Checklist use in evaluating pediatric disaster training


  • Rita V. Burke, PhD, MPH
  • Kathy Lehman-Huskamp, MD
  • Rachel E. Whitney, MD
  • Gitanjli Arora, MD, DTMH
  • Daniel B. Park, MD
  • Pamela Mar, MD
  • Mark X. Cicero, MD



checklist, disaster preparedness, disaster medicine, resident education, simulation


Objective: Disaster preparedness training has a small but growing part in medical education. Various strategies have been used to simulate disaster scenarios to safely provide such training. However, a modality to compare their effectiveness is lacking. The authors propose the use of checklists, which have been a standard in aviation safety for decades.

Design: Residents at four different academic pediatric residency programs volunteered to participate in tabletop simulation of a timed, pediatric disaster scenario. Resident teams were required to properly triage and manage simulated patients. Care intervention requests corresponding to each of the patients were recorded on a premade checklist.

Results: Thirty-six teams provided a total of 1,476 possible care intervention requests for three pediatric patients: one with crush injury, one with increased intracranial pressure, and a nonverbal child. Some interventions were more likely to be omitted than others, and some teams performed extra interventions. Twenty-five entries from the checklist intervention responses were missing, affecting three of the teams. On average, teams requested 65 percent, were prompted to request 11 percent, and missed 22 percent of all checklist interventions with only 2 percent of all items not being recorded. Chi-square tests were performed for each patient scenario using R software. Categories compared included total counts of “requested,” “prompted,” and “missed” responses. Chi-square values were all statistically significant (p value < 0.05).

Conclusions: In the checklist use during a tabletop disaster simulation, the authors have demonstrated that the checklist allows trainees to receive near immediate feedback. This training exercise provided them an opportunity to explore their own preparedness for a disaster scenario in a low-stress environment and allows for evaluation of such preparedness in a safe environment.

Author Biographies

Rita V. Burke, PhD, MPH

Children's Hospital Los Angeles, Division of Pediatric Surgery, Keck School of Medicine, University of Southern California, California; Keck School of Medicine, University of Southern California, Los Angeles, California.

Kathy Lehman-Huskamp, MD

Department of Pediatrics, Medical University of South Carolina, South Carolina

Rachel E. Whitney, MD

Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, Connecticut

Gitanjli Arora, MD, DTMH

Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California

Daniel B. Park, MD

Department of Pediatrics, Medical University of South Carolina, South Carolina

Pamela Mar, MD

Keck School of Medicine, University of Southern California, Los Angeles, California

Mark X. Cicero, MD

Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, Connecticut


Williams J, Nocera M, Casteel C: The effectiveness of disaster training for health care workers: A systematic review. Ann Emerg Med. 2008; 52(3): 211-22, 222.e1-2.

Bagatell S, Wiese J: The elite code grey team: A new model for residency preparedness and training in advance of a disaster. Am J Med Sci. 2008; 336(2): 174-178.

Jasper E, Berg K, Reid M, et al.: Disaster preparedness: What training do our interns receive during medical school? Am J Med Qual. 2013; 28(5): 407-413.

Martin SD, Bush AC, Lynch JA: A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs. Pediatrics. 2006; 118(3): e620-e626.

Ablah E, Tinius AM, Konda K: Pediatric emergency preparedness training: Are we on a path toward national dissemination? J Trauma. 2009; 67(2 suppl): S152-S158.

Cicero MX, Auerbach MA, Zigmont J, et al.: Simulation training with structured debriefing improves residents’ pediatric disaster triage performance. Prehosp Disaster Med. 2012; 27(3): 239-244.

Atack L, Parker K, Rocchi M, et al.: The impact of an online interprofessional course in disaster management competency and attitude towards interprofessional learning. J Interprof Care. 2009; 23(6): 586-598.

Leroy Heinrichs W, Youngblood P, Harter PM, et al.: Simulation for team training and assessment: Case studies of online training with virtual worlds. World J Surg. 2008; 32(2): 161-170.

Scott LA, Carson DS, Greenwell IB: Disaster 101: A novel approach to disaster medicine training for health professionals. J Emerg Med. 2010; 39(2): 220-226.

Steward D, Wan TT: The role of simulation and modeling in disaster management. J Med Syst. 2007; 31(2): 125-130.

