Characterizing Emergency Department Visits to Pediatric Hospitals After Local Disaster Declarations

Pediatric data on health care utilization following disasters are limited, with most studies focused on adults. This study evaluated changes in pediatric emergency department (ED) volumes, hospital admissions, and diagnoses following Major Disaster Declarations by the Federal Emergency Management Agency.

This was a retrospective observational analysis of patients aged ≤18 years presenting to a Pediatric Health Information System-participating ED between 2010 and 2023. We paired each Pediatric Health Information System ED with any major disaster that occurred within 50 miles of the ED. For each ED-disaster pair, we analyzed changes in weekly ED visits, admissions, and diagnoses for weeks 1 to 4 after the disaster. We report mean counts (SD) and percent changes (95% confidence interval), stratified by the 5 disaster types (severe storm/flood, snow/ice storm, fire, tornado, and earthquake).

Across 288 Major Disaster Declarations over 14 years, there were 409 ED-disaster pairs. For all disaster types, ED visits and admissions showed modest week 1 declines followed by a return to baseline levels. Tornadoes were associated with consistent decreases in ED visits over all 4 weeks, whereas snow/ice storms, severe storms/floods, and earthquakes demonstrated early decreases followed by recovery. Fires were associated with sustained increases, particularly for respiratory diagnoses. Admissions declined after tornadoes, with smaller decreases after snow/ice storms and earthquakes, whereas remaining stable after severe storms/floods and fires.

Pediatric ED utilization generally declined modestly after most disasters but increased following fires, driven by respiratory presentations. Declines likely reflect disruptions in access and care seeking, whereas fire-related surges highlight distinct respiratory effects. Preparedness efforts should incorporate event and diagnosis-specific trends to support continuity of operations and capacity for brief surges when they occur.