UH Rainbow Helping to Make America’s Kids More Disaster-Resistant

Innovations in Pediatrics | Winter 2026

Disasters in the United State are on the rise, and children are among the most at-risk in the wake of a severe weather event, pandemic, mass casualty -- and even information technology disruptions.  For example, a cybersecurity disruption occurred at a major U.S. children's hospital, which created challenges for healthcare providers to provide the usual care to patients and families, lasting more than 30 days.

Charles Macias, MD, MPH

Experts from UH Rainbow Babies & Children’s are tackling these issues head-on, working with partners across the country to put the nation’s children on a more secure footing.

“Among the most at-risk populations in disasters are children, whose unique physical, psychological, and developmental vulnerabilities place them at a higher likelihood of mortality and morbidity as compared to adults,” says UH Rainbow Pediatric Emergency Medicine Division Chief and Chief Quality Officer Charles Macias, MD, MPH.

Further complicating this is data from the 2021 National Pediatric Readiness Project survey, showing that fewer than half of all U.S. hospitals include the needs of children in their disaster plans.

Fortunately, the team at UH Rainbow and colleagues have made significant progress in just a short time to address these issues. In 2019, the hospital was one of just two initial sites in the U.S. to receive funding from the HHS Office of the Administration for Strategic Preparedness and Response (ASPR) to establish a Pediatric Disaster Care Center of Excellence.

Ongoing work through this funding stream has focused on improving pediatric disaster readiness, response and recovery, encompassing six Midwest states, says UH Rainbow emergency medicine specialist and co-principal investigator Deanna Dahl-Grove, MD.

“We work to bring the pediatric expertise of disaster medicine to communities through several organizations including healthcare coalitions — with representatives from first responders, public health, urban, rural and community hospitals,” she says.”We work with communities on how we can help them to improve their care for children and families.”

To date, the Pediatric Disaster Center of Excellence operating out of UH Rainbow has developed and implemented educational programs for healthcare providers on managing children during disasters, as well as playbooks, guidance documents and white papers for a clinical audience. The team has also produced family-facing resources and recently hosted a well-attended cybersecurity showcase, attended by 38 healthcare coalitions and 13 hospital systems.

The team at UH Rainbow is also deeply involved with the efforts of the federal Emergency Medical Services for Children’s Innovation and Improvement Center (EIIC), which coordinates pediatric everyday readiness and disaster readiness components. Accomplishments to date include pediatric disaster checklists for hospital and pre-hospital providers, many multi-modal training modules and a clinic- and hospital-based learning network that has yielded improvements in readiness in both settings.

“Most children with acute emergencies are not seen in children's hospitals emergency departments– they’re seen in community hospital emergency departments,” she says. “The EIIC really concentrates in that space, and they talk about a concept of pediatric readiness across the board. For pediatricians in communities, EIIC is an important component of helping their emergency departments, where their kids might just end up because their offices aren't open.”

Complementing this work is UH Rainbow’s leadership of the initial $48 million Pediatric Pandemic Network. Encompassing five children’s hospitals, its goal is to bolster preparedness in pediatrics across the healthcare system for future pandemics and all types of disasters. That network has know grown to 14 hub sites with a more than doubling of annual federal investments to support the work.

"We must support structures and processes that are going to create an even level of care across the country by engaging our community partners to expand their reach, their programs and their knowledge,” says Dr. Macias, who is also one of the project’s principal investigators. "More than 80% of emergencies — acute injuries and illnesses — in children don't present to the children's hospitals, they present to community hospitals."

Already, the massive project is yielding dividends. A learning management system called PPN Learn offers training and free CEs related to pediatric disaster education. At UH Rainbow, a pilot project with primary care and pediatric primary care providers across Ohio is focusing on practical steps private practices can take to better prepare children and families to be ready for disasters and support the community for disasters. The monthly educational series reaches practices of every demographic, focusing on bread-and-butter issues like vaccine storage and storm-related power outages. And it’s working.

“We take surveys monthly, and we see the needle moving on their preparedness activities, as evidenced by having plans in place,” says Elizabeth Foster, Hub Manager for the Pediatric Pandemic Network grant at UH Rainbow. “These practices are more prepared now after going through our training.”

In addition, the UH Rainbow team is now providing 40 easy-to-use standards of care for multiple diseases, direct to all UH Rainbow clinicians via the electronic medical record.

“It’s an interoperable platform that allows us to push guidelines across all of the emergency departments, pediatric practices and subspecialty practices so that we create a common model for the management of multiple diseases,” Dr. Macias says. “It’s about delivering the right care, at the right place, at the right time. It provides a way of democratizing the optimal care that should be delivered, linking community sites that wouldn't otherwise have that expertise at the time they need it most.”

“The ability to build contingency plans in community hospitals means that we can really spread the intellectual knowledge and the capabilities into the sites where patients are,” he says. “That’s critical to achieving the best outcomes.”

Contributing Expert:
Charles Macias, MD, MPH
Chief, Pediatric Emergency Medicine
Chief Quality Officer
UH Rainbow Babies & Children's Hospital
Associate Professor of Pediatrics
Case Western Reserve University School of Medicine