Abstract：
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.
摘要：
美国大多数儿童到社区医院接受急诊科（ED）护理。那些患有严重疾病并需要重症监护的人将被稳定并转移到具有重症监护能力的三级儿科医院。在2022年秋季“三分法”期间，“随着病毒负担的显著增加，全国范围内儿科ED患者数量激增.这导致ED拥挤，美国各地儿科重症监护病床的可用性下降。因此,无法将危重病人转移出去，在社区医院一级，对长期管理的需求增加了。我们描述了马萨诸塞州社区ED在这次激增期间的经历，包括大量涌入的儿科患者，需要重症监护的人数增加，以及与2021年同期(9月至12月)相比的重症监护总时数。为了应对这些挑战，儿科ED领导层应用了基于4S空间的灾害管理框架，工作人员,东西，和结构。我们与普通急诊医学领导合作，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）来创建和实施儿科激增策略。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者，这可以应用于其他面临类似挑战的社区医院。
