Nager Alan L, Khanna Kajal
Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, University of Southern California, and The Keck School of Medicine, Los Angeles, CA 90027, USA.
J Trauma. 2009 Aug;67(2 Suppl):S96-9. doi: 10.1097/TA.0b013e3181ad2aaa.
Emergency Department crowding has long been described. Despite the daily challenges of managing emergency department volume and acuity; a surge response during a disaster entails even greater challenges including collaboration, intervention, and resourcefulness to effectively carry out pediatric disaster management. Understanding surge and how to respond with appropriate planning will lead to success. To achieve this, we sought to analyze models of surge; review regional and national data outlining surge challenges and factors that impact surge; and to outline potential solutions.
We conducted a systemic review and included articles and documents that best described the theoretical and practical basis of surge response. We organized the systematic review according to the following questions: What are the elements and models that are delineated by the concept of surge? What is the basis for surge response based on regional and national published sources? What are the broad global solutions? What are the major lessons observed that will impact effective surge capacity?
Multiple models of surge are described including public health, facility-based and community-based; a 6-tiered response system; and intrinsic or extrinsic surge capacity. In addition, essential components (4 S's of surge response) are described along with regional and national data outlining surge challenges, impacting factors, global solutions, and lesions observed.
There are numerous shortcomings regionally and nationally affecting our ability to provide an effective and coordinated surge response. Planning, education, and training will lead to an effective pediatric disaster management response.
急诊科拥挤问题早已被描述过。尽管日常应对急诊科的工作量和病情严重程度面临挑战，但灾难期间的激增应对带来的挑战更大，包括协作、干预和应变能力，以有效开展儿科灾难管理。了解激增情况以及如何通过适当规划做出应对将带来成功。为实现这一目标，我们试图分析激增模式；审查概述激增挑战和影响激增因素的区域和国家数据；并概述潜在解决方案。
我们进行了一项系统综述，纳入了最能描述激增应对理论和实践基础的文章和文件。我们根据以下问题组织了系统综述：激增概念所界定的要素和模式有哪些？基于区域和国家已发表资料的激增应对基础是什么？广泛的全球解决方案有哪些？观察到的哪些主要经验教训会影响有效的激增能力？
描述了多种激增模式，包括公共卫生模式、基于设施的模式和基于社区的模式；一个六级应对系统；以及内在或外在激增能力。此外，还描述了基本组成部分（激增应对的4个S）以及概述激增挑战、影响因素、全球解决方案和观察到的经验教训的区域和国家数据。
区域和国家层面存在诸多不足，影响我们提供有效和协调的激增应对的能力。规划、教育和培训将带来有效的儿科灾难管理应对。
