Concepts of Hospital Management During Natural Disasters: A Review with Global Case Applications

Abstract

Natural disasters place significant strain on hospitals by increasing patient demand while compromising infrastructure, thereby making surge capacity an essential operational requirement. Reverse triage, a protocol-driven approach for identifying hospitalized patients at low short-term risk for adverse outcomes who can be safely discharged, transferred, or relocated to lower-acuity settings, remains an underutilized strategy for rapidly expanding treatment capacity. This review synthesizes current concepts in hospital disaster management and utilizes global case evidence to illustrate how hospitals can transform nominal resources into hazard-specific clinical capabilities. This review employs a narrative, framework-based methodology that integrates the four phases of emergency management (mitigation, preparedness, response, recovery), the 4S surge domains (staff, stuff, space, system), and the anticipate, recruit, retain, adapt, sustain (ARRAS) workforce framework. Evidence from earthquake responses demonstrates that structural survival does not guarantee operational continuity, as non-structural failures and fragmented command structures can render hospitals clinically non-functional. Within the space domain, studies from pediatric and general hospitals show that reverse triage can substantially expand available bed capacity during surges; however, its effectiveness is context-dependent and limited in high-risk services such as neonatal care and labor and delivery, where premature discharge presents significant risks. Reverse triage is a high-impact intervention when integrated into robust governance structures. Service-specific discharge criteria, escalation triggers, and clearly defined Incident Command System (ICS) decision rights are essential to prevent the unsafe expansion of bed capacity. Implementing reverse triage alongside infrastructure mapping, supply chain resilience, tiered staffing models, and decision-support tools can strengthen hospital resilience and improve system-wide disaster response performance.