Heat Waves, Pediatric Readiness, and Child Outcomes: Risk, Mitigation, and Resilience in Emergency Care - Proposed Approach: We will use data science and data integration across 13 different data sources to study the intersection of climate change, children, and emergency care. The project will provide a comprehensive evaluation of climate and health among children, with a focus on heatwaves. We will use existing research infrastructure, weather data with detailed spatial resolution, geospatial analyses, advanced analytics, modeling, and an interdisciplinary team to address this critical public health issue. Importance: Children are vulnerable to climate change, yet the science of climate and health in children is underdeveloped. We have recently shown that high emergency department (ED) pediatric readiness is independently associated with improved survival, but the function of high-readiness EDs during heatwaves is unknown. Addressing children in a changing climate is critical to their welfare, including methods to mitigate adverse outcomes and ways the U.S. healthcare system can remain resilient. This project is designed to inform EDs, hospitals, healthcare systems, and national health policy for children. Objectives: There are three specific aims: Aim 1: Using the national assessment of ED pediatric readiness, detailed weather data, pediatric census data, and geospatial analysis, we will identify the most geographically vulnerable areas for children due to heatwaves that also lack access to high-readiness EDs. Aim 2: We will create three national samples of children receiving emergency services (prehospital, EDs, and trauma centers) to evaluate the association of heatwaves with excess mortality and healthcare utilization across millions of children. Aim 3: Using two longitudinal pediatric cohorts, we will assess whether high-readiness EDs mitigate excess mortality during heatwaves and are resilient in their known survival benefit. Study Design & Setting: We will build three large samples of children using emergency services from 1/1/2012 to 12/31/2023 during the “warm season” (May to September), including 9-1-1 responses from over 14,000 emergency medical services (EMS) agencies (the Prehospital Sample), ED visits to 1,856 EDs across 16 states (the ED Cohort), and admissions to 999 trauma centers across the U.S. (the Trauma cohort). To assess access to high-quality emergency care, we will estimate the driving time to 4,840 EDs across the U.S., combined with their level of pediatric readiness. For weather data, we will use a 1 x 1 kilometer spatial resolution for heatwaves (defined as average daily temperature ≥ 95%ile for ≥ 2 days), air quality (fine particulate matter), humidity, and greenspace (Normalized Difference Vegetation Index). Participants: Children 0–17 years using emergency services, including 4.9 million 9-1-1 EMS responses, 53 million ED visits, 1.8 million hospitalizations, 29,527 deaths after ED presentation, plus 311,490 injured children admitted to US trauma centers and 4,517 deaths after injury. Outcome measures: We will evaluate mortality (primary) and healthcare utilization among children.
