Pediatric Hospital and Intensive Care Unit Capacity in Regional Disasters: Expanding Capacity by Altering Standards of Care

This study uses simulation to estimate how many children New York City hospitals could care for during a regional disaster. Under normal operations, hospitals could reliably absorb only about half of the federal target for pediatric surge capacity. Modest actions like earlier discharge and canceled elective admissions helped, but were still not enough. Meeting larger surge targets would require altered standards of care, meaning hospitals would stretch each bed and staff team to treat more patients than usual. The biggest gap was pediatric intensive care. Overall, general pediatric beds could be expanded, but ICU capacity remained a major bottleneck in large disasters.