Sand ambulance

Self-Organised Criticality: Why your ED is like a Sand Pile

Emergency departments (EDs) often seem to shift from calm to crisis in an instant. Why? This article explores ED crowding through the lens of complexity science and self-organised criticality, explaining how minor changes—like a few extra patients—can trigger disproportionate chaos. Using the sandpile analogy and concepts like power law distributions, we reveal why traditional linear models and static targets often fail to manage ED flow effectively. Instead, we offer a data-driven, systems-based approach: identifying tipping points, recognising early warning signs, and implementing proactive, anticipatory interventions. From real-time dashboards to weekly cycle planning and distributed decision-making, this article offers a practical guide for building resilience in emergency care. Learn how your ED can thrive in complexity, not just survive it.

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Derivation and Validation of the Simplified Bleeding Audit Triage Trauma (sBATT) Score

The simplified BATT (sBATT) score offers a practical trauma triage tool for use in motor vehicle collisions where monitoring equipment may be unavailable. Derived from the original BATT score and validated on over 70,000 UK patients, the sBATT shows excellent performance in predicting early death using only observable signs. Ideal for lay responders, trapped patients, and low-resource settings, this novel tool could help guide early trauma care and emergency dispatch.

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