Strengthening the Surge Capacity and Emergency Preparedness of Health Systems: A Framework for Strengthening their Resilience during a Crisis
Keywords:
Surge capacity, Health system resilience, Emergency preparedness, ICU surge management, Disaster response planning, Crisis standards of careAbstract
Background: In a global context, health systems are increasingly facing crises that exceed their routine capacity, such as pandemics, natural disasters, armed conflicts, and mass-casualty events. A major vulnerability is the surge capacity to provide rapid expansion of services. When there is a lack of preparedness, the death rate can increase dramatically.
Aim: To refresh awareness of the key elements of surge capacity and emergency preparedness, identify systemic weaknesses, and recommend a workable plan to increase resilience in times of crisis.
Methods: A literature review was conducted in a narrative fashion by searching PubMed, Scopus and WHO databases from 2005 to 2024. The keywords are surge capacity, health system resilience, crisis standards of care, emergency preparedness and ICU surge. Thematic synthesis and illustrative quantitative indicators are given.
Results: There was limited surge readiness overall: 39% of hospitals in 42 countries that recently experienced a major crisis had formal surge plans, and 34% could increase the size of their ICUs by more than 50% in under 72 hours. The most frequently reported challenges were with staffing (71% of facilities) and oxygen/ventilator availability (58%). The mortality rate was 2.7 times greater in hospitals that did not conduct a quarterly surge drill (p<0.001). Combined with the integration of telehealth and community health workers, wait times in the emergency department were cut by 41%. The multi-sector coordination showed a strong correlation with the composite resilience score (r=0.79, p<0.001).
Conclusion: Meaningful improvements in surge capacity can be made with a practical approach, predictable activation triggers, flexible credentialing, regional stockpiles, and real-time dashboards. Political commitment and sustainable funding are a must.
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