Most children in the United States present to community hospitals for emergency department (ED) care. Those who are acutely ill and require critical care are stabilized and transferred to a tertiary pediatric hospital with intensive care capabilities. During the fall of 2022 “tripledemic,” with a marked increase in viral burden, there was a nationwide surge in pediatric ED patient volume. This caused ED crowding and decreased availability of pediatric hospital intensive care beds across the United States. As a result, there was an inability to transfer patients who were critically ill out, and the need for prolonged management increased at the community hospital level. We describe the experience of a Massachusetts community ED during this surge, including the large influx in pediatric patients, the increase in those requiring critical care, and the total number of critical care hours as compared with the same time period (September to December) in 2021. To combat these challenges, the pediatric ED leadership applied a disaster management framework based on the 4 S’s of space, staff, stuff, and structure. We worked collaboratively with general emergency medicine leadership, nursing, respiratory therapy, pharmacy, local clinicians, our regional health care coalition, and emergency medical services (EMS) to create and implement the pediatric surge strategy. Here, we present the disaster framework strategy, the interventions employed, and the barriers and facilitators for implementation in our community hospital setting, which could be applied to other community hospital facing similar challenges.

中文翻译：

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灾害管理框架 4S：2022 年社区医院儿科三疫应对案例研究

美国的大多数儿童都会到社区医院接受急诊 (ED) 护理。病情急重、需要重症监护的患者病情稳定后，转至具有重症监护能力的三级儿科医院。2022 年秋季“三疫”期间，病毒负荷显着增加，全国范围内的儿科急诊患者数量激增。这导致美国各地急诊室拥挤，儿科医院重症监护床位减少。结果，重症患者无法转出，社区医院层面的长期管理需求也随之增加。我们描述了马萨诸塞州社区急诊室在这次激增期间的经历，包括儿科患者的大量涌入、需要重症监护的患者的增加以及与去年同期（9 月至 12 月）相比，重症监护的总小时数。 2021 年。为了应对这些挑战，儿科急诊领导层应用了基于 4S（空间、人员、人员和结构）的灾难管理框架。我们与普通急诊医学领导层、护理、呼吸治疗、药房、当地临床医生、我们的区域医疗保健联盟和紧急医疗服务 (EMS) 合作，制定并实施儿科激增战略。在这里，我们提出了灾害框架战略、所采用的干预措施以及在我们的社区医院环境中实施的障碍和促进因素，这些可以适用于面临类似挑战的其他社区医院。