J Korean Med Sci.  2021 Aug;36(33):e210. 10.3346/jkms.2021.36.e210.

Surge Capacity and Mass Casualty Incidents Preparedness of Emergency Departments in a Metropolitan City: a Regional Survey Study

  • 1Department of Emergency Medicine, Korea University Guro Hospital, Seoul, Korea
  • 2Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  • 3Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
  • 4Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
  • 5Department of Emergency Medicine, Hanyang University Seoul Hospital, Seoul, Korea
  • 6Department of Emergency Medicine, Korea University Anam Hospital, Seoul, Korea
  • 7Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
  • 8Department of Emergency Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea


Emergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city.
This cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government's public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity.
In the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity.
If the hospital's emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.


Disasters; Mass Casualty Incidents; Surge Capacity; Hospital Emergency Service; Health Care Surveys
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