The surge does not stop at the hospital doors

Khorram-Manesh A. Flexible surge capacity–public health, public education, and disaster management. Health promotion perspectives. 2020;10(3):175.




(Surge capacity: a concept that includes vulnerability analysis, community awareness, vulnerable populations, education, and so much more...)

Context: The standard approach to disaster planing leaves gaps in all facets of disaster response, especially when it comes to meeting the needs of underserved communities.

Methods: Systematic literature review on flexible surge capacity, the concept of including community in disaster planning. Search terms used: flexible, surge capacity, disasters, healthcare, delivery, emergencies, community, resources, and public health

Conclusion: Flexible surge capacity is necessary to respond to disasters and would increase efficacy and efficiency of over-taxed emergency management structures. A huge interdisciplinary effort and a robust public health system would be necessary.


This article is based on the distinction between major incidents and disasters, the latter being unmanageable with emergency management systems in place, and more damaging, necessitating more awareness and appreciation for untapped (community) resources. Dr. Khorram-Manesh brings together a bunch of principles of disaster management:

-based on an accurate risk and vulnerability analysis

-vulnerable populations (underserved communities) a big consideration in vulnerability assessment

-need for communications within hospitals and with other organizations

-need for education, preparedness, leadership in hospitals, prehospital, and, really, all levels, all the way to community and family


I'll highlight one point, not the focus of the paper, but key to understanding why this is important, and why many answers to the question of resilience are not to be found within the walls of the tertiary hospital:


Hospitals’ shortcomings: Hospitals’ emergency department overcrowding, poor strategic leadership, along with a shortage of devices and medical products, increased staff sub-specialization, and inadequate training in the management of MID, all result in defective healthcare


This is a great vision. A strong public health system, engagement by stakeholders on all sides (hospitals, community organizations, NGO's, community, and families), and organized and effective education in both public and private sectors. Maybe in Sweden...

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