Kin-Keeping and the Complacency-Panic Mismatch: A Community-Level Analysis of Evacuation-Related Falls.

INTRODUCTION/OBJECTIVE: Early warning systems compress evacuation windows, creating secondary domestic hazards. This study analyzes the community epidemiology and behavioral dynamics of evacuation falls during Israel's 2026 missile crisis. METHODS: A retrospective study analyzed 2,941 emergency department visits. Daily alert volumes were integrated with municipal warning times (15-90 seconds) to calculate exposure-adjusted risk and map socioeconomic and architectural vulnerabilities. RESULTS: Evacuation falls comprised 36.9% of crisis presentations. Per-alert relative risk multiplied more than eightfold over time, revealing a "complacency-panic mismatch." Women comprised 66.7% of casualties aged 46+, indicating a caregiving ("kin-keeping") burden. This was supported by strict gender parity among injured infants (0-4), signaling passive trauma via burdened caregivers. Risk patterns depended on warning times: 0-30s zones shifted risk to younger adults (acute flight response), whereas 90s windows affected frail populations (43.7% aged 66+). Concurrently, 51.4% of injuries occurred in high-socioeconomic municipalities due to internal architectural hazards. CONCLUSIONS: Evacuation injuries represent a critical public health crisis. Mitigating this burden requires time-tailored protocols addressing caregiver biomechanics and household hazards, while prioritizing in-room protection for mobility-impaired individuals during acute scenarios.