Disaster Medicine and Public Health Preparedness

Research Article

Mapping US Pediatric Hospitals and Subspecialty Critical Care for Public Health Preparedness and Disaster Response, 2008

Mary D. Brantley c1, Hua Lu, Wanda D. Barfield, James B. Holt and Alcia Williams


Objective: The objective is to describe by geographic proximity the extent to which the US pediatric population (aged 0-17 years) has access to pediatric and other specialized critical care facilities, and to highlight regional differences in population and critical resource distribution for preparedness planning and utilization during a mass public health disaster.

Methods: The analysis focused on pediatric hospitals and pediatric and general medical/surgical hospitals with specialized pediatric critical care capabilities, including pediatric intensive care units (PICU), pediatric cardiac ICUs (PCICU), level I and II trauma and pediatric trauma centers, and general and pediatric burn centers. The proximity analysis uses a geographic information system overlay function: spatial buffers or zones of a defined radius are superimposed on a dasymetric map of the pediatric population. By comparing the population living within the zones to the total population, the proportion of children with access to each type of specialized unit can be estimated. The project was conducted in three steps: preparation of the geospatial layer of the pediatric population using dasymetric mapping methods; preparation of the geospatial layer for each resource zone including the identification, verification, and location of hospital facilities with the target resources; and proximity analysis of the pediatric population within these zones.

Results: Nationally, 63.7% of the pediatric population lives within 50 miles of a pediatric hospital; 81.5% lives within 50 miles of a hospital with a PICU; 76.1% lives within 50 miles of a hospital with a PCICU; 80.2% lives within 50 miles of a level I or II trauma center; and 70.8% lives within 50 miles of a burn center. However, state-specific proportions vary from less than 10% to virtually 100%. Restricting the burn and trauma centers to pediatric units only decreases the national proportion to 26.3% for pediatric burn centers and 53.1% for pediatric trauma centers.

Conclusions: This geospatial analysis describes the current state of pediatric critical care hospital resources and provides a visual and analytic overview of existing gaps in local pediatric hospital coverage. It also highlights the use of dasymetric mapping as a tool for public health preparedness planning.

(Disaster Med Public Health Preparedness. 2012;6:117–125)

(Received November 19 2010)

(Accepted May 11 2012)

Key Words:

  • pediatric critical care;
  • regionalization;
  • dasymetric mapping;
  • hospitals, pediatric;
  • intensive care units, pediatric;
  • disaster planning;
  • geography;
  • mass casualty incidents;
  • burn units;
  • trauma centers;
  • health services accessibility;
  • children's health


c1 Correspondence: Mary D. Brantley, MPH, Centers for Disease Control and Prevention 4770 Buford Hwy NE, MS K-22, Atlanta, GA 30341 (e-mail: mdb4@cdc.gov).

Author Affiliations: Division of Reproductive Health (Dr Barfield and Ms Brantley) and Division of Adult and Community Health (Dr Holt and Ms Lu), National Center for Chronic Disease Prevention and Health Promotion, and Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (Dr Williams), Centers for Disease Control and Prevention, Atlanta, Georgia.

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