Surge planning

COVID-19 has shown the ability to overwhelm healthcare systems around the world regardless of size or resource availability. Excess demand for PPE, medical equipment, staff, and space should be anticipated early and managed proactively. This occasionally will necessitate deviation from conventional operating procedures and developing novel solutions to new problems. Clearly defined leadership and command control facilitate streamlined operations and clear communication among multiple agencies. Resource inventory and management is critical on both short-term and long-term timelines, often necessitating coordination of regional and national agencies and stockpiles. Best practices include stockpiling resources, judicious use and preservation of PPE, protection of healthcare workers, minimizing iatrogenic transmission, redeployment of non-EM and CCM workforce to new roles, deferring elective cases, and creation of new patient care spaces. Coordination of care within the hospital as well as with other institutions in the healthcare system and local and federal government is important. The capacity of any given healthcare system to meet unanticipated increases in resource demand will fluctuate during any pandemic, and criteria for resource allocation may change under crisis situations, in relation to standard operating procedures. Rationing of care should only be used in extreme circumstances and should be done in an equitable and just way. The hope is that proper preemptive planning and management can relegate care rationing to the most rare clinical and disaster circumstances.