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The design recommendations are also proposed to enhance ED surge capacity for further pandemics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The COVID-19 pandemic imposed unprecedented demands on EDs worldwide, compelling EDs to adopt spatial adaptive measures to accommodate overflow patients and mitigate the risk of nosocomial infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>15 EDs in 3A-Grade general hospitals in the central city area of Shanghai are selected as research objects. Data are collected during the peak surge period (December 2022\u2013January 2023) using a web crawling program and field research to extract patient volume statistics, patient spatial distribution, and spatial adaptive measures from the text and image clusters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the surge, the EDs had to accommodate patients with peak volume 2 to 3 times higher than normal patient volume, resulting in ED overcrowding and public space occupation including hallways and corridors. Spatial adaptive measures, including existing space requisition, existing patient flow improvement, and the construction of the \u201cSecond ED\u201d were adopted to maintain ED's normal operation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The COVID-19 surge overwhelmed EDs in Shanghai, prompting the implementation of relevant spatial adaptive measures. Design recommendations include establishing integrated related medical spaces with surge capacity planning, incorporating flexible public spaces by predesign, and designing isolated treatment areas for infectious patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19375867251365877","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T07:02:31Z","timestamp":1755586951000},"page":"254-276","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Spatial Adaptive Measures of the Emergency Departments in Response to the COVID-19 Surge\u2014A Case Study of the Central City Area of Shanghai, China"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4847-4334","authenticated-orcid":false,"given":"Yuxuan","family":"Chen","sequence":"first","affiliation":[{"name":"Tongji University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leiqing","family":"Xu","sequence":"additional","affiliation":[{"name":"Tongji University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingwei","family":"Shi","sequence":"additional","affiliation":[{"name":"East China Architectural Design & Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejor.2012.07.028"},{"key":"e_1_3_2_3_1","unstructured":"Australasian College for Emergency Medicine. 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