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Study objectiveOne in 4 deaths from COVID-19 has been attributed to hospital crowding. We simulated how many ambulances would be required to rebalance hospital load through systematic interhospital transfers. We assessed the potential feasibility of such a strategy and explored whether transfer requirement was a helpful measure and visualization of regional hospital crowding during COVID-19 surges.MethodsUsing data from the United States hospitals reporting occupancy to the Department of Health and Human Services from July 2020 to March 2022 and road network driving times, we estimated the number of ambulances required weekly to relieve overcapacity hospitals.ResultsDuring the peak week, which ended on January 8, 2021, approximately 1,563 ambulances would be needed for 15,389 simulated patient transports, of which 6,530 (42%) transports involved a 1-way driving time of more than 3 hours. Transfer demands were dramatically lower during most other weeks, with the median week requiring only 134 ambulances (interquartile range, 84 to 295) and involving only 116 transports with 1-way driving times above 3 hours (interquartile range, 4 to 548). On average, receiving hospitals were larger and located in more rural areas than sending hospitals.ConclusionThis simulation demonstrated that for most weeks during the pandemic, ambulance availability and bed capacity were unlikely to have been the main impediments to rebalancing hospital loads. Our metric provided an immediately available and much more complete measure of hospital system strain than counts of hospital admissions alone.

The emergency department (ED) serves as the main source of care for patients who are victimsof interpersonal violence. As a result, emergency physicians across the nation are at the forefrontof delivering care and determining dispositions for many at-risk patients in a dynamic healthcareenvironment. In the majority of cases, survivors of interpersonal violence are treated and dischargedbased on the physical implications of the injury without consideration for risk of reinjury and thestructural drivers that may be at play. Some exceptions may exist at institutions with hospital-basedviolence intervention programs (HVIPs). At these institutions, disposition decisions often includeconsideration of a patient’s risk for repeat exposure to violence. Ideally, HVIP services would beavailable to all survivors of interpersonal violence, but a variety of current constraints limit availability.Here we offer a scoping review of HVIPs and our perspective on how risk-stratification could helpemergency physicians determine which patients will benefit most from HVIP services and potentiallyreduce re-injury secondary to interpersonal violence.