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  • Surge capacity is composed of the domains space, staff, supplies, and systems. Progressive strain across any of these domains compromises the quality of care provided for patients.

  • Hospitals should develop mitigating strategies that are proportionally implemented as strain compromises patient care, codified as conventional, contingency, and crisis standards of care.

  • The worldwide pandemic caused by COVID-19 strained the international health care system, causing numerous hospitals to operate under contingency and crisis standards of care.

  • A pandemic can cause unique and sometimes unforeseen strain in space, staff, supplies, and systems.

  • Staff mental health may be overlooked in disaster planning, but resiliency is particularly important for prolonged disasters as well as for individuals practicing outside their routine duties.

  • Despite the most detailed and contingency pandemic planning, preparations should remain operation focused as plans do not always align with a disaster’s actual trajectory.


Disaster medicine requires provision of health care to those afflicted from a event or series of events that impact a community or region. Surge capacity can be defined as a hospital’s ability to manage an increase in patient needs (patient volume or required services) that would otherwise severely challenge or exceed the present capacity of the facility.1,2 Examples of events that may require increased surge capacity include mass casualty events such as natural disasters, terrorist attacks, manufacturing or industrial accidents, mass shootings, or pandemics.

There have been numerous infectious disease outbreaks of high consequence including H1N1 Flu of 1918, H5N1 Avian flu of 1997, SARS, MERS, H1N1 swine flu of 2009, and Ebola. New York City has experienced numerous unfortuante disasters including 9/11, Superstorm Sandy, and now COVID-19.3 A pneumonia of unknown cause was first reported by the World Health Organization on 12/31/19, later identified as a new novel coronavirus SARS-CoV-2 resulting in the disease syndrome COVID-19.4 By the start of 2021 over 88 million people have been infected by COVID-19, killing almost 2 million people.5 The majority of cases and deaths have been in the United States,5 and only 10 countries have not reported a single case of COVID-19.6 However, unlike many preceding pandemics, COVID-19 can propagate by asymptomatic, presymptomatic, or mildly symptomatic individuals.7 Hospitals all over the world have found it challenging to provide adequate patient care.

Hospitals’ capacity to provide high-quality, appropriate care is dependent upon the strength and depth of their health care resources. Resource strain, resulting from a supply-demand mismatch, exists on a continuum from mild (related to routine fluctuations in patient needs such as the “daily surge”) to severe (related to either profound supply limitations or excess demand common during public health emergencies).8–11 Specfic patient-related aspects that define strain are broad but include admission dwell time, patient severity of illness, current patient census or bed availability, staff-to-patient ratios, and patient turnover.12 Strain characteristics can be mapped across the ...

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