title: Geographical maldistribution of pediatric medical resources in Seattle-King County.
abstract: OBJECTIVE
  Seattle-King County (SKC) Washington is at risk for regional disasters, especially earthquakes. Of 1.8 million residents, >400,000 (22%) are children, a proportion similar to that of the population of the State of Washington (24%) and of the United States (24%). The county's large area of 2,134 square miles (5,527 km2) is connected through major transportation routes that cross numerous waterways; sub-county zones may become isolated in the wake of a major earthquake. Therefore, each of SKC's three subcounty emergency response zones must have ample pediatric medical response capabilities. To date, total quantities and distribution of crucial hospital resources (available in SKC) to manage pediatric victims of a medical disaster are unknown. This study assessed whether geographical distribution of hospital pediatric resources corresponds to the pediatric population distribution in SKC.
  
  
  METHODS
  Surveys were delivered electronically to all eight acute care hospitals in SKC that admit pediatric patients. Quantities and categories of pediatric resources, including inpatient treatment space, staff, and equipment, were queried and verified via site visits.
  
  
  RESULTS
  Within the seven responding hospitals of eight queried, the following were identified: 477 formal pediatric bed spaces (pediatric intensive care unit, neo-natal intensive care unit, general wards, and emergency department), 43 informal pediatric bed spaces (operating room and post-anesthesia care unit), 1,217 pediatric nurses, 554 pediatric physicians, and 252 infant/pediatric-adaptable ventilators. The City of Seattle emergency response zone contains 82.1% of bed spaces, 83.5% of nurses, and 95.8% of physicians, yet only 22.8% of all SKC children live in that zone.
  
  
  CONCLUSIONS
  The majority of hospital pediatric resources are located in the SKC sub-region with the fewest children. These resources are potentially inaccessible and unable to be redistributed by ground transportation in the event of a significant regional disaster. Future planning for pediatric care in the event of a medical disaster in SKC must address this vulnerability.
authors.affiliation: Seattle Children's, Pediatric Critical Care Medicine, Harborview Medical Center, Seattle, WA 98105, USA. maryking@u.washington.edu
authors.forename: Mary A
authors.initials: MA
authors.lastname: King
authors.forename: Kathryn
authors.initials: K
authors.lastname: Koelemay
authors.forename: Jerry
authors.initials: J
authors.lastname: Zimmerman
authors.forename: Lewis
authors.initials: L
authors.lastname: Rubinson
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D004189:Disaster Planning; D055866:Earthquakes; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005843:Geography; D006265:Health Care Coalitions / Q000458:organization & administration; D019538:Health Care Surveys; D006295:Health Resources / Q000458:organization & administration / Q000600:supply & distribution*; D006776:Hospitals, Pediatric / Q000458:organization & administration* / Q000600:supply & distribution; D006801:Humans; D014861:Washington