Hospitals throughout Arizona have been scrambling to find enough beds to accommodate all the people who’ve had to be admitted due to an unusually widespread outbreak of the flu and other illnesses,” recently reported the Payson Roundup.

It's a problem that many other hospitals across the nation have hade to cope with this flu season.

"This is the worst outbreak of flu in a small amount of time that I've seen in the six years I've been here," Chris Wolf, CEO of Payson Regional Medical Center (PRMC), was quoted saying.

During February, the hospital's emergency room had 1,103 visits, compared to 942 last year, said Kim Reger, director of emergency services at the medical center.

PRMC has received calls from hospitals in Prescott and Cottonwood seeking to transfer patients because they have run out of beds. PRMC has also sought permission to send patients elsewhere at different points during the last several weeks.

In Jackson County, Georgia, the high number of patients showing up with flu-like symptoms caused some area hospitals to at times not have enough beds for inpatient admissions.

In Visalia, California, a 35-foot tent had to be erected to handle emergency room overflow at Kaweah Delta Hospital in response to the surge in flu admissions. The hospital's emergency department typically treats about 190 patients per day, but suddenly had to deal with a surge of between 240 and 250 a day.

In Tulare, the District Hospital at one point was seeing a hundred or more persons coming into its ER, forcing administrators to make plans to utilize outpatient areas.

In and around Syracuse, New York, the Post-Standard reported, the surge in flu patients had created a "gridlock in local hospital emergency rooms, which have been turning away ambulances." And at one area hospital, the staff is insufficient to handle its patient load.

The problem, known as “surge,” isn’t surprising to national public health preparedness authorities or to HSToday readers who understand that nationally, surge capacity is inadequate, especially for a large-scale catastrophic medical crisis.

Indeed, in the July HSToday feature, “Seeking to Surge,” we reported that even modest increases in admissions can tax many hospitals’ capabilities.

This was exemplified in the March HSToday report, “The Ice Storm Cometh,” on the massive ice storm in Oklahoma in December that left more than 700,000 homes and businesses without power for nearly a week.

As HSToday reported, hospitals throughout the state got a first-hand lesson in dealing with the surge of persons who sought both storm-related injury care and shelter.

In the event of a calamitous medical risis, having someplace to treat immense numbers of injured and sick will, in most places, be overwhelming - exhausting supplies, resources and people.

The California Department of Public Health recently released the first comprehensive surge guidelines for health care during a catastrophic emergency.

The new "surge capacity guidelines"  - which authorities hope will serve as guidlines for hospitals nationwide, especially in the event of a pandemic - calls for letting older, sicker patients be allowed to die in order to save the lives of patients more likely to survive a catastrophic public health crisis.

“During a major disaster, the heath care system will look very different from what we are accustomed to,” said Dr. Mark Horton, director of the California Department of Public Health. “These guidelines will help communities as they plan how to sustain a functioning health care system following a catastrophic event such as a severe earthquake, bioterrorism attack or outbreak of pandemic influenza.“

In 2006, the Joint Commission on Accreditation of Healthcare Organizations also issued the report, "Surge Hospitals: Providing Safe Care in Emergencies."

More than 115 million people visited emergency rooms across the United States in 2005, according to the Centers for Disease Control and Prevention - a 20 percent increase over the previous decade. Meanwhile, between 1995 and 2005 the number of ERs dropped by nine percent.

In addition, dozens of trauma units have shuttered their doors, and many others face closure, largely due to economic reasons. See the groundbreaking HSToday report, "The Trauma in America's Trauma Care."

In St. Louis, the potential closure of Kenneth Hall Regional Hospital has regional public health authorities alarmed.

"We are concerned about a medical surge or mass-casualty incident," Nick Gragnani, executive director of the St. Louis Area Regional Response System, told the St. Louis Post-Dispatch. "We would be losing those beds, and we're losing a spot where we can stage much-needed medical surge equipment."

A recent national survey by Trust for America’s Health disturbingly found that 25 states would run out of hospital beds within two weeks of a moderate pandemic.

Nationally, analysts predict a 191 percent increase in the number of hospital beds that will be needed, and a 461 percent increase in intensive care beds to cope with just a 1918-equivalent pandemic.

Researchers at Rutgers and the State University in New Brunswick, NJ analyzed daily bed availability in 78 New Jersey hospitals and found that at certain times of the year, the number of available beds falls below federal disaster planning benchmarks.

"We’re over-extended,” without having to worry about surge, HSToday.us was told by Ron Anderson, president and chief executive officer of Parkland Health & Hospital System in Dallas, Texas.

“Surge is an issue we’re not going to have our arms around for a long time. It’s a huge problem,” Dr. Tilman Jolly, associate chief medical officer for medical readiness in the Office of the Chief Medical Officer of the Department of Homeland Security, told HSToday.us.

He added: “If you want to know how to deal and respond to this situation, just call any ER [emergency room]administrator and ask him what he did last night … We’re dealing now every day with routine closings of emergency rooms because they’re all full.”

“Our [national] surge capacity is shallow,” added Dr. Susan Penefield, manager of the Texas Department of Health’s Infectious Disease Control Unit. She pointed out that it took only 352 severe acute respiratory syndrome cases in Canada in 2003 to max out hospitals’ surge capacity.

“ER’s are surging all the time!” Dr. Brit Oiulfstad, pandemic coordinator for the Los Angeles health department’s Public Health Emergency Preparedness and Response Program, told HSToday.us.

“During the past decade, emergency department visits have increased by 26 percent, while the number of emergency departments has decreased by nine percent,” Rep. Ed Markey, (D-Mass.), a senior member of the House Homeland Security Committee, told HSToday.us. “In 2003, [emergency room] diversions [to other hospitals] occurred more than half a million times—an average of once per minute, and the problem is not getting better. When our health care system is on life support, it does little good to stock up on new thermometers.”