Emergency Departments ‘too crowded’ to cope with a disaster

Sunday 12 January 2025

A survey has found fewer than one in 10 emergency doctors feel confident they could evacuate their A&Es in a crisis, because they are routinely too full.

The Royal College of Emergency Medicine (RCEM) has described the research as “sobering proof that that the Urgent and Emergency Care system in this country falls short of what the public deserve.”

The study, called ‘A Survey of Major Incident Preparedness in English, Type 1 Emergency Departments’ was published in the EMJ (Emergency Medicine Journal) on Tuesday 7 January 2025.

Researchers surveyed doctors working in Emergency Departments (EDs) across the country – including major trauma centres and trauma units – on the level of crowding currently experienced and how they felt their department would be able to respond to a major incident.

With a 47% response rate (71 EDs in total), the survey found:

• 88.7% (63 total) reported that their hospital’s major incident plan required them to clear the ED but only six (9.5%) of the 63 thought this was achievable.
• 100% of respondents said their ED experienced crowding, with 53.5% (38) saying their ED was crowded more than 75% of the time.
• 5% (11 total) were confident that their ED could adequately respond to a major incident.

Dr Adrian Boyle, President of The Royal College of Emergency Medicine said: “Just this week we have seen how sorely unprepared the health system is to deal with events as predictable as a surge in flu and cold weather. If hospitals currently don’t have capacity to deliver safe emergency care on a normal day – how can we expect them to respond to a major incident?

“While the results of this survey are sobering reading, they sadly come as no surprise to anyone that has worked in or attended an Emergency Department in the last few years. Overcrowded A&Es, burnt-out doctors and nurses forced to deliver care to people in corridors – this is now the norm.”

“At RCEM we have campaigned extensively about the very real dangers of long A&E waits, particularly to the elderly and vulnerable – and the increased risk of avoidable death these long waits bring. This survey shows another danger of the fragility of the current system, that in the event of a major incident – it is reasonable to believe that hospitals would struggle to cope because they are too full. This research is sobering proof that the Urgent and Emergency Care system falls short of what the people of this country deserve.”

Last month, RCEM described NHS England guidance on how patients can be ‘safely’ treated in corridors as a “normalisation of the unacceptable and dangerous”.