<
h4 class=""
h4"">Background
h4>Disasters occur randomly and can severely tax t
he
healt
h care delivery system of affected and surrounding regions. A significant proportion of disaster survivors are c
hildren, w
ho
have unique medical, psyc
hosocial, and logistical needs after a mass casualty event. C
hildren are often transported to specialty centers after disasters for a
hig
her level of pediatric care, but t
his can also lead to separation of t
hese survivors from t
heir families. In a recent t
heoretical article, we s
howed t
hat t
he availability of a pediatric trauma center after a mass casualty event would decrease t
he time needed to definitively treat t
he pediatric survivor co
hort and decrease pediatric mortality. However, we also found t
hat if t
he pediatric center was too slow in admitting and disc
harging patients, t
hese benefits were at risk of being lost as c
hildren became ¡°trapped¡± in t
he slow center. We
hypot
hesized t
hat t
his effect could result in furt
her increased mortality and greater costs.<
h4 class=""
h4"">Met
hods
h4>
Here, we expand on these ideas to test this hypothesis via mathematical simulation. We examine how a delay in discharge of part of the pediatric cohort is predicted to affect mortality and the cost of inpatient care in the setting of our model.<h4 class=""h4"">Resultsh4>
We find that mortality would increase slightly (from 14.2 % -16.1 % ), and the cost of inpatient care increases dramatically (by a factor of 21) if children are discharged at rates consistent with reported delays to reunification after a disaster from the literature.<h4 class=""h4"">Conclusionsh4>
Our results argue for the ongoing improvement of identification technology and logistics for rapid reunification of pediatric survivors with their families after mass casualty events.