Parsons SE, Carter EA, Waterhouse LJ, et al.: Improving ATLS performance in simulated pediatric trauma resuscitation using a checklist. Ann Surg. 2014; 259(4): 807-813.

Winters BD, Aswani MS, Pronovost PJ: Commentary: Reducingd iagnostic errors: Another role for checklists? Acad Med. 2011; 86(3): 279-281.

Ely JW, Graber ML, Croskerry P: Checklists to reduce diagnostic errors. Acad Med. 2011; 86(3): 307-313.

Arriaga AF, Bader AM, Wong JM, et al.: Simulation-based trial of surgical-crisis checklists. N Engl J Med. 2013; 368(3): 246-253.

Fusco FM, Schilling S, Puro V, et al.: EuroNHID checklists for the assessment of high-level isolation units and referral centres for highly infectious diseases: Results from the pilot phase of a European survey. Clin Microbiol Infect. 2009; 15(8): 711-719.

Smith PW, Boulter KC, Hewlett AL, et al.: Planning and response to Ebola virus disease: An integrated approach. Am J Infect Control. 2015; 43(5): 441-446.

Kaji AH, Coates W, Fung CC: A disaster medicine curriculum for medical students. Teach Learn Med. 2010; 22(2): 116-122.

Barkemeyer BM: Practicing neonatology in a blackout: The University Hospital NICU in the midst of Hurricane Katrina: Caring for children without power or water. Pediatrics. 2006; 117(5 Pt 3): S369-S374.

Berggren R: Hurricane Katrina. Unexpected necessities—Inside Charity Hospital. N Engl J Med. 2005; 353(15): 1550-1553.

Curiel TJ: Murder or mercyϿ. Hurricane Katrina and the need for disaster training. N Engl J Med. 2006; 355(20): 2067-2069.

Huntington MK, Gavagan TF: Disaster medicine training in family medicine: A review of the evidence. Fam Med. 2011; 43(1): 13-20.

Chokshi NK, Behar S, Nager AL, et al.: Disaster management among pediatric surgeons: Preparedness, training and involvement. Am J Disaster Med. 2008; 3(1): 5-14.

Rassin M, Avraham M, Nasi-bashari A, et al.: Emergency department staff preparedness for mass casualty events involving children. Disaster Manag Response. 2007; 5(2): 36-44.

Borron SW: Checklists for hazardous materials emergency preparedness. Emerg Med Clin North Am. 2015; 33(1): 213-232.

Kim J, Neilipovitz D, Cardinal P, et al.: A comparison of global rating scale and checklist scores in the validation of an evaluation tool to assess performance in the resuscitation of critically ill patients during simulated emergencies (abbreviated as “CRM simulator study IB”). Simul Healthc. 2009; 4(1): 6-16.

Higgins W, Wainright C, Lu N, et al.: Assessing hospital preparedness using an instrument based on the Mass Casualty Disaster Plan Checklist: Results of a statewide survey. Am J Infect Control. 2004; 32(6): 327-332.

Johnson WP: Evaluation of the Pediatric Trauma Triage Checklist as a prehospital pediatric trauma triage tool for the state of Florida. Prehosp Disaster Med. 1996; 11(1): 20-25; discussion 25-26.

McGrady E, Blanke SJ, Swanson C: Hospice patient evacuation: A case for using a checklist for safe disaster response. Am J Hosp Palliat Care. 2014; 31(3): 260-268.

Morris JT, Jones ML: Emergency preparedness for people with disabilities: Guide and checklist. Arch Phys Med Rehabil. 2013; 94(2): 219-220.

Sorensen BS: Checklist for hospital pandemic preparedness: A World Health Organization innovation with future application. Disaster Med Public Health Prep. 2010; 4(3): 195-196.

Gawande A: The Checklist Manifesto—How to Get Things Right. New York: Metropolitan Books, 2009.



How to Cite

Burke, PhD, MPH, R. V., K. Lehman-Huskamp, MD, R. E. Whitney, MD, G. Arora, MD, DTMH, D. B. Park, MD, P. Mar, MD, and M. X. Cicero, MD. “Checklist Use in Evaluating Pediatric Disaster Training”. American Journal of Disaster Medicine, vol. 10, no. 4, Oct. 2015, pp. 285-94, doi:10.5055/ajdm.2015.0210.




Most read articles by the same author(s)

1 2 > >>