US Emergency Department Use and Operations Amid Natural Disasters: A Narrative Review

In the United States from 2014-2024, an average of 18.2 national disasters per year caused over a billion dollars in inflation-adjusted damage, compared with 3.3 national disasters per year during the 1980s. The increased frequency and intensity of severe weather phenomena—attributed by climate science experts to climate change—have raised concerns about national emergency preparedness. One aspect of emergency preparedness is the functioning of emergency departments (ED). In this narrative review, we examine patterns of ED use and operations amid natural disasters in the US, with a special focus on vulnerable populations. The review highlights studies comparing ED use patterns between periods of disaster and non-disaster for specific disaster types, including hurricanes, wildfires, floods, winter storms, and earthquakes, as well as studies that identify disaster-mediated changes in ED visits among specific populations, including the elderly, individuals experiencing homelessness, children and youth with special health care needs, and individuals with chronic medical and psychiatric conditions. Finally, we highlight the challenges posed to EDs by these disasters, including crowding, resource scarcity, and operational strain, and proposed steps to strengthen ED preparedness for climate-related disasters.