Surge Capacity

     The attacks of 9/11, the anthrax incidents that followed, SARS, Hurricanes Katrina and Rita and other events have shaken our nation's healthcare infrastructure, including EMS systems. Every day we face the possibilities of further disasters, outbreaks and terrorist acts. As first responders to incidents of all sizes and varieties, EMS systems are heavily impacted by these events. We can easily be thrown into chaos through a lack of ability to respond.

     The populations we serve remain vulnerable because of our lack of surge capacity. Most EMS systems are stretched to their limits on a daily basis, and the additional stress of an unexpected surge from a catastrophic event can be overwhelming. Without proper planning, systems can fail. So what should EMS know about surge and surge capacity? How does it impact us, and what can we do about it?

     A surge is a sudden or unexpected increase in patient volume that has the potential to severely challenge or exceed the capacity of the healthcare system. The American College of Emergency Physicians (ACEP), in a 2004 policy statement entitled Health Care System Surge Capacity Recognition, Preparedness, and Response, defines surge capacity as "a measurable representation of a healthcare system's ability to manage a sudden or rapidly progressive influx of patients within the currently available resources at a given point in time." Surge capacity can also be defined as the maximum delivery of services a system can provide if all its available and potential resources are mobilized.

     Surge capacity is a necessity. This was emphasized in the Institute of Medicine's 2006 Emergency Medical Services at the Crossroads report: In its recommendations for achieving its vision of a 21st century emergency care system, the IOM targets enhancing the disaster preparedness of EMS systems through increased funding and training of personnel.

     A number of states have addressed EMS surge capacity and developed plans. One of the most comprehensive is the EMS Surge Capacity Planning Kit released in 2006 by the Georgia Division of Public Health, which includes planning worksheets for personnel and other resources, sample memoranda of understanding to utilize and various appendixes, including scenarios and a planning kit evaluation. Another example is the North Dakota Department of Health's Public Health and Medical All Hazards Plan, which, among aspects such as prepositioning of medical resources and hospital surge capacity, references EMS in regard to personnel training, development of mutual aid agreements, identification and use of nontraditional transportation (e.g., school buses), creation of regional equipment caches and development of regional response teams.

     Most EMS systems run at or above full capacity on a daily basis. Long waits for ambulances are common in many parts of the country. In some cases, patients with high-priority medical complaints must wait for available ambulances to be dispatched. This problem is compounded by full-capacity emergency departments diverting ambulances and long waits to turn over EMS patients to ED staff. Such circumstances are hard on personnel and potentially hazardous to patients. At the same time, we're dealing with understaffed EMS systems that are trying to find and keep employees, limited budgets and a shortage of providers to hire in many parts of the country. As well, demand for EMS continues to increase in many areas. The aging of our population, fragmentation of healthcare and lack of places to go besides EDs for acute medical issues will continue to result in increasing call volumes and turnaround times in many systems.