Post-Disaster Critical Care Demand Exceeds Initial Acuity: Tree-Related Trauma at a Rural Appalachian Level 1 Trauma Center Following Hurricane Helene

Background Following Hurricane Helene, our rural level 1 trauma center in Eastern Tennessee managed a sharp rise in tree-related injuries. We sought to determine whether post-disaster patients required greater inpatient resources than patients injured under baseline conditions, independent of presenting injury severity. Methods This IRB-approved (#0125.12) retrospective study identified adult patients with tree-related injuries from our trauma registry using ICD-10 E codes. We compared a pre-Helene cohort (January 2018-September 26, 2024; n = 176) to a post-Helene cohort (September 27-December 2024; n = 25). Outcomes included ICU admission, ICU length of stay, mechanical ventilation, operative intervention, and discharge disposition. Results Post-Helene patients required significantly more intensive care despite presenting with similar injury severity scores and initial physiologic parameters. Mechanical ventilation was needed in 24% of post-Helene patients vs 9.1% pre-Helene (OR 3.16, 95% CI: 1.10-9.04, P = 0.025). ICU length of stay was longer post-Helene (6 days [IQR 3-16] vs 3 days [IQR 2-7], P = 0.036). Discharge to extended care facilities was more frequent (36% vs 15.9%, OR 2.97, 95% CI: 1.20-7.39, P = 0.015). Post-Helene patients also carried a substantially higher burden of cardiopulmonary and renal comorbidities. Conclusion In a rural disaster setting, tree-related trauma patients placed greater demands on critical care, ventilator, and post-acute resources than their initial presentations predicted. Hospital preparedness plans for rural level 1 trauma centers must account for this gap between triage acuity and downstream resource utilization.