TABLE 2.

Summary of Future Research Priorities

Term	Content	Research Priorities
Surge	A sudden, unexpected escalation in health care needs induced by a public health emergency. May be (adopting Bonnet and colleagues’ terms) geographically “contained” or widespread (“population-based”).	• Analysis of the past hazard-event's characteristics, duration, and phased impacts and of key event-site characteristics (demographic, geographic, and infrastructural) to inform mathematical modeling to estimate the care needs for a range of surge scenarios.
Health system's resource command	The total stock of resources (staff, “stuff,” and structures/space) on which a health system can legitimately draw. We propose that this be composed of five categories: “critical baseline,” “available,” “increasable,” “triagable baseline,” and “mobilizable.”	• Development of data sources and methods to quantify a health system's national baseline resource stocks, disaggregated by relevant geographical and administrative unit (province, district, facility).
		• Development of methods and data to indicate proportion of “baseline” resources amenable to triage.
		• Development of user-friendly, updatable systems to enable resource use and depletion to be tracked over time and space.
	Staff	• Elaboration of the emerging literature on staff willingness (and ability) to respond to a range of event scenarios. Survey and interviews with medical and nonmedical health personnel.
		• Assessment of the relevance of existing research on the impacts of stress and trauma on ability to undertake and perform professional duties.
		• Assessment of the feasibility of volunteer registers.
	“Stuff”	• Identification of the key physical resources (beds, ventilators, other medical apparatus, pharmaceuticals, non-pharmaceutical equipment) that best articulate “surge capacity.” The literature indicates beds to be a necessary but not sufficient proxy, but it is impractical to incorporate every resource in estimates and models. A balance should be sought. Evaluation of the risks posed by supply chains in the event that imports are compromised.
	Structures/space	• Development of a framework to assess available in-house “surge spaces.”
		• Identification of feasible modifications to medical facilities to increase surge capacity.
		• Appraisal of past experiments with spillover spaces (schools, sports arenas, community centers, etc.).
Health system's surge capacity	The portion of health system resources (staff, stuff, and structures/space) available to meet surge needs (excludes “critical baseline” resources committed to meeting non-surge-related needs).	• Development of data sources and methods to enable a health system's baseline resource demand to be accurately assessed and/or modeled. Analysis should, when possible, be sensitive to temporal fluctuations in baseline demand.
Health system's surge capability	What can actually be achieved with a health system's surge capacity; the systems (defined broadly to include governance arrangements, legal frameworks, and precedents; bilateral and multilateral agreements and precedents; feasible and practiced procedures and plans; communications and transport logistics; and the staff's and the public's response) can be thought of as the conversion factors translating capacity into capability.	• Identification of potential legal and bureaucratic obstacles to resource, staff, and patient mobilization across geographical and administrative boundