Pediatric Disaster Preparedness at Rural and Critical Access Hospitals: A Mixed-Methods Study

Over 80% of pediatric emergency department (ED) visits in the United States occur outside of children's hospitals. Although previous studies have described gaps in pediatric readiness, few studies have focused on pediatric disaster preparedness at rural and critical access hospitals (CAHs). During periods of pediatric surge, CAHs may be forced to manage pediatric patients with delayed transfer times. This mixed-methods study, conducted by the Region V for Kids (RV4K) Pediatric Disaster Center of Excellence, elicited strengths and barriers to pediatric disaster preparedness in rural and CAHs.

We conducted a qualitative study of clinicians from CAHs in the Health Resources and Services Administration (HRSA) Region 5. After completing a demographic survey, respondents were invited to participate in focus groups about pediatric disaster preparedness, followed by an open-response questionnaire about how RV4K can support rural and CAHs. Descriptive statistics were calculated. Focus group transcripts and questionnaire responses were analyzed using a constant comparative approach to identify themes.

Of the 41 survey respondents, 19 participated in focus groups. Most study participants worked at EDs seeing <1800 children per year, and less than half had pediatric inpatient capabilities. Few hospital disaster plans considered children. Four focus group themes emerged: strengths of staff and community, staffing limitations, and desire for targeted pediatric education resources and pediatric disaster plan development.

Our study engaged directly with staff at rural and CAHs to gain insights about pediatric preparedness that will be used to develop resources specifically tailored to CAHs' unique clinical needs.