Assessing Healthcare Accessibility and System Resilience during 2019 Midwest Flood Disruptions in Douglas County Nebraska: An Integrated Graph-Theoretic and Monte Carlo Simulation Framework Incorporating Transportation, Capacity, and Social Vulnerability

Floods can severely disrupt emergency healthcare by damaging roads, closing bridges, and straining hospital capacity. This study presents an integrated approach to assess hospital accessibility and community resilience during the 2019 Midwest Flood in Douglas County, Nebraska. We combined graph-theoretic network analysis, social vulnerability rating, and Monte Carlo simulation to evaluate physical and social impacts. First, we modeled flood and flood-related road closures and calculated changes in travel times to trauma hospitals before and during the disaster. We also used the social vulnerability index to identify high-risk populations facing greater challenges during emergencies. Next, we simulated thousands of flood scenarios to assess how hospital capacity loss and bridge closures influenced access and recovery. Results show that delayed access, caused by road disruptions, had a more significant impact on system resilience than hospital capacity loss. These findings highlight the need for integrated disaster planning that considers infrastructure and social vulnerability to ensure accessible healthcare.