Defining a rational back-up policy for emergency departments.

All emergency departments face the possibility of having insufficient personnel to provide adequate care for patients. Such occasions may present an emergency department with several severely injured patients or merely an unusually large number of that emergency department's usual patient profile. When such staffing inadequacies occur, emergency department directors must respond with additional personnel. Since there is no national standard for back-up policies for emergency departments, emergency medicine has a responsibility to examine this question in order to arrive at some possible solutions. In addition, emergency department directors have an obligation to consider their particular staffing and usage patterns in order to try to devise the most efficient back-up policy prior to need. Finally, assessment of the success with which such back-up policies are used is discussed.