A tabletop school bus rollover: Connecticut-wide drills to build pediatric disaster preparedness and promote a novel hospital disaster readiness checklist


  • Mark X. Cicero, MD
  • Klevi Golloshi, BS
  • Marcie Gawel, MSN
  • James Parker, MD
  • Marc Auerbach, MD, MSci
  • Pina Violano, PhD, MSPH, RN-BC, CCRN




tabletop exercise, statewide disaster coalition, EMS, disaster education


Objective: To assess emergency medical services (EMS) and hospital disaster plans and communication and promote an integrated pediatric disaster response in the state of Connecticut, using tabletop exercises to promote education, collaboration, and planning among healthcare entities.

Design: Using hospital-specific and national guidelines, a disaster preparedness plan consisting of pediatric guidelines and a hospital checklist was created by The Connecticut Coalition for Pediatric Disaster Preparedness.

Setting: Five school bus rollover tabletop exercises were conducted, one in each of Connecticut’s five EMS regions. Action figures and playsets were used to depict patients, healthcare workers, vehicles, the school, and the hospital.

Participants: EMS personnel, nurses, physicians and hospital administrators.

Intervention: Participants had a facilitated debriefing of the EMS and prehospital response to disasters, communication among prehospital organizations, public health officials, hospitals, and schools, and surge capacity, capability, and alternate care sites. A checklist was completed for each exercise and was used with the facilitated debriefing to generate an after-action report. Additionally, each participant completed a postexercise survey.

Main Outcome Measures: Each after-action report and postexercise survey was compared to established guidelines to address gaps in hospital specific pediatric readiness.

Results: Exercises occurred at five hospitals, with inpatient capacity ranging 77-1,592 beds, and between 0 and 221 pediatric beds. There were 27 participants in the tabletop exercises, and 20 complete survey responses for analysis (74 percent). After the exercises, pediatric disaster preparedness aligned with coalition guidelines. However, methods of expanding surge capacity and methods of generating surge capacity and capability varied (p < 0.031).

Conclusion: Statewide tabletop exercises promoted coalition building and revealed gaps between actual and ideal practice. Generation of surge capacity and capability should be addressed in future disaster education.

Author Biographies

Mark X. Cicero, MD

Associate Professor, Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut

Klevi Golloshi, BS

Yale Molecular, Cellular and Developmental Biology, Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut

Marcie Gawel, MSN

Injury Prevention, Community Outreach, and Research, Yale-New Haven Children’s Hospital, New Haven, Connecticut

James Parker, MD

Associate Professor, Pediatrics and Emergency Medicine/Traumatology, University of Connecticut School of Medicine, Hartford, Connecticut

Marc Auerbach, MD, MSci

Associate Professor, Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut

Pina Violano, PhD, MSPH, RN-BC, CCRN

Manager, Injury Prevention, Community Outreach, and Research, Yale-New Haven Children’s Hospital, New Haven, Connecticut


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How to Cite

Cicero, MD, M. X., K. Golloshi, BS, M. Gawel, MSN, J. Parker, MD, M. Auerbach, MD, MSci, and P. Violano, PhD, MSPH, RN-BC, CCRN. “A Tabletop School Bus Rollover: Connecticut-Wide Drills to Build Pediatric Disaster Preparedness and Promote a Novel Hospital Disaster Readiness Checklist”. American Journal of Disaster Medicine, vol. 14, no. 2, Apr. 2019, pp. 75-87, doi:10.5055/ajdm.2019.0318.




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