Community Efforts to Develop Surge Capacity for Public Health Emergencies

September 11 highlighted the need for public health surge capacity, which Hurricane Katrina further emphasized, but 7 years later communities are concerned that federal and public support are waning. Communities define their needs for surge capacity broadly, from pre-hospital and ambulatory care needs, to hospital and emergency care, to transporting patients to communication, although hospital care remains a key focus. This community-level research project found that significant collaboration among state and local agencies, hospitals and others facilitate work on surge capacity development and test response plans, and personal relationships are key to effective surge response. Federal funding has helped support these activities, but declining funding levels raise sustainability concerns. Extracting lessons from natural and human-made disasters, and guided by federal, state and local priorities, surge capacity activities include identifying alternate care sites, purchasing equipment and supplies (e.g., ventilators and cots), implementing additional communication systems, and ensuring an adequate and resilient workforce. Having adequate physical capacity (space, equipment and supplies) is generally more attainable than securing sufficient workforce capability, as having enough staff for even day-to-day demands is a chronic challenge. Particular attention should be paid to communities' ability to develop and maintain an adequate workforce and policies to facilitate care for many people under potentially less-than-optimal conditions, particularly for a longer-term event like pandemic influenza. Efforts to build surge capacity should also seek to facilitate day-to-day patient care, in order to make it more likely for surge capacity to be sustained and to potentially help leverage funds for both purposes.