image_pdfimage_print healthcare surge is proclaimed in a local jurisdiction when an authorized local official, such as a local health officer or other appropriate designee,3 using professional judgment determines, subsequent to a significant emergency or circumstances, that the healthcare delivery system has been impacted, resulting in an excess in demand over capacity in hospitals, long-term care facilities, community care clinics, public health departments, other primary and secondary care providers, resources and/or emergency medical services. The local health official uses the situation assessment information provided from the healthcare delivery system partners to determine overall local jurisdiction/Operational Area medical and health status.

An influenza pandemic is an example of the type of natural disaster that would require health care surge. As an update of where we are at with H5N1 and bird flu, try this piece from the Times (UK):

This triage discussion has already begun. New York State, for example, has developed ventilator triage in the event of a pandemic:

Ventilators may be in short supply in a flu pandemic, so New York state officials have drafted guidelines to determine which patients would get one if there weren’t enough to go around.

Similar suggestions have been made for ICU beds.

Development of a triage protocol for critical care during an influenza pandemic

California takes it one step further:

The new “surge capacity guidelines”  – which authorities hope will serve as guidlines for hospitals nationwide, especially in the event of a pandemic – calls for letting older, sicker patients be allowed to die in order to save the lives of patients more likely to survive a catastrophic public health crisis.

“During a major disaster, the heath care system will look very different from what we are accustomed to,” said Dr. Mark Horton, director of the California Department of Public Health. “These guidelines will help communities as they plan how to sustain a functioning health care system following a catastrophic event such as a severe earthquake, bioterrorism attack or outbreak of pandemic influenza.”

In the event of a pandemic, the hospital would be overflowing with patients. To alleviate some of the bed crunch, the area nursing homes and extended care facilities would pool their available beds, accept transfers from the hospital to free up bed space, and utilize empty beds remaining to act as a 23 hour alternate care facility for flu patients. The Ottilie W. Lundgren Memorial Field Hospital would be set up adjacent to an area nursing home (not the hospital), and the parking garage would be used as a drive-thru (stay in your car) flu clinic…

To minimize is not to eliminate. Tough choices would still be made, and home care in one form or another would still be needed. To that end, personal preparation never stops being needed. More people would need to be cared for at home than in the hospitals, and without decent home care, planned in advance, and including food and water so as to be able to stay at home with ill family members (HHS recommends two weeks of food and water be stockpiled by all Americans), increased surge capacity will not be enough.

Through websites like and Flu Wiki (both of which I have contributed material to), and though service organizations like American Red Cross and Lions Clubs, and professional organizations like Trust for America’s Health and the American Academy of Pediatrics, serious steps are being taken to prepare. Hospital Surge, Exercises and Pandemics