Management of Emergency DepartmentEmergency department (ED) operations is challenging due to the high variability in patient arrivals and medical acuity. Simulators of patient flow can help in analysing and planning of resources and operations. A number of ED simulators are reviewed based on their published descriptions. Their utilization in practical ED operations is discussed. The research objectives were to create a simulationSimulation model (SM) to support management decisions for a general class of EDs related to near real-time resources allocations. The SM integrates discrete-event and agent-based simulationSimulation approaches. Systems engineeringSystems engineering approach has been used in the SM design and development. The patient flow includes two paths, depending on the emergency severity index. The SM is well suited for the patient flow analysis. Initial results confirmed the importance of using the fast track. The SM makes it possible to simulate and analyse both entire patient flows and flow fragments. Patient flow statistics were validated using a specific ED, including discharges and admission to hospital. The SM supports identification and resolution of systemic problems, including waiting waste reduction, which is significant for patient health and satisfaction, as well as quality of hospital operations. Implementation of the SM in a particular ED requires a reference table which provides data on past statistics of patients arrivals, severity, and utilized medical resources. The SM does not perform financial or layout analysis.