Pan American Health Organization · version 5, April 2020
Operational guidance for hospital incident management and surge capacity expansion during the COVID-19 pandemic (April 2020).
- Issuer
- Pan American Health Organization
- Edition
- version 5, April 2020
- Audience
- Hospital administrators, incident commanders, health facility managers
- Evidence
- Expert consensus
- Reviewed
- 19 Oct 2026 · GMJ
What this guideline says
GMJ summary
This technical working document from the Pan American Health Organization provides strategic and operational guidance for hospitals managing increased patient volumes during the COVID-19 pandemic. The document emphasises the critical role of leadership and incident management systems in coordinating hospital response.
The guidance centres on implementing basic response functions through hospital incident management systems or equivalent mechanisms, enabling facility authorities to establish clear command structures, set strategic and operational objectives, and improve both institutional and inter-institutional coordination. The document addresses the development and implementation of strategies to provide care and treatment for growing numbers of COVID-19 patients whilst maintaining essential hospital functions.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Activate hospital emergency response mechanisms through incident management systems based on facility readiness, experience and regulatory requirements
- Establish clear chain of command and authority with defined objectives at strategic, management and tactical/operative levels
- Implement leadership as a main response function to coordinate facility-wide COVID-19 response
- Develop strategies for providing care and treatment to growing numbers of COVID-19 patients
- Improve institutional and inter-institutional coordination through structured incident management
- Enable informed decision-making by hospital authorities through systematic response mechanisms
From the guideline
Verbatim
“Leadership is one of the main response functions, performing a key role in activating a hospital's emergency response mechanism, through the hospital incident management system.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute of Georgia, I recognise this PAHO guidance addresses fundamental organisational principles that proved essential during Georgia's COVID-19 response in 2020–2021. The emphasis on hospital incident command structures is particularly relevant given the decentralised nature of Georgia's hospital sector following UHC reforms since 2013, where coordinating surge capacity across autonomous facilities presented significant challenges. I would stress to Georgian hospital administrators the recommendation to establish incident management systems adapted to local readiness and regulatory context rather than importing models wholesale. The main implementation caveat is that effective inter-institutional coordination requires pre-existing formal agreements and communication channels, which many Georgian facilities lacked in early 2020 and which take considerable time to establish during an active outbreak.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 19 Oct 2026
Applicability
Georgia and the South Caucasus
This guidance remains highly relevant for hospital preparedness planning in Georgia and the South Caucasus, particularly for managing surge capacity during respiratory disease outbreaks. Georgian health facilities should adapt the incident management principles to local governance structures and health system organisation, considering the mix of public and private hospitals and existing emergency response mechanisms. National adaptation would need to account for regional variation in hospital capacity, staffing patterns and inter-facility referral networks across urban and rural settings in Georgia, Armenia and Azerbaijan.
Questions this guideline answers
Quick answers
What is a hospital incident management system?
A structured mechanism that enables hospital authorities to make informed decisions, establish a single chain of command and set clear response objectives at all organisational levels—strategic, management and tactical/operative—whilst improving institutional and inter-institutional coordination.
Why is leadership emphasised as a main response function?
Leadership performs a key role in activating the hospital's emergency response mechanism and coordinating the implementation of strategies to manage growing numbers of COVID-19 patients effectively.
Can hospitals use mechanisms other than formal incident management systems?
Yes, hospitals may adopt response mechanisms based on their readiness, experience and regulatory aspects, not necessarily a standardised incident management system.
What are the essential basic functions for expanding hospital capacity?
The document identifies leadership as one of the main response functions, working through incident management systems to coordinate care provision, treatment strategies and management of increasing patient volumes.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
Quality & accreditation
Other guidelines on this topic
- Emergency Use of Unproven Interventions Outside of Research: Ethics Guidance for the COVID-19 Pandemic
- Measures to ensure the continuity of the response to malaria in the Americas during the COVID-19 pandemic
- Checklist for the Management of Human Resources for Health in Response to COVID-19
- Caribbean Shelter Guide: COVID-19 Considerations
- Prehospital Emergency Medical Services Readiness Checklist for COVID-19
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- version 5, April 2020
- Status
- Current
- Published
- 2020-01-01
- Scope
- Hospital reorganisation and capacity expansion
- Audience
- Hospital administrators, incident commanders, health facility managers
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus
- Record history
- Created 19 Oct 2026 · updated 19 Oct 2026 · next check Apr 2027
Pan American Health Organization. Recommendations for Reorganization and Expansion of Hospital Services in Response to COVID-19. Technical Working Document, version 5. Washington, D.C.: PAHO; 2020 Apr.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
Was this article helpful?
