Concepts of Hospital Management During Natural Disasters: A Review with Global Case Applications
Abstract
Natural disasters place significant strain on hospitals by increasing patient demand while compromising infrastructure, thereby making surge capacity an essential operational requirement. Reverse triage, a protocol-driven approach for identifying hospitalized patients at low short-term risk for adverse outcomes who can be safely discharged, transferred, or relocated to lower-acuity settings, remains an underutilized strategy for rapidly expanding treatment capacity. This review synthesizes current concepts in hospital disaster management and utilizes global case evidence to illustrate how hospitals can transform nominal resources into hazard-specific clinical capabilities.
This review employs a narrative, framework-based methodology that integrates the four phases of emergency management (mitigation, preparedness, response, recovery), the 4S surge domains (staff, stuff, space, system), and the anticipate, recruit, retain, adapt, sustain (ARRAS) workforce framework. Evidence from earthquake responses demonstrates that structural survival does not guarantee operational continuity, as non-structural failures and fragmented command structures can render hospitals clinically non-functional. Within the space domain, studies from pediatric and general hospitals show that reverse triage can substantially expand available bed capacity during surges; however, its effectiveness is context-dependent and limited in high-risk services such as neonatal care and labor and delivery, where premature discharge presents significant risks.
Reverse triage is a high-impact intervention when integrated into robust governance structures. Service-specific discharge criteria, escalation triggers, and clearly defined Incident Command System (ICS) decision rights are essential to prevent the unsafe expansion of bed capacity. Implementing reverse triage alongside infrastructure mapping, supply chain resilience, tiered staffing models, and decision-support tools can strengthen hospital resilience and improve system-wide disaster response performance.
Keywords
Full Text:
PDFReferences
Hasan MK, Nasrullah SM, Quattrocchi A, Arcos González P, Castro-Delgado R. Hospital surge capacity preparedness in disasters and emergencies: a systematic review. Public Health 2023;225:12-21.
Shahverdi B, Tariverdi M, Miller-Hooks E. Assessing hospital system resilience to disaster events involving physical damage and demand surge. Socioecon Plann Sci 2020;70:100729.
Petanidis S, Chandramouli K, Floros G, Nifakos S, Kolomvatsos K, Tsekeridou S, et al. Optimizing emergency response in hospitals: a systematic review of surge capacity planning and crisis resource management. Healthcare (Basel) 2025;13:2819.
Nates JL, Manjappachar N, Botdorf J. ICU capacity management and surge preparedness. Crit Care Clin 2026;42:361-78. doi: 10.1016/j.ccc.2025.12.003.
Salamati Nia SP, Kulatunga U. Safety and security of hospitals during natural disasters: challenges of disaster managers. Int J Saf Secur Eng 2017;7:234-46.
Pouraghaei M, Jannati A, Moharamzadeh P, Ghaffarzad A, Far MH, Babaie J. Challenges of hospital response to the twin earthquakes of August 21, 2012, in East Azerbaijan, Iran. Disaster Med Public Health Prep 2017;11:422-30.
Yoo KJ, Mannan M, Weerasinghe I, Borse NN, Bishai D. Illustrating the anticipate, recruit, retain, adapt, sustain (ARRAS) Framework for surge capacity. How bangladesh, sri lanka, and nepal maintained their health workforce during COVID-19. Disaster Med Public Health Prep 2024;18:e217. doi: 10.1017/dmp.2024.261.
Snively E. 4 phases of emergency management for hospitals and health systems. Relias [serial on the Internet]. 2024 [cited 2025 Dec 25]. Available from: https://www.relias.com/blog/4-phases-of-emergency-management-for-hospitals-and-health-systems
Marcozzi DE, Pietrobon R, Lawler JV, French MT, Mecher C, Peffer J, et al. Development of a hospital medical surge preparedness index using a national hospital survey. Health Serv Outcomes Res Methodol 2020;20:60-83. doi: 10.1007/s10742-020-00208-6.
Koka PM, Sawe HR, Mbaya KR, Kilindimo SS, Mfinanga JA, Mwafongo VG, et al. Disaster preparedness and response capacity of regional hospitals in Tanzania: a descriptive cross-sectional study. BMC Health Serv Res 2018;18:835. doi: 10.1186/s12913-018-3609-5.
Benishek LE, Kachalia A, Daugherty Biddison L, Wu AW. Mitigating health-care worker distress from scarce medical resource allocation during a public health crisis. Chest 2020;158:2285-7.
Cho H, Sagherian K, Steege LM. Hospital nursing staff perceptions of resources provided by their organizations during the COVID-19 pandemic. Workplace Health Saf 2021;69:174-81.
Kelen GD, Troncoso R, Trebach J, Levin S, Cole G, Delaney CM, et al. Effect of reverse triage on creation of surge capacity in a pediatric hospital. JAMA Pediatr 2017;171:e164829. doi: 10.1001/jamapediatrics.2016.4829.
Esmailian M, Salehnia MH, Shirani M, Heydari F. Reverse triage to increase the hospital surge capacity in disaster response. Adv J Emerg Med 2018;2:e17. doi: 10.22114/AJEM.v0i0.48.
Haroon MZ, Thaver IH. An assessment of existing surge capacity of tertiary healthcare system of Khyber Pakhtunkhwa province of Pakistan using workload indicators for staffing need method. Hum Resour Health 2022;19:120.
Phillips L, Leggett N, Miller J, McKinlay L, May K, Haines K. Implementation of a novel team-based model of care using expert intensive care unit physiotherapists to supplement critical care surge demand. Aust Crit Care 2023;36:159-66.
Asthana S, Gibson A. The national health service (NHS) in crisis: the role played by a shift from horizontal to vertical principles of equity. Health Econ Policy Law 2020;15:1-17.
Latruwe T, van der Wee M, Vanleenhove P, Devriese J, Verbrugge S, Colle D. A long-term forecasting and simulation model for strategic planning of hospital bed capacity. Oper Res Health Care 2023;36:100375.
Christen P, D’Aeth JC, Løchen A, Rizmie D, Schmit N, Nayagam S, et al. The J-IDEA pandemic planner: a framework for implementing hospital provision interventions during the COVID-19 pandemic. Med Care 2021;59:371-8.
Slovis BH, Ji X, Chang AM, Kairys J, Hollander JE. Relationship between on-demand telehealth visits and emergency department and hospital surge during the COVID-19 pandemic. J Am Coll Emerg Physicians Open 2024;5:e13128. doi: 10.1002/emp2.13128.
Toerper MF, Kelen GD, Sauer LM, Bayram JD, Catlett C, Levin S. Hospital surge capacity: a web-based simulation tool for emergency planners. Disaster Med Public Health Prep 2018;12:513-22.
Montán KL, Örtenwall P, Blimark M, Montán C, Lennquist S. A method for detailed determination of hospital surge capacity: a prerequisite for optimal preparedness for mass-casualty incidents. Eur J Trauma Emerg Surg 2023;49:619-32.
Gorgi HA, Jafari M, Shabanikiya H, Seyedin H, Rahimi A, Vafaee A, et al. Hospital surge capacity in disasters in a developing country: challenges and strategies. Trauma Mon 2017;22.
Mackie BR, Weber S, Mitchell ML, Crilly J, Wilson B, Handy M, et al. Chemical, biological, radiological, or nuclear response in queensland emergency services: a multisite study. Health Secur 2022;20:222-9.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.