A major incident was declared at Belfast's Royal Victoria Hospital on Wednesday due to a large backlog of patients at the A&E department.
The hospital said additional staff had to be called in and extra beds opened to relieve pressure on the unit.
At one stage, 42 people were waiting on trolleys and staff described the situation as "horrendous".
The Belfast Trust said the situation was brought under control just before midnight.
At about 20:00 GMT, trolleys from the emergency department were backed up into the x-ray area.
As a result, some A&E patients were placed in the recovery area and fracture clinic. The day procedure unit was also re-opened.
Joe McCusker, from health union Unison, said the situation "had been on the cards".
"My understanding is that a lot of the outliers and people on trolleys had been diverted from Antrim A&E, Craigavon A&E and Lagan Valley.
'Seven hours of sheer hell'"We have a crisis in our A&E services. It's not just a Belfast Trust issue, it's a Northern Ireland wide issue."
Mr McCusker said the problems in Belfast A&Es had been highlighted in a report by the College of Emergency Medicine last November.
"My concern is what is being done about this by the health minister and Health and Social Care Board," he said.
Analysis
For several hours on Wednesday night, Belfast's Royal Victoria Hospital was "at breaking point", some members of staff said.
But what is worrying was that this was no major trauma. There had been no major car accident or fire; there was no flu epidemic or winter vomiting bug.
All of this happened against a relatively quiet backdrop. So why?
The lack of middle-grade doctors across the United Kingdom is partly to blame. There is a 50% shortage affecting emergency departments nationwide.
Staff burn-out in A&E is another issue.
In November 2012, almost all of the emergency medicine consultants in the Belfast Health Trust raised concerns about the safety of A&E.
Another problem for emergency departments is the four-hour target for patient waiting times. There is tremendous pressure on staff and on individual health trusts to tick that four-hour box.
Ultimately one question must be put to Health Minister Edwin Poots.
Is the current policy on accident and emergency working in Northern Ireland?
Staff at the hospital told the BBC that if a major trauma had been brought into the hospital on Wednesday night, there was neither space nor staff to cope with it.
Eamonn Hughes was at the hospital as his brother, Patrick, needed emergency treatment.
He described the scene as "seven hours of sheer hell".
"It was like something you would see in third world countries," he said.
Ambulances diverted"The staff were overworked. There were hundreds of people who were not being attended to.
"This is a normal Wednesday night. There are no major disasters thankfully or car crashes, so I dread to think what would happen if something abnormal happened."
Ambulances were diverted to the Ulster Hospital in Dundonald for several hours during the evening.
The hospital said some patients were transferred to other sites.
Janice Smyth from the Royal College of Nursing said the situation on Wednesday night was "quite horrendous" and "totally unacceptable".
"The pressure on that department has been building for the last few weeks," she told BBC Radio Ulster's Nolan Show.
"We are really concerned that the situation was allowed to develop to the point that we had to implement a major incident plan to deal with it.
"Nurses are really concerned that patients are not getting the care they need and they're certainly not getting it in a dignified manner."
She said many staff members did not leave the department until 03:00 GMT on Thursday.
Colm Donaghy, the chief executive of the Belfast Health Trust, paid tribute to the staff.
He added: "Whenever we are under that level of pressure it can seem that we're not coping, but, in fact, we did cope".
"Normally when we have hundreds of people attending our A&E, we would expect to admit something like 27-28% of those people," he said.
"In the last couple of days we have been admitting over 40% of the people who have been attending."
"Start Quote
End Quote Colm Donaghy Belfast Health TrustMajor incident planning is a part of our ongoing planning. It was unusual, but not unique, to declare a major incident"
He said that there had been 10% rise in the numbers of people with fractures compared to last year, and there were also more people with respiratory conditions attending the hospital.
"Major incident planning is a part of our ongoing planning," he said. "It was unusual, but not unique, to declare a major incident.
"The circumstances differ at different times. Last night, I felt we had so many very ill and very sick patients that the way to deal with that was to ensure that we mobilised all of our resources."
He said at least 10 very senior medical staff were brought into cope with the situation, and more than 24 nurses.
'Goodwill of staff'Mr Donaghy said that had a major accident or similar incident happened on Thursday night, the trust would have been able to handle it.
Alison Millar, from the Nipsa union, said: "The trust is relying on the goodwill of staff who are stressed, overworked and are working under extreme pressure.
"Staff's goodwill is being taken for granted. The trust and the (health) minister need to take corporate responsibility for the provision of A&E services both in the Belfast Trust and across Northern Ireland."
BBC Northern Ireland health correspondent Marie-Louise Connolly said: "Clearly what happened in the Royal Victoria Hospital last night proves that the current A&E policy is not working.
"Considering a major incident was declared, this time it cannot be dismissed as media speculation."
On Monday, the BBC reported that the A&E at the Royal had struggled at the weekend to cope with its intake.
The health board said the weekend had passed without major difficulty.
In November 2011, Belfast City Hospital's Accident and Emergency Unit closed its doors and the Royal became the main hub of emergency care in Belfast.
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