Emergency department surge: models and practical implications.
BACKGROUND
Emergency Department crowding has long been described. Despite the daily challenges of managing emergency department volume and acuity; a surge response during a disaster entails even greater challenges including collaboration, intervention, and resourcefulness to effectively carry out pediatric disaster management. Understanding surge and how to respond with appropriate planning will lead to success. To achieve this, we sought to analyze models of surge; review regional and national data outlining surge challenges and factors that impact surge; and to outline potential solutions.


METHODS
We conducted a systemic review and included articles and documents that best described the theoretical and practical basis of surge response. We organized the systematic review according to the following questions: What are the elements and models that are delineated by the concept of surge? What is the basis for surge response based on regional and national published sources? What are the broad global solutions? What are the major lessons observed that will impact effective surge capacity?


RESULTS
Multiple models of surge are described including public health, facility-based and community-based; a 6-tiered response system; and intrinsic or extrinsic surge capacity. In addition, essential components (4 S's of surge response) are described along with regional and national data outlining surge challenges, impacting factors, global solutions, and lesions observed.


CONCLUSIONS
There are numerous shortcomings regionally and nationally affecting our ability to provide an effective and coordinated surge response. Planning, education, and training will lead to an effective pediatric disaster management response.
Nager
Alan L
AL
Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, University of Southern California, and The Keck School of Medicine, Los Angeles, CA 90027, USA. anager@chla.usc.edu
Khanna
Kajal
K
D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D004189:Disaster Planning; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D017146:Models, Organizational; D055872:Surge Capacity