The coronavirus disease (COVID-19) pandemic caused critical hospital bed and staffing shortages in parts of California for most of 2020 and 2021. Alternate Care Sites (ACS) were established in several regions to alleviate the hospital patient surge and to maximize staffed bed capacity. Over 1900 patients were successfully provided medical care (with physician, nursing, respiratory therapy, oxygen, and pharmacy services) in relatively austere settings. This paper examines the challenges faced at these ACS facilities and how adaptations were incorporated according to the changing dynamics of the COVID-19 pandemic to successfully manage higher acuity patients. ACS facilities were 1 approach to California’s surge of COVID-19 patients, despite limited medical supplies and staffing.

The state of California, in the United States of America, has a population of nearly 40 million people and is the 5th largest economy in the world. During the coronavirus disease 2019 (COVID-19) pandemic in 2020-2021, the state experienced a medical surge that stressed its sophisticated health-care and public health system. During this period, ventilators, oxygen, and other equipment necessary for providing ventilatory support became a scarce resource in many health-care settings. When demand overwhelms supply, creative solutions are required at all levels of disaster management and health care. This study describes the disaster response by the state of California to mitigate the emergency demands for oxygen delivery resources.

The foreground of Elisebreen, a retreating valley glacier in West Svalbard, exhibits a well-preserved assemblage of subglacial landforms including ice-flow parallel ridges (flutings), ice-flow oblique ridges (crevasse-fill features), and meandering ridges (infill of basal meltwater conduits). Other landforms are thrust-block moraine, hummocky terrain, and drumlinoid hills. We argue in agreement with geomorphological models that this landform assemblage was generated by ice-flow instability, possibly a surge, which took place in the past when the ice was thicker and the bed warmer. The surge likely occurred due to elevated pore-water pressure in a thin layer of thawed and water-saturated till that separated glacier ice from a frozen substratum. Termination may have been caused by a combination of water drainage and loss of lubricating sediment. Sedimentological investigations indicate that key landforms may be formed by weak till oozing into basal cavities and crevasses, opening in response to accelerated ice flow, and into water conduits abandoned during rearrangement of the basal water system. Today, Elisebreen may no longer have surge potential due to its diminished size. The ability to identify ice-flow instability from geomorphological criteria is important in deglaciated terrain as well as in regions where ice dynamics are adapting to climate change.

Introduction: The goal of this study was to determine if emergency department (ED) surge and end of shift assessment of patients affect the extent of diagnostic tests, therapeutic interventions performed and accuracy of diagnosis prior to referral of patients to Internal Medicine as well as the impact on patient outcomes. Methods: This study was a health records review of consecutive patients referred to the internal medicine service with an ED diagnosis of heart failure, COPD or sepsis, at two tertiary care EDs. We developed a scoring system in consultation with senior emergency and internal medicine physicians to uniformly assess the treatments and investigations performed for patients diagnosed in the ED with heart failure, COPD or sepsis. These scores were then correlated with surge levels and time of day at patient assessment and disposition. Rate of admission and diagnosis disagreements were also assessed. Results: We included 308 patients (101 with heart failure, 101 with COPD, 106 with sepsis). Comparing middle of shift to end of shift, the overall weighted mean scores were 92.2% vs. 91.7% for investigations and 73.5% vs. 70.0% for treatments. Comparing low to high surge times, the overall weighted mean scores were 89.9% vs. 92.6% for investigations and 68.6% vs. 71.7% for treatments. Evaluating each condition separately for investigations and treatments according to time of shift or surge conditions, there were no consistent differences in scores. We found overall high admission rates (93.1 % for heart failure, 91.1% for COPD, 96.2% for sepsis patients), and low rates of diagnosis disagreement (4.0 % heart failure, 10.9% COPD, 8.5% sepsis). Conclusion: We found that surge levels and end of shift did not impact the extent of investigations and treatments provided to patients diagnosed in the emergency department with heart failure, COPD or sepsis and referred to internal medicine. Admission rates for the patients referred were above 90% and there were very few diagnosis disagreements or diversion to alternate service by internal medicine. We believe this supports the emergency physician's ability to adapt to time and surge constraints, particularly in the context of commonly encountered conditions.

This paper presents the analysis of the instabilities inception in a transoniccentrifugal compressor for different rotation speeds. The analysis was conducted fromexperimental results obtained with unsteady pressure sensors implanted in the inducer,vaneless diffuser and vaned diffuser. Beyond the stability limit the compressor entersinto a deep surge without any precursor, whatever the speed. The surge process isinitiated in the vaned diffuser by a massive boundary layer separation. For low speeds,together with the surge which remains triggered in the diffuser, aerodynamic instabilitiesare detected in the inducer. These instabilities can be understood as “tip clearancerotating disturbances” because they are generated at the leading edge of the impeller mainblades and move along the tip clearance trajectory.

The Bay of Bengal is surrounded by coastline except to the south, where there is open sea. The coastline bends most sharply along the coast of Bangladesh, and there are many small and large islands in the off shore region there. In order to incorporate the island boundaries and the curved coastline properly, in any numerical scheme it is often necessary to consider a very fine grid resolution along the coastal belts whereas this is unnecessary away from the coasts. However, a very fine resolution involves more memory and more CPU time in the numerical solution process, and invites numerical instability. On the other hand, boundary-fitted curvilinear grids in hydrodynamic models for coastal seas, bays and estuaries not only fit to the coastline but also render the finite difference schemes simpler and more accurate. In this article, the boundary-fitted curvilinear grids for the model represent the complete boundary of the area considered by four curves defined by four functions, and the four boundaries of two of the larger islands are then represented approximately by two general functions. An appropriate independent coordinate transformation maps the curvilinear physical area to a square domain, and each island boundary is transformed to a rectangle within this square domain. The vertically integrated shallow water equations are transformed to the new space domain, and solved by a regular explicit finite difference scheme. The model is applied to compute the water levels due to astronomical tides, and also the water levels due to surges associated with tropical storms that hit the coast of Bangladesh.

Introduction The 2009 H1N1 influenza pandemic created a surge of patients with low-acuity influenza-like-illness (ILI) to hospital Emergency Departments (EDs). The development and results of a tiered surge plan to care for these patients at a Pediatric Emergency Department (PED) were studied.

Hypothesis/Problem By providing standard assessment and treatment algorithms within physically separate ILI Extension Areas, it was hypothesized that patient care could be streamlined and the quality of care maintained.

Methods Hospital administrators created the tiered H1N1 surge plan within the framework of the existing emergency operations plan (EOP). After the initial expansion of space and staff utilization within the existing PED footprint, ILI Extension Areas were opened and staffed by non-ED physicians and nursing to provide care rapidly for ILI patients after Registered Nurse (RN) screening. Volumes, length of stay (LOS), left without being seen (LWBS) rates, patient satisfaction, and costs were tracked and measured.

Results Significantly elevated volumes of patients were seen in the months of September and October of 2009 (42.0% and 32.7% increase over 2008). During this time, 612 patients were triaged to the ILI Extension Areas. The LOS was similar to that experienced in prior years. The LWBS rates in September (4.8%) and October (3.4%) were slightly elevated over the 2009 yearly average (3.2%), but remained lower than during a prior, high-volume month. Satisfaction, measured as patients’ “likelihood to recommend,” remained within the range observed during other parts of the year. Cost estimates indicate favorable financial performance for the institution.

Conclusion The tiered surge response plan represented a success in managing large volumes of low-acuity patients during an extended period of time. This design can be utilized effectively in the future during times of patient surge.

During a disaster, victims with varied morbidities are located at incident sites, while healthcare facilities with varied healthcare resources are distributed elsewhere. Transportation serves an essential equilibrating role: it helps balance the patients' need for care with the supply of care. Studying the special case of New York City, this article sets out the healthcare transportation components as: (1) incident morbidity; (2) transportation assets; and (3) healthcare capacity. The relationship between these three components raises an assignment problem: the management of healthcare transportation within a dynamic and partly unpredictable incident-transportation-healthcare nexus, under urban disruption. While the routine dispatch problem can be tackled through better geographic allocation software and technical algorithms, the disaster assignment problem must be confronted through real-time, mutual adjustment between institutions. This article outlines institutional alternatives for managing the assignment problem and calls for further research on the merits of alternative institutional models.