Pediatric Disaster Preparedness

Episode 46: Pediatric Disaster Preparedness with Dr. Jeffery Upperman

Dr. Jeffery Upperman M.D.

Surgeon In Chief at the Monroe Carell Jr. Children’s Hospital in Nashville, TN

Chair Department of Pediatric Surgery

  • Disaster Olympix Gamified Preparation.  This helps draw out creativity and problem solving. Builds teamwork.  You need this in big situations.
  • “Disasters are agnostic” Unless it is someone with intent on harm
  • “Train with Spontaneity”
  • “We are all concerned with our own mortality”
  • “Know your team”
  • “Identify stakeholders”
  • “Build Relationships”
  • “Know your staff and their families”
  • “Training can be easy and fun”

LA Childrens Disaster Olympix

In this episode we sat down with Dr. Jeffery Upperman while attending the Rocky Mountain Trauma and Emergency Medicine Conference in Breckenridge, CO.  Dr. Upperman is a pediatric surgeon by specialty but has extensive experience in leadership and preparedness.  He has served in the United States Army and several large Childrens Hospitals including Los Angeles Childrens and the Monroe Carell Jr. Children’s Hospital at Vanderbilt.  Dr. Upperman takes the subject of pediatric disaster preparedness to a new level of enthusiasm.  His lecture, designed to be energetic and thought provoking, was both.  His message was simple but also not easy.  Focus on key principles when preparing for these unplanned events.  As soon as complex plans are created, something will come along and “break the mold.”  Have some flexibility in the way you think.  Cultivate this through regular training but training that is fun, light, and engaging.  The following are his key principles.

Know your Team

His first message was simple and valuable.  Know your team.  Know who works with/ for you. Know their children.  A pediatric disaster triggers a response in parents to protect.  If anyone you work with has children of their own, their mind may be “out of the game” when responding to an event.  There may be times where the best thing for a team is for one member to leave and take care of their family.  If your members are able to respond and be present, they will eventually need to attend to the needs of their families.  Dr. Upperman gives the example of a natural disaster that may include a widespread power outage.  Leaders may need to set up shelter or daycare for the children of their team members.  Give you people a save place to bring their family.  Good leaders take care of their team.  Without their team they are unable to accomplish their goals and their mission.

Knowing your team can also include underutilized strengths they may possess.  In a disaster or unplanned event, creativity of problem solving will be valuable.  People are going to draw on their experience. A teammeber that regularly works as a paramedic, may also have skills which better serve the group in a slightly different capacity.

Remember Basic Needs

If you do end up taking care of children, do you have diapers?  Do you have entertainment?  You may need to take care a large group of uninjured children.  Perhaps their siblings or parents are patients and are unable to entertain their child/ family member.  Be able to shelter and care for children that do not have immediate medical needs.

Identify Stakeholders

Dr. Upperman’s next principle was, “know your stakeholders and grow your Rolodex.”  To rephrase in different words, grow your team.  During an unplanned event that is stretching your capability you will call upon resources that are infrequently used or being used in ways not commonly considered.  Dr. Upperman gave the example of physically walking around your area of responsibility or facility and introduce yourself to people.  He goes further to explain if there is a restaurant that is adjacent to his hospital and his hospital has a disaster, he may call upon that restaurant to help feed his team.  When your staff is working extra hours or difficult hours, meeting their physical needs speaks volumes to successful leaders.  It is much easier to build these relationships in calm times than in the heat of a situation.  Another illustration is, know who fixes your stuff.  Sounds simple, but seriously.  Know the people that work on your equipment and keep your operation running.  They will be needed during a large event.


The word training gets thrown around quite a bit, for good reason.  Training and practicing are critical disciplines.  Dr. Upperman added some context that was valuable.  He said training should have some spontaneity, be fun, and doesn’t always need to be complex.  He gave more than one example of having tabletop discussions with his staff as an opener or conclusion to a meeting.  Throwing out questions to spur thought.  “What would we do if ____ happened.”  Speaking personally.  This is something I have found incredibly valuable.  While working for the Denver Health Paramedic Division I was one of three command staff members that oversaw Denver International Airport.  A literal city within a city.  We would regularly eat meals together as a staff and I loved asking our paramedics, what if questions.  I learned from them.  I learned new ways to get from one place to another.  I learned about resources in our complex environment.  I learned about new relationships to foster.  These things always pay dividends when you are in the middle of something unannounced and out of the norm.

LA Disaster Olympix

To illustrate this point, check out this YouTube video about an event Dr. Upperman helped create in Los Angeles.  His disaster Olympix gamified preparedness.  Teams of staffers would work together to solve preparedness type problems in a friend competition environment.  What does this mean?  In our conversation he talked about two scenarios.  First, teams had to move five-gallon bucks or pretend radioactive waste without spilling any.  You may be thinking, “why?!”  He explains their Cancer Unit produces radioactive run off. When staff was asked what to do if the mitigation systems in place failed, they answered, “call___.”  His response was simple, “what if you can’t call _____?”  Patient care must continue, how are you going to solve the problem?

Sure, his staff will hopefully not be faced with this exact situation however it forced them to be creative.  It forced them to work together.  It forced them to get to know each other.  I would also wager that staff members who do not work on or near the cancer unit started to consider what hazards exist in their unit.  It got them to think in a preparedness mindset.  Another example he gave which stuck out to me, was centered around patient movement.  “What if you need to move 20 patients?”  Olympix participants then had to move several patient simulators.  This is near and dear to me because so many people in preparedness or response roles do not consider how long and how labor intensive it is to move people.  It takes a lot of people to successfully move one non-ambulatory patient.  Ask anyone that has worked Search and Rescue.  These professionals work this problem every time they get deployed. 

If you are a frontline worker or lead a small team, remember training can be simple.  Keep it focused on shifting someone’s mindset.  Get them out of their normal grind and have them think creatively with you about how to solve a problem. 

Thank you Dr. Upperman for your time.  This topic is not regularly discussed but is of great importance.  Attached are some valuable resources.

LA Childrens Disaster Olympix

Pediatric Disaster Resource and Training Center

Report on the 2010 Chilean Earthquake and Tsunami Response

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