Recommendations for medical surge capacity and deployment of emergency medical teams

What this guideline says

GMJ summary

This preliminary PAHO document provides a framework for countries to expand health system capacity during COVID-19 surges through three-tiered response strategies. Based on cohort data showing 40% of patients have mild disease, 40% moderate requiring hospitalisation, 15% severe requiring oxygen, and 5% critical requiring mechanical ventilation, the guidance addresses the rapid case doubling observed every 3 days in some countries.

The document outlines four epidemiological scenarios (C1–C4) from no cases to community transmission, with corresponding response strategies. It describes six types of emergency medical teams (EMTs) ranging from Type 1 mobile outpatient units to high-capacity mobile hospitals (HCMC) with 180-bed modular configurations. The three-tiered surge capacity approach progresses from strengthening existing facilities (Tier 1), optimising network resources and interhospital transfers (Tier 2), to establishing alternative care sites in hotels, stadiums and large enclosed spaces (Tier 3).

The guidance emphasises that additional beds are meaningless without adequate staffing and supplies, urging focus on patient care capacity rather than bed numbers alone. It provides detailed criteria for selecting alternative sites, expanding pre-hospital emergency medical services, and establishing medical coordination cells for information management across the health network.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. 40% of COVID-19 patients have mild disease requiring symptomatic treatment only; 40% moderate disease potentially requiring hospitalisation; 15% severe requiring oxygen therapy; 5% critical requiring mechanical ventilation
2. Cases may double every 3 days during surges, creating urgent need for capacity expansion to prevent health system collapse
3. Tier 1 response: establish pre-triage areas at hospital entrances, strengthen primary care for the 80% of patients manageable on an outpatient basis
4. Tier 2 response: deploy EMTs specialising in severe acute respiratory infections (SARI) capable of caring for 30 critical COVID-19 patients; establish medical coordination cell for interhospital transfers and bed availability tracking
5. Tier 3 response: establish alternative sites (medicalised hotels for mild/moderate cases; stadiums for high-capacity mobile hospitals with 180-bed modules: 160 moderate/severe and 20 critical)
6. EMT Type 3 teams deploy facilities with minimum 40 hospital beds, 4 ICU beds, laboratory, radiology and two operating rooms convertible to ICUs
7. Pre-hospital EMS should maximise transport capacity by deploying no more than 2 professionals per ambulance vehicle
8. Alternative care sites must be located near hospitals to facilitate patient transfer and share laboratory/diagnostic resources

Epidemiological scenarios and health service response requirements (C1–C4)

Table extracted from the guideline

Source: Pan American Health Organization, Recommendations for medical surge capacity and deployment of emergency medical teams. Reproduced in summary form.

From the guideline

Verbatim

“It is therefore important to focus expansion planning on increasing the capacity for patient care rather than increasing the number of beds without having adequate staffing and self-sufficiency to make care and operations feasible.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

Related on GMJ

Interconnected resources

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