Published online January 4, 2006
PEDIATRICS Vol. 117 No. 1 January 2006, pp. e8-e15 (doi:10.1542/peds.2005-0927)
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Mass-Casualty Events at Schools: A National Preparedness Survey

James Graham, MD, Steve Shirm, MD, Rebecca Liggin, MD, Mary E. Aitken, MD, MPH and Rhonda Dick, MD

Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine and Arkansas Children's Hospital, Little Rock, Arkansas

OBJECTIVE. Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objective of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event.

METHODS. A survey was mailed to 3670 school superintendents of public school districts that were chosen at random from a list of school districts from the National Center for Education Statistics of the US Department of Education in January 2004. A second mailing was sent to nonresponders in May 2004. Descriptive statistics were used for survey variables, and the {chi}2 test was used to compare urban versus rural preparedness.

RESULTS. The response rate was 58.2% (2137 usable surveys returned). Most (86.3%) school superintendents reported having a response plan, but fewer (57.2%) have a plan for prevention. Most (95.6%) have an evacuation plan, but almost one third (30%) had never conducted a drill. Almost one quarter (22.1%) have no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local ambulance officials to discuss emergency planning. Urban school districts were better prepared than rural districts on almost all measures in the survey.

CONCLUSIONS. There are important deficiencies in school emergency/disaster planning. Rural districts are less well prepared than urban districts. Disaster/mass-casualty preparedness of schools should be improved through coordination of school officials and local medical and emergency officials.

Key Words: disasters • emergency aid • school health • terrorism

Abbreviations: NCES—National Center for Education Statistics • MSA—metropolitan statistical area • EMS—emergency medical services

Accepted Jul 5, 2005.




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Preparing for the worst: Pediatricians can have positive influence on school's disaster preparedness plans
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