J Korean Med Sci.  2021 Aug;36(33):e210. 10.3346/jkms.2021.36.e210.

Surge Capacity and Mass Casualty Incidents Preparedness of Emergency Departments in a Metropolitan City: a Regional Survey Study

• Park S
• Jeong J
• Song KJ
• Yoon YH
• Oh J
• Lee EJ
• Hong KJ
• Lee JH

• KMID: 2519351
• DOI: http://doi.org/10.3346/jkms.2021.36.e210

Abstract

Background
Emergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city.
Methods
This cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government's public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity.
Results
In the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity.
Conclusion
If the hospital's emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.

Keyword

Disasters; Mass Casualty Incidents; Surge Capacity; Hospital Emergency Service; Health Care Surveys

Figure

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  Fig. 1 Box plot on the overall differences of the ability to accommodate patients during ordinary and crisis condition according to the classification of severity by KTAS, surge capacity, need for ICU care, and emergency operation (n = 31).KTAS = Korean Triage and Acuity Scale, ICU = intensive care unit.

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  Fig. 2 Box plot on the overall differences in the number of medical staffs and beds between regional EMC (n = 5) and local EMC (n = 24).EMC = emergency medical center, ED = emergency department, ICU = intensive care unit, OR = operation room.

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