An influenza pandemic will undoubtedly create a major increase in demand for critical care services. The majority of UK hospital intensive care units (ICUs) are already operating at > 98% bed occupancy. Integral to the success of any emergency planning strategy is 'surge capability', incorporating the ability to scale up the delivery of appropriate specialist care to those that require it [4] . Modelling of the impact of an influenza pandemic on UK critical care services has been carried out using the FluSurge 1.0 programme developed at the US Centers for Disease Control [5] . With simulation of an 8-week epidemic and 25% attack rate the demand for critical care beds from patients with influenza would represent 208% of current combined level 2 (highdependency unit) and level 3 (ICU) bed capacity, and 231% of current level 3 capacity [6] . Even allowing for optimistic estimates of other modulating factors (50% reduction in ICU demand with use of neuraminidase inhibitors and 50% upgrade of level 2 to level 3 beds), level 3 bed occupancy due to the pandemic would remain at 75%. Furthermore, occupancy of level 3 beds by 'flu patients' was unsustainable at approximately 50% in terms of care for other patients even in the most optimistic conditions. SARS outbreak, up to 32% of cases were admitted to ICU, 25% were mechanically ventilated and 28 day mortality for ventilated patients was 45% [13] . In Singaporean SARS patients admitted to ICU, 98% developed ARDS [13] .