title: Developments in Surge Research Priorities: A Systematic Review of the Literature Following the Academic Emergency Medicine Consensus Conference, 2007-2015.
abstract: OBJECTIVE
  In 2006, Academic Emergency Medicine (AEM) published a special issue summarizing the proceedings of the AEM consensus conference on the "Science of Surge." One major goal of the conference was to establish research priorities in the field of "disasters" surge. For this review, we wished to determine the progress toward the conference's identified research priorities: 1) defining criteria and methods for allocation of scarce resources, 2) identifying effective triage protocols, 3) determining decision-makers and means to evaluate response efficacy, 4) developing communication and information sharing strategies, and 5) identifying methods for evaluating workforce needs.
  
  
  METHODS
  Specific criteria were developed in conjunction with library search experts. PubMed, Embase, Web of Science, Scopus, and the Cochrane Library databases were queried for peer-reviewed articles from 2007 to 2015 addressing scientific advances related to the above five research priorities identified by AEM consensus conference. Abstracts and foreign language articles were excluded. Only articles with quantitative data on predefined outcomes were included; consensus panel recommendations on the above priorities were also included for the purposes of this review. Included study designs were randomized controlled trials, prospective, retrospective, qualitative (consensus panel), observational, cohort, case-control, or controlled before-and-after studies. Quality assessment was performed using a standardized tool for quantitative studies.
  
  
  RESULTS
  Of the 2,484 unique articles identified by the search strategy, 313 articles appeared to be related to disaster surge. Following detailed text review, 50 articles with quantitative data and 11 concept papers (consensus conference recommendations) addressed at least one AEM consensus conference surge research priority. Outcomes included validation of the benchmark of 500 beds/million of population for disaster surge capacity, effectiveness of simulation- and Internet-based tools for forecasting of hospital and regional demand during disasters, effectiveness of reverse triage approaches, development of new disaster surge metrics, validation of mass critical care approaches (altered standards of care), use of telemedicine, and predictions of optimal hospital staffing levels for disaster surge events. Simulation tools appeared to provide some of the highest quality research.
  
  
  CONCLUSIONS
  Disaster simulation studies have arguably revolutionized the study of disaster surge in the intervening years since the 2006 AEM Science of Surge conference, helping to validate some previously known disaster surge benchmarks and to generate new surge metrics. Use of reverse triage approaches and altered standards of care, as well as Internet-based tools such as Google Flu Trends, have also proven effective. However, there remains significant work to be done toward standardizing research methodologies and outcomes, as well as validating disaster surge metrics.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.|Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.|National Center for the Study of Critical Event Preparedness and Response, Johns Hopkins University, Baltimore, MD.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Morton
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: DeAugustinis
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Velasquez
authors.affiliation: Department of Medicine Division of General and Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.|Department of Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Sonal
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.|National Center for the Study of Critical Event Preparedness and Response, Johns Hopkins University, Baltimore, MD.|Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins University, Baltimore, MD.
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
mesh_terms: D003142:Communication; D003245:Consensus Statements as Topic; D003422:Critical Care / Q000458:organization & administration; D003657:Decision Making; D004189:Disaster Planning / Q000458:organization & administration*; D004635:Emergency Medicine / Q000458:organization & administration*; D015276:Health Care Rationing / Q000458:organization & administration; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D020380:Needs Assessment; D011446:Prospective Studies; D012106:Research / Q000458:organization & administration*; D012189:Retrospective Studies; D055872:Surge Capacity / Q000458:organization & administration*; D014218:Triage / Q000379:methods