Vignette Closure 

Your ED received 23 blast injury patients, and although it was disruptive, the disaster plans that were in place were enacted, and the ED was able to make space to care for the patients from the MCI. After seeing how this MCI was handled, hospital and ED administrators started to work with the ED leadership to develop high capacity plans similar to disaster plans and to seek to enact them all the time so that the ethical issues of disparate patient care are addressed.

Dr. Marshall is vice chair of operations and associate professor of emergency medicine at the University of Kansas Medical Center.

Dr. Leigh is an associate professor of emergency medicine and palliative medicine at Cleveland Clinic Akron General in Akron, Ohio. 

Dr. Sauder is a community emergency physician, practicing in the Dayton, Ohio, area. 

Dr. Bookman is vice chair and professor of emergency medicine at the University of Colorado School of Medicine.

References

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2. Andress K, Hanfling D. Disaster Planning and Response. In: Strauss & Mayer’s Emergency Department Management. ACEP; 2021.
3. ACEP. Crowding (policy statement). https://www.acep.org/patient-care/policy-statements/crowding.
4. Moskop JC, Sklar DP, Geiderman JM, et al. Emergency department crowding, part 1–concept, causes, and moral consequences. Ann Emerg Med. 2009;53(5):605-611.
5. Moskop, JC, Geiderman, JM, Marshall KD, et al. Another look at the persistent moral problem of emergency department crowding. Annals of Emerg Med. 2019;74(3):357-364.
6. Moskop JC, Sklar DP, Geiderman JM, et al. Emergency department crowding, part 2–barriers to reform and strategies to overcome them. Ann Emerg Med. 2009;53(5):612-617.
7. Moskop JC, Iserson KV. Triage in medicine, part II: Underlying values and principles. Ann Emerg Med. 2007;49(3):282-287.
8. Kelen GD, Wolfe R, D’Onofrio G, et al. Emergency department crowding: the canary in the health care system. NEJM Catalyst. https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0217. Published September 28, 2021. Accessed June 14, 2025.
9. McNeilly BP, Lawner BJ, Chizmar TP. The chronicity of emergency department crowding and rethinking the temporal boundaries of disaster medicine. Ann Emerg Med. 2023;81(3):282-285.