title: Emergency department surge capacity: recommendations of the Australasian Surge Strategy Working Group.
abstract: For more than a decade, emergency medicine (EM) organizations have produced guidelines, training, and leadership for disaster management. However, to date there have been limited guidelines for emergency physicians (EPs) needing to provide a rapid response to a surge in demand. The aim of this project was to identify strategies that may guide surge management in the emergency department (ED). A working group of individuals experienced in disaster medicine from the Australasian College for Emergency Medicine Disaster Medicine Subcommittee (the Australasian Surge Strategy Working Group) was established to undertake this work. The Working Group used a modified Delphi technique to examine response actions in surge situations and identified underlying assumptions from disaster epidemiology and clinical practice. The group then characterized surge strategies from their corpus of experience; examined them through available relevant published literature; and collated these within domains of space, staff, supplies, and system operations. These recommendations detail 22 potential actions available to an EP working in the context of surge, along with detailed guidance on surge recognition, triage, patient flow through the ED, and clinical goals and practices. The article also identifies areas that merit future research, including the measurement of surge capacity, constraints to strategy implementation, validation of surge strategies, and measurement of strategy impacts on throughput, cost, and quality of care.
authors.affiliation: From the Department of Emergency Medicine, Royal Melbourne Hospital (DAB), Parkville, Victoria; Anton Breinl Centre, James Cook University (PA), Townsville; the Emergency Department, The Townsville Hospital; and Queensland Emergency Medicine Research Foundation (QEMRF) (PA), Queensland; Public Health (Emergency and Disaster Management), Queensland University of Technology (GF), Brisbane, Queensland; Discipline of Emergency Medicine, University of Western Australia, and the Emergency Department, Sir Charles Gairdner Hospital (RS), Perth; The Emergency and Trauma Centre, The Alfred Hospital (GO), Melbourne, Victoria; and The Emergency Department, The Geelong Hospital (BB), Victoria, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Bradt
authors.affiliation: From the Department of Emergency Medicine, Royal Melbourne Hospital (DAB), Parkville, Victoria; Anton Breinl Centre, James Cook University (PA), Townsville; the Emergency Department, The Townsville Hospital; and Queensland Emergency Medicine Research Foundation (QEMRF) (PA), Queensland; Public Health (Emergency and Disaster Management), Queensland University of Technology (GF), Brisbane, Queensland; Discipline of Emergency Medicine, University of Western Australia, and the Emergency Department, Sir Charles Gairdner Hospital (RS), Perth; The Emergency and Trauma Centre, The Alfred Hospital (GO), Melbourne, Victoria; and The Emergency Department, The Geelong Hospital (BB), Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Aitken
authors.affiliation: From the Department of Emergency Medicine, Royal Melbourne Hospital (DAB), Parkville, Victoria; Anton Breinl Centre, James Cook University (PA), Townsville; the Emergency Department, The Townsville Hospital; and Queensland Emergency Medicine Research Foundation (QEMRF) (PA), Queensland; Public Health (Emergency and Disaster Management), Queensland University of Technology (GF), Brisbane, Queensland; Discipline of Emergency Medicine, University of Western Australia, and the Emergency Department, Sir Charles Gairdner Hospital (RS), Perth; The Emergency and Trauma Centre, The Alfred Hospital (GO), Melbourne, Victoria; and The Emergency Department, The Geelong Hospital (BB), Victoria, Australia.
authors.forename: Gerry
authors.initials: G
authors.lastname: FitzGerald
authors.affiliation: From the Department of Emergency Medicine, Royal Melbourne Hospital (DAB), Parkville, Victoria; Anton Breinl Centre, James Cook University (PA), Townsville; the Emergency Department, The Townsville Hospital; and Queensland Emergency Medicine Research Foundation (QEMRF) (PA), Queensland; Public Health (Emergency and Disaster Management), Queensland University of Technology (GF), Brisbane, Queensland; Discipline of Emergency Medicine, University of Western Australia, and the Emergency Department, Sir Charles Gairdner Hospital (RS), Perth; The Emergency and Trauma Centre, The Alfred Hospital (GO), Melbourne, Victoria; and The Emergency Department, The Geelong Hospital (BB), Victoria, Australia.
authors.forename: Roger
authors.initials: R
authors.lastname: Swift
authors.affiliation: From the Department of Emergency Medicine, Royal Melbourne Hospital (DAB), Parkville, Victoria; Anton Breinl Centre, James Cook University (PA), Townsville; the Emergency Department, The Townsville Hospital; and Queensland Emergency Medicine Research Foundation (QEMRF) (PA), Queensland; Public Health (Emergency and Disaster Management), Queensland University of Technology (GF), Brisbane, Queensland; Discipline of Emergency Medicine, University of Western Australia, and the Emergency Department, Sir Charles Gairdner Hospital (RS), Perth; The Emergency and Trauma Centre, The Alfred Hospital (GO), Melbourne, Victoria; and The Emergency Department, The Geelong Hospital (BB), Victoria, Australia.
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Reilly
authors.affiliation: From the Department of Emergency Medicine, Royal Melbourne Hospital (DAB), Parkville, Victoria; Anton Breinl Centre, James Cook University (PA), Townsville; the Emergency Department, The Townsville Hospital; and Queensland Emergency Medicine Research Foundation (QEMRF) (PA), Queensland; Public Health (Emergency and Disaster Management), Queensland University of Technology (GF), Brisbane, Queensland; Discipline of Emergency Medicine, University of Western Australia, and the Emergency Department, Sir Charles Gairdner Hospital (RS), Perth; The Emergency and Trauma Centre, The Alfred Hospital (GO), Melbourne, Victoria; and The Emergency Department, The Geelong Hospital (BB), Victoria, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Bartley
mesh_terms: D026683:Advisory Committees; D044362:Australasia; D003697:Delphi Technique; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006752:Hospital Planning / Q000379:methods; D006801:Humans; D009874:Operations Research; D055872:Surge Capacity / Q000458:organization & administration*