Pan American Health Organization · Version 3.5, 2020
Configuration and operational standards for deploying portable 30-bed field hospitals to treat critical COVID-19 and SARI patients during surge capacity emergencies.
- Issuer
- Pan American Health Organization
- Edition
- Version 3.5, 2020
- Audience
- Emergency planners, ministries of health, Emergency Medical Team coordinators, hospital administrators, infectious disease specialists, critical care teams
- Evidence
- Expert technical consensus based on COVID-19 response experience and WHO Emergency Medical Team standards
- Reviewed
- 20 Oct 2026 · GMJ
What this guideline says
GMJ summary
This technical manual provides detailed specifications for establishing specialized Emergency Medical Teams (EMT-SARI) to manage severe acute respiratory infections, particularly COVID-19, when hospital intensive care capacity is overwhelmed. The units are modular, portable facilities (tents or containers) providing up to 30 beds in three flexible configurations: 10 critical suspected + 10 critical confirmed + 10 severe cases, or 30 critical, or 30 severe beds expandable in 10-bed increments.
The document specifies facility requirements including approximately 5,500 m² total space, eight functional zones (patient reception, staff entry/exit, medical care, support services, sanitation, administrative, staff living, morgue), ventilation standards (160 litres/second/patient air circulation, minimum 80 l/s/patient), medical gas systems, water supply (12,000 litres/day), electrical capacity (25–100 KVA depending on climate control), and 14-day operational self-sufficiency. Staffing ratios include one intensivist per 10 critical beds, one physician per 5 critical beds, one professional nurse per 2 critical beds, plus respiratory therapists, laboratory and pharmacy technicians, and support staff operating 24/7.
Critical infection control specifications include negative pressure in isolation areas using HEPA-filtered air conditioning, separate flows for staff/patients/materials, chlorine disinfection (1,000 ppm), and hot-water laundry (65–71°C for ≥3 minutes). The modular design allows rapid deployment to expand existing facilities or establish standalone field hospitals during respiratory disease outbreaks.
Key points
For clinicians — doses and thresholds as stated in the guideline
- 30-bed modular capacity in three configurations: 10 critical suspected + 10 critical confirmed + 10 severe; or 30 critical; or 30 severe beds, expandable by 10-bed units
- Ventilation: 160 litres/second/patient air circulation in patient areas, minimum 80 l/s/patient, using natural ventilation or forced systems with HEPA filters
- Staffing per shift: one intensivist per 10 critical beds; one physician per 5 critical beds; one professional nurse per 2 critical beds; one respiratory therapist per critical patient area
- Operational self-sufficiency: 14 days of drugs, consumables and supplies; 12,000 litres water/day; 25–100 KVA electrical capacity; 1,000–8,000 litres diesel per 14 days
- Oxygen supply: 75% simultaneity factor; 3.5 standard cubic feet per minute airflow through ventilators; 1,000 cubic feet per month per bed; ASTM B 819 Type L copper tubing with CGA G-4.1 cleaning for piped systems
- Infection control: negative pressure in isolation areas with HEPA filtration; chlorine disinfection at 1,000 ppm; linen washing at 65–71°C for minimum 3 minutes; separate flows for sterile and contaminated materials
- Facility size: approximately 5,500 m² total; individual patient areas 70–75 m² per 10-bed module; 2 metres minimum separation between beds; smooth, seamless, fire-retardant, waterproof surfaces
- Medical equipment per 10 critical beds: 10 ventilators, 20 syringe/infusion pumps, 10 vital signs monitors, 10 oxygen concentrators (or 30 oxygen tanks), 1 defibrillator, 1 portable x-ray, 1 ultrasound
Staffing requirements for EMT-SARI
Table extracted from the guideline
| Role | Ratio/Number per EMT-SARI | Specific allocation |
|---|---|---|
| Intensivist physician | 1 per 10 critical beds | For critical patient areas |
| Physician (specialty preferred) | 1 per 10 severe beds; 1 per 5 critical beds | Higher ratio for critical care |
| Professional nurse (intensive/emergency) | 1 per 2 critical beds; 1 per 5 severe beds | One per 10 critical beds must have extensive ICU experience |
| Auxiliary nurse | 6 per EMT-SARI | Total across facility |
| Respiratory therapy technician | 1 per critical patient area | Each critical hospitalization zone |
| Radiology technician | 1 per EMT-SARI | Total |
| Pharmacist | 1 per EMT-SARI | Total |
| Pharmacy technician | 2 per EMT-SARI | Total |
| Clinical laboratory technician | 2 per EMT-SARI | Total |
| Medical records technician | 1 per EMT-SARI | Total |
| Cleaning/disinfection staff | 6 per EMT-SARI | Total across facility |
| Logistics (stores) | 1 per EMT-SARI | Total |
| Electromechanical maintenance | 1 per EMT-SARI (2 during setup) | Technical support |
| Medical equipment technician | 1 per EMT-SARI | Total |
| WASH technicians | 2 per EMT-SARI | Water, sanitation, hygiene |
Source: Pan American Health Organization, Technical recommendations for the configuration of a specialized Emergency Medical Team for the treatment of Severe Acute Respiratory Infection (SARI). Version 3.5. Reproduced in summary form.
From the guideline
Verbatim
“Air circulation of 160 l/s/patient can be maintained in the rooms of patients admitted with severe acute respiratory infections, ensuring at least a minimum of 80 l/s/patient.”
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 someone who has advised on health emergency preparedness in the South Caucasus, I find these EMT-SARI specifications particularly relevant for Georgia's context of limited ICU surge capacity—our 2020 COVID-19 response revealed critical gaps when Tbilisi's intensive care units reached saturation. The oxygen supply calculations (1,000 cubic feet per bed per month, 75% simultaneity) and the staffing ratios (1 nurse per 2 critical beds) provide concrete planning targets that our Ministry of Health can use for stockpile and workforce mobilisation scenarios. The modular 10-bed expansion model is realistic for phased deployment. However, Georgian planners must candidly assess our actual availability of trained intensivists and ICU nurses—the document's staffing standards exceed what many regional hospitals can currently mobilise even for existing beds, let alone field expansions, suggesting that any EMT-SARI deployment would require international clinical team augmentation or else operate initially at lower acuity levels until domestic capacity grows through the targeted training programmes we have been developing since 2021.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 20 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia’s experience with COVID-19 surge capacity challenges in 2020–2021 and ongoing respiratory disease threats make these EMT-SARI specifications directly applicable for national emergency preparedness planning. The Ministry of Health and the National Centre for Disease Control and Public Health should assess feasibility of pre-positioning modular components—particularly given Georgia’s seismic risk and the need for rapidly deployable health infrastructure. Key implementation considerations include: integration with existing oxygen supply chains (hospital versus concentrator-based systems), availability of trained intensivists and ICU nurses (which remain in short supply nationally), electrical grid capacity in deployment locations, and cold-climate modifications for winter operations in mountain regions. The 14-day self-sufficiency target aligns with Georgia’s strategic pharmaceutical reserve policies but requires dedicated budget allocation for stocks that can deploy within 24–48 hours of an outbreak declaration.
Questions this guideline answers
Quick answers
What are the three standard bed configurations for an EMT-SARI?
Configuration 01: 10 critical suspected + 10 critical confirmed + 10 severe beds (20 critical + 10 severe). Configuration 02: 30 critical beds (either 10 suspected + 20 confirmed, or vice versa). Configuration 03: 30 severe beds. All configurations are modular and expandable in 10-bed units.
What ventilation rate is required in patient isolation areas?
Air circulation of 160 litres/second/patient should be maintained where possible, with a minimum of 80 l/s/patient. This can be achieved through natural ventilation (cross-currents via windows/doors, or convection via ceiling vents) or forced ventilation with electric exhaust fans, ideally with HEPA filters. People must stay at least 2 metres from air exit points where microdroplets accumulate.
What oxygen supply capacity is needed per critical care bed?
Plan for a 75% simultaneity factor, 3.5 standard cubic feet per minute airflow through ventilators, and 1,000 cubic feet per month per bed. Oxygen can be supplied via secured tanks beside each patient, oxygen concentrators (when tank supply is limited), or piped networks using ASTM B 819 Type L copper tubing cleaned to CGA G-4.1 standards for oxygen service.
How many nurses are required per shift for a 30-bed EMT-SARI with 20 critical and 10 severe beds?
For 20 critical beds: 10 professional ICU/emergency nurses (1 per 2 critical beds, with at least 2 having extensive ICU experience). For 10 severe beds: 2 professional nurses (1 per 5 severe beds). Plus 6 auxiliary nurses for the entire facility. Total: 18 nurses per shift, operating 24/7.
Related on GMJ
Interconnected resources
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- Initial care of persons with acute respiratory illness (ARI) in the context of coronavirus disease (COVID-19) in healthcare facilities: assess the risk, isolate, refer
- Recommendations for the Management of Solid Waste
- Considerations for the Use of Hotels during the COVID-19 Pandemic
- Flowchart for the Management of Suspected COVID-19 Patients at the First Level of Care and in Remote Areas in the Region of the Americas
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- Version 3.5, 2020
- Status
- Current
- Published
- 2020-01-01
- Languages
- English, Spanish
- Scope
- Configuration and operational standards for portable 30-bed field hospitals treating severe acute respiratory infections and COVID-19 during health emergencies
- Audience
- Emergency planners, ministries of health, Emergency Medical Team coordinators, hospital administrators, infectious disease specialists, critical care teams
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert technical consensus based on COVID-19 response experience and WHO Emergency Medical Team standards
- Record history
- Created 20 Oct 2026 · updated 20 Oct 2026 · next check Apr 2027
Pan American Health Organization. Technical recommendations for the configuration of a specialized Emergency Medical Team for the treatment of Severe Acute Respiratory Infection (SARI). Version 3.5 (5 April 2020). Washington, D.C.: PAHO; 2020. Available from: https://iris.paho.org/handle/10665.2/52136GMJ 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.
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