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A health care crisis is triggered by a natural disaster, an infectious disease, or acts of war. The surge can occur over a short period or linger for a prolonged period of time. It can also evolve, with ever-changing treatment guidelines. With inadequate planning, transition from resource rich to resource poor conditions can occur.

The recent health crisis is coronavirus disease 2019 (COVID-19). According to the World Health Organization (WHO), there are 155,506,494 cases and 3,247,228 deaths worldwide.1 As of May 6, 2021, there were 32,356,034 cases with 576,238 deaths in the United States.2 The New York City (NYC) region was an epicenter for COVID-19 during the initial surge from March to June 2020. One expected the volume at a local hospital to double every three to five days.3 Hackensack University Medical Center (HUMC) is a 771 bed hospital in northern New Jersey just outside of New York City, and had one of the largest inpatient COVID-19 cases in one hospital.

We would like to describe our protocol to accommodate the first COVID-19 surge from March to June 2020 by the conversion of 47 intensive care unit (ICU) beds to 190 ICU beds, and our plan to return to normal operations. We performed daily surveillance for new peer reviewed literature and guidance from the Centers for Disease Control and Prevention (CDC), WHO, American College of Chest Physicians (ACCP), and Society of Critical Care Medicine (SCCM).1–7 We consolidated their recommendations and adjusted for our hospital, resources, and patient needs. The strategies included tier-based staffing models, mechanical ventilator allocation, adjustments for medication shortages, cleaning and reusing of personal protective equipment (PPE), as well as designated teams for vascular access, intubations, prone positioning, and updating of families, counseling for health care workers, and decontamination of COVID-19 designated floors once the COVID-19 census decreased.


This was a multidisciplinary assessment of the current number of patients, opening and conversion of various units, available PPE, mechanical ventilation, medical supplies, and new treatment options. A follow-up meeting in the afternoon re-assessed and identified any adjustments to the action plan.

To accommodate the surge in patients, coordination and input from various stakeholders were essential. The clinical teams include medicine, emergency medicine, surgery, critical care (physicians, nursing, and respiratory), as well as the departments of Engineering, Biomedical Engineering, Plant Operations, Environmental Services, Information Technology, Capacity management/Bed Board, and Hospital Leadership/Administration.4


Maximizing the containment to reduce community impact is key. Patients under investigation (PUI) are rapidly identified through their history, physical examination, and laboratory values. They are isolated in the emergency department (ED) and triaged to the appropriate ward or unit according to the lab results.


We geographically cohorted COVID-19 patients to minimize health care personnel ...

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