Letter to the Editor Dear Editor, On 11 March 2020, the World Health Organization declared COVID-19 a global pandemic. 1 Since then, COVID-19 cases have risen exponentially in Singapore, 2 resulting in a corresponding need to rapidly increase our national treatment capacity, especially for patients requiring intensive care. With direction from Singapore's Ministry of Health (MOH), Tan Tock Seng Hospital (TTSH) worked together with its affiliated institution, National Centre of Infectious Diseases (NCID), to comprehensively plan to increase ICU capacity across the 2 institutions. NCID was purpose-built to treat patients with infectious diseases and to shoulder Singapore's outbreak response with peacetime capacity of 330 beds and flexibility to ramp-up to more than 500 beds. 3 NCID is located adjacent to TTSH-one of Singapore's largest tertiary hospitals, with a large capacity of over 1,500 beds. NCID is currently the frontline healthcare institution for the screening and treatment of COVID-19 patients in Singapore. 4 A decision was made from the onset to streamline all COVID-19 work processes within TTSH-NCID. Since January 2020, all COVID-19 patients requiring intensive care in TTSH-NCID were managed within NCID's 2 ICU wards. i TTSH's 4 ICU wards (Medical, Cardiac, Surgical and Neuroscience) continued to treat all non-COVID-19 'business-as-usual' (BAU) patients. As national cases steadily rose throughout March, and in anticipation of a potential exponential increase, TTSH-NCID (with direction from MOH) formulated an integrated plan to increase ICU capacity. Although TTSH-NCID's target ICU capacity was aligned to MOH's national objectives, TTSH-NCID planned to progressively ramp-up in phases according to realtime utilisation and demand. This plan was executed in April, as national cases started to rise exponentially. The ramp-up in Outbreak ICU (OICU) capacity to treat COVID-19 patients was achieved via 3 phases: (1) converting 2 BAU ICU wards in TTSH into OICU wards, (2) repurposing COVID-19 General Wards (GWs) in i NCID has a capacity of 38 ICU beds, of which only 10 are operational during peacetime.

The maritime environment presents a unique set of challenges to search and recovery (SAR) operations. There is a paucity of information available to guide provision of medical support for SAR operations for aircraft disasters at sea. The Republic of Singapore Navy (RSN) took part in two such SAR operations in 2014 which showcased the value of a military organization in these operations. Key considerations in medical support for similar operations include the resultant casualty profile and challenges specific to the maritime environment, such as large distances of area of operations from land, variable sea states, and space limitations. Medical support planning can be approached using well-established disaster management life cycle phases of preparedness, mitigation, response, and recovery, which all are described in detail. This includes key areas of dedicated training and exercises, force protection, availability of air assets and chamber support, psychological care, and the forensic handling of human remains. Relevant lessons learned by RSN from the Air Asia QZ8501 search operation are also included in the description of these key areas. Teo KAC , Chong TFG , Liow MHL , Tang KC . Medical support for aircraft disaster search and recovery operations at sea: the RSN experience. Prehosp Disaster Med. 2016; 31(3):294-299.