Volume 11

The snow and freezing temperatures will hopefully have passed by the time this edition reaches you; the sight of daffodils may be asignal that the relief of spring is not far off. Winter frequently stretches AMU resources to the limit – in recent years we have had epidemics of seasonal and swine f lu, but this year Norovirus seems to have been the bigger challenge. Ward closures from diarrhoea outbreaks have traditionally been more of a ‘downstream’ problem (no pun intended), but the impact of closure of the AMU would be substantial.At the time of writing this has still, thankfully, been avoided in my own hospital; however it remains a circumstance for which we have to be prepared. This edition’s ‘Viewpoint’ article describes how temporary closure of the AMU was managed in a London hospital. The use of an empty ‘winter pressures ward’ eased the burden in this case, enabling the AMU service to be maintained. Even with the luxury of this spare capacity, there was clearly significant disruption, requiring close collaboration between a variety of departments, which is well described by the authors. Many hospitals have become highly dependent on a functioning AMU to provide timely, safe and effective care for medical emergencies. Major incident plans are in place to deal with mass casualty incidents; we need to consider similar contingencies to deal with AMU closure if patient safety is going to be maintained. This article is a timely reminder of the need for forward planning.