Use of emergency services in response to a flood: an account of the aftermath of the May 2023 flood in Romagna, Italy

Background: Extreme weather events due to human activities have significantly increased the frequency and severity of hydrological disasters like floods, impacting human health and healthcare systems worldwide. This study analyses the patterns of emergency service utilisation of the May 2023 flood in Romagna, Italy, and specifically investigates the differences in emergency department (ED) visits and mortality between individuals exposed and not exposed to the flood. Methods: A retrospective cohort study was conducted including 813 724 citizens of Romagna, Italy, from 15 May to 31 August 2023 (ie, 14 weeks after flood inception). The study differentiated between individuals in flood-affected (exposed) and non-affected (unexposed) areas, assessing ED visit rates (overall and by disease category), hospitalisation odds and mortality. Data were analysed using multivariate regression models, adjusting for demographic variables, comorbidities and social frailty, assessed using the Deprivation Index. Results: Of the study population, 586 437 were exposed to the flood, while 227 287 were not exposed. ED visits totalled 33 331 for those exposed to the flood and 13 185 for the unexposed group. Overall, 27 527 (4.7%) of those in the exposed group and 10 829 (4.8%) in the unexposed group experienced at least one ED visit (OR 0.98; 95% CI 0.96 to 1.01). Frequency of access with severe triage scores was higher among those exposed as well as rate of hospitalisation after ED visit. Among those exposed, the rate of ED admission was lower for ophthalmology diseases (OR 0.84; 95% CI 0.77 to 0.92) and general disorders and minor problems (OR 0.85; 95% CI 0.78 to 0.93), and higher for trauma (OR 1.22; 95% CI 1.09 to 1.36) and mental health disorders (OR 1.40; 95% CI 1.17 to 1.75). Exposed individuals had a slightly increased risk of death in the subsequent weeks (OR: 1.09; 95% CI 1.00 to 1.19). Conclusion: The May 2023 flood in Romagna revealed enhanced vulnerability of the directly affected population, as shown by higher acuity ED presentations and subsequent hospitalisations, as well as more visits for trauma and mental health.