Using GDACS to anticipate clinical and operational burden after earthquakes: A global event-level analysis (2020-2024).

Global Disaster Alert and Coordination System (GDACS) alerts are widely used after earthquakes, yet their clinical relevance is uncertain. We performed a retrospective, global, event-level study spanning 2020-2024. To avoid double counting, alerts were clustered into country-bounded representatives using a 48-hour gap, retaining the alert with the highest GDACS score (n = 85; Red = 17, Orange = 68). Primary outcomes were reported deaths and field-hospital deployment. Associations used Spearman correlation; deployment was modeled with Firth logistic regression. Sensitivity analyses used alternative deployment definitions and composite windows. The GDACS score correlated with deaths (ρ = 0.522, p = 3.0 × 10 ⁻ ⁷). Field-hospital deployment occurred in 52.9% of Red events and 0% of Orange events. The GDACS score strongly predicted deployment (OR=42.7, 95% CI 4.7-385.7), with AUC = 0.98 and Brier = 0.034. An exploratory exposure-normalized subset where GDACS reported population "within 100 km" (n = 19) showed directionally consistent results (ρ = 0.50, p = 0.029).GDACS metrics provide early, scalable indicators for surge planning, but are hazard- and exposure-centric and cannot capture mediators such as collapse dynamics or health-system resilience. Treating GDACS as a first-layer signal, complemented by subnational exposure and rapid damage assessment, can support more timely, evidence-based medical response after major earthquakes.