Dr. Erica Popovsky’s team at Lurie Children’s know the right drill at the right time can prepare them for the worst-case scenario.
Background
Each summer, right on time, Lollapalooza brings more than 400,000 excited fans to Chicago to watch something that will not happen anywhere else – a unique blend of the hottest musical performances. And each summer, right on time, dedicated teams at Ann & Robert H. Lurie Children’s Hospital of Chicago prepare for something they hope will never happen anywhere – a pediatric mass casualty incident (MCI).
Located in the heart of Chicago, Lurie Children’s is close to many activities that attract large groups of kids including parades, major sporting events, and Lollapalooza, one of the world’s biggest music festivals. The hospital’s proximity to these events means staff must be prepared to mobilize rapidly at any time for an MCI response, which includes readiness to reunify children with their families.
Lurie’s Medical Director of Emergency Preparedness, Erica Popovsky, MD, FAAP, had always led teams through simulations. However, given the increasing national frequency of pediatric MCIs coupled with the hospital’s proximity to high-capacity events, her team recognized the need to increase MCI and reunification planning.
Broader Challenge
While hospitals are built to handle many kinds of emergencies, any type of high-capacity entertainment event can increase the potential for unique emergencies and surges that strain hospital staff, resources, and reunification efforts.
While the frequency of pediatric MCIs is increasing nationally, most hospitals will not experience this type of emergency regularly. Another challenge is that most emergency departments do not function like smaller health care units with the same people working together each shift. Instead, they have large teams of different people who may not have worked together before but need to respond efficiently to a high-stress scenario. Scheduling mass casualty drills ahead of high-capacity events is one way to significantly improve system processes and help team members work in a more streamlined way.
Action
To ensure emergency responders and health care workers are as prepared as possible to handle a mass casualty event, Lurie supplements emergency planning and small-scale drills with annual, hospital-wide exercises. The planning team uses Lollapalooza’s annual event as a prompt to schedule their drill before the festival. To make the drills as realistic as possible, they incorporate young volunteers from Lurie’s Discovering Healthcare Careers Program that act as pediatric patients.
Each year, Erica’s team identifies key objectives and designs a different MCI scenario to address them. In 2025, the team simulated a Chicago Transit Authority train derailment with injured children, parents, and other adults.
During recent MCIs in the U.S., emergency department (ED) staff have not always received notification before the initial arrival of injured patients. With that in mind, one drill objective in 2025 was to practice responding to an MCI without notice. The size and inter-disciplinary nature of the hospital-wide drill means that the date and time are typically distributed widely, but they designed the 2025 exercise so that volunteer patients arrived at Lurie’s triage unit 15 minutes before the expected start time.
Impact
Erica’s team understands the right drill at the right time can make all the difference. The 2025 drill revealed some impressive insights including a collaboration between emergency department and perioperative services teams who quickly started a communication chain to rapidly open operating rooms.
This drill also showed that Lurie’s work to streamline their reunification process was beneficial. “It was great to see our Family Services team mobilize their plan, open the family reunification center, and quickly coordinate all their supplies including phone apps and Polaroid cameras,” Erica states. “It’s always rewarding to see a process the teams have been working on is functioning the way we want.”
After every drill, the Lurie Emergency Management team, simulation facilitators, and participants debrief and evaluate their findings to identify systems that are working well, pinpoint what to improve, and create recommendations to make emergency processes more efficient.
Next Steps
Lurie’s Emergency Management team uses the annual drill as a starting point to refine job action sheets, which are quick visual aids that outline hospital personnel roles during high-stress mass casualty responses. After the 2025 drill, they added information about the teams’ quick-thinking communication chain to open operating rooms.
The team is also refining their surge processes by creating a decompression plan through the Pediatric Pandemic Network’s (PPN) Disaster Response Collaborative (DRC). They conducted an initial test of the plan during the 2025 drill which went well. They are refining their activation and communications lists, which are an important part of any MCI response plan.
Key Takeaways
This story highlights one successful approach for improving response when children are impacted. Refining children’s hospitals disaster plans through exercises, drills, and focused improvement planning is the aim of the DRC.
Erica notes that regular preparation, planning, and practice to evaluate improvement strategies is essential. “There is no such thing as a perfect mass casualty preparedness drill because a real mass casualty event will always be a tragedy,” she states. “A pediatric mass casualty is an awful, high-stress situation and there is no way for it to go perfectly. It won’t. But the more prepared we can be, the more quickly we can act, the faster we can have our teams in place, the better the outcomes will be for children. And that’s our overarching goal for all of this.”