens Hospital Los Angeles, University of Southern California/Keck School of Medicine, Los Angeles, California.


Garrett AL, Grant R, Madrid P, et al.: Children and megadisasters: Lessons learned in the new millennium. Adv Pediatr. 2007; 54: 189-214.

Hu YY,Adams RE, Boscarino JA, et al.: Training needs of pediatricians facing the environmental health and bioterrorism consequences of September 11th. Mt Sinai J Med. 2006; 73: 1156-1164.

Markenson D, Redlener I: Pediatric preparedness for disasters and terrorism. A National Consensus Conference,Washington, DC; 2003: 1-45.

Shirm S, Liggin R, Dick R, et al.: Prehospital preparedness for pediatric mass-casualty events. Pediatrics. 2007; 120: e756-e761.

Gausche-Hill M, Schmitz C, Lewis RJ: Pediatric preparedness of US emergency departments: A 2003 survey. Pediatrics. 2007; 120: 1229-1237.

Kanter RK, Moran JR: Pediatric hospital and intensive care unit capacity in regional disasters: Expanding capacity by altering standards of care. Pediatrics. 2007; 119: 94-100.

Kaji A, Freeman C: Disaster Pediatric Survey Results and Recommendations. Los Angeles, CA: Emergency Medical Services Authority, 2006.

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.

Rassin M, Avraham M, Nasi-Bashari A, et al. Emergency department staff preparedness for mass casualty events involving children. Disaster Manag Response. 2007; 5: 36-44.

Chokshi NK, Behar S, Nager AL, et al.: Disaster management among pediatric surgeons: Preparedness, training and involvement. Am J Disaster Med. 2008; 3: 5-14.

Federal Emergency Management Agency: NIMS implementation activities for hospitals and healthcare systems. Available at www. fema.gov/pdf/emergency/nims/imp_hos.pdf. Accessed January 7, 2008.

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.

Klein KR, Brandenburg DC, Atas JG, et al.: The use of trained observers as an evaluation tool for a multi-hospital bioterrorism exercise. Prehosp Disaster Med. 2005; 20: 159-163.

Joint Commission on Accreditation of Healthcare Organizations: Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, Illinois: Joint Commission Resources, 2007.

Center for Health Policy Columbia University: Health Emergency Exercise Toolkit. New York, NY: Columbia University School of Nursing, 2007: 1-79.

California Office of Statewide Health Planning and Development: Data and reports. Available at http://oshpd.ca.gov/HID/DataFlow/ index.html. Accessed January 7, 2008.

Institute of Medicine, Committee on Pediatric Emergency Medical Services: Emergency Medical Services for Children. Washington, DC: National Academy Press, 1993.

Perry RW, Lindell MK: Preparedness for emergency response: Guidelines for the emergency planning process. Disasters. 2003; 27: 336-350.

Ballow S, Behar S, Claudius I, et al.: Hospital-based disaster preparedness for pediatric patients: How to design a realistic set of drill victims. Am J Disaster Med. 2008; 3: 1-10.

Braun BI, Darcy L, Divi C, et al.: Hospital bioterrorism preparedness linkages with the community: Improvements over time. Am J Infect Control. 2004; 32: 317-326.

Gildea JR, Etengoff S:Vertical evacuation simulation of critically ill patients in a hospital. Prehosp Disaster Med. 2005; 20: 243-248.

Gilmore GD, Schwan WR, McLaughlin MK: An assessment of emergency preparedness in western Wisconsin. WMJ. 2007; 106: 71-77.

Sexton KH, Alperin LM, Stobo JD: Lessons from Hurricane Rita: The University of Texas Medical Branch Hospital’s evacuation. Acad Med. 2007; 82: 792-796.

French ED, Sole ML, Byers JF: A comparison of nurses’ needs/ concerns and hospital disaster plans following Florida’s Hurricane Floyd. J Emerg Nurs. 2002; 28: 111-117.

Altered Standards of Care in Mass Casualty Events: Prepared by Health Systems Research Inc. under Contract No. 290-04-0010. AHRQ Publication No. 05-0043. Rockville,MD:Agency for Healthcare Research and Quality. Available at www.ahrq.gov/research/altstand/altstand.pdf. Accessed April 2005.



How to Cite

Ferrer, PhD, R. R., M. Ramirez, PhD, MPH, K. Sauser, MD, E. Iverson, MPH, and J. S. Upperman, MD, FACS, FAAP. “Emergency Drills and Exercises in Healthcare Organizations: Assessment of Pediatric Population Involvement Using After-Action Reports”. American Journal of Disaster Medicine, vol. 4, no. 1, Jan. 2009, pp. 23-32, doi:10.5055/ajdm.2009.0004.

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