Several studies have shown that the incidence of fractures during periods of snow and ice increases significantly and continues to persist despite preventative measures. The studies discussed in this article suggest that these predominantly consist of "walking wounded" with significant increase in demands in specific services such as the emergency department and the trauma and orthopaedic department. Traditionally, the only formal mechanism in place for most hospitals to react to extreme events is to declare a major incident. This is a binary, all or nothing response, and it is questionable whether an increase of snow and ice-related fractures would be justified in triggering such an extreme response. On the other end is the "do nothing" approach, which relies heavily on the professionalism, adaptability, and resilience of the staff to deal with the additional demand. The authors present a graded surge plan model for escalation in key resources, such as staff, space, and supplies in order to achieve the most efficient response ensuring good clinical outcome for patients.
Keywords: escalation; fracture incidence; major incident; surge response.
© 2019 John Wiley & Sons, Ltd.