A Crowding Challenge

The four new arrivals are:

1. An 82-year-old who fell at home and has right hip pain. She was able to bear weight afterwards and is sitting in a wheelchair. Her heart rate is 105 beats per minute.
2. A 78-year-old man who has colicky right flank pain for the last 4 hours. He has a blood pressure of 93/60.
3. A 39-year-old man with vomiting and diarrhoea over the past 24 hours. He has normal vital signs.
4. A 26-year-old man with splash burns from a deep fat fryer to his face and forearms. Cooling gel had been applied to the affected areas in his workplace. His pain is adequately controlled.

Who do you prioritise for your remaining resuscitation bed?

When an ED cannot function properly due to crowding, how are shift leaders advised to attempt to maintain safety?

The senior executive management team suggest some options that may help. Which one do you endorse, based on current RCEM guidance?