Measuring Pediatric Disaster Readiness of United States Emergency Departments

The state of pediatric disaster readiness of United States emergency departments is largely unknown. Using the questions from the National Pediatric Readiness Project (NPRP) 2021 assessment, we sought to define the domains important for a hospital's disaster response for children, develop a consensus-based pediatric weighted disaster readiness score (WDRS), measure the state of pediatric disaster readiness, and identify gaps in disaster planning.

The 2021 NPRP assessment identified 8 domains of disaster readiness. Using an iterative consensus-based approach, we determined weighting for each of these disaster domains. We calculated a normalized pediatric WDRS for all hospitals that participated in the NPRP assessment (range, 0-100 points).

Of 5150 hospitals surveyed in the 2021 NPRP assessment, 3647 responded, and 3458 (94.8%) of these had complete data. Median WDRS was 52.0 (IQR, 36.0, 75.0). Higher WDRS was associated with the presence of a pediatric emergency care coordinator, a comprehensive quality improvement plan for children, staffing with board-certified emergency physicians, and trauma center designation with adult and pediatric capabilities. The WDRS was highly correlated with the NPRP's day-to-day readiness score (r = 0.88). Common missing elements in disaster plans included the lack of pediatric patients in disaster drills and plans for children with behavioral health conditions and special health care needs.

Overall, pediatric disaster readiness in the United States is low with high variability across hospitals. Disaster readiness is linked with day-to-day pediatric readiness of emergency departments to care for children.