Surge Capacity and Capability: Flexible Frameworks for Expanding Care Beyond the Hospital Walls
Abstract
Background: Traditional hospital-centric surge capacity models are increasingly inadequate for modern mass-casualty events, pandemics, and infrastructure failures. These crises demand the rapid creation of clinical care capacity beyond fixed facilities, requiring a fundamental reimagining of healthcare delivery. Aim: This narrative review synthesizes evidence from 2010-2024 on innovative frameworks for expanding clinical care into alternative settings during surges, analyzing the integration of emergency management systems, paramedic scope expansion, and nursing leadership in non-traditional environments. Methods: A comprehensive search of PubMed, Scopus, CINAHL, and disaster medicine databases was conducted. Thematic analysis integrated literature from public health, emergency medical services, nursing science, and health policy. Results: Evidence identifies three key models: (1) Alternative Care Sites (ACS), including field hospitals and repurposed community venues; (2) Pre-hospital treat-in-place and community paramedicine to decompress emergency departments; and (3) Virtual care surge through telehealth. Successful implementation hinges on pre-event planning, legal/regulatory flexibilities, adaptable clinical protocols, and crucially, the defined roles of paramedics and nurses operating beyond their traditional settings. Conclusion: Effective surge response requires a paradigm shift from "beds inside hospitals" to "care anywhere." This demands integrated systems where emergency management provides the structure, nursing provides the clinical leadership, and paramedicine provides the mobile extension of care. Future resilience depends on investing in these flexible frameworks, standardized training, and policy reforms that enable healthcare to dynamically scale beyond institutional walls.
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Authors
Copyright (c) 2024 Mousa Hamoud Alqayd, Mohammed Hamoud Alqayd, Fahad Khalid Alotaibi, Khulud Saud Alowayni, Kazem Hamdan Mohammed Al-Amri, Nourah Abdullah Ali Alslole, Tahani Menwer Almutairi, Amal Mohammed Hassan Alharbi, Mariam Mohaya Almagady, Fatoom Abdullah Alhaitei, Noura Alarifi, Abdulrahman Falah Almutairi
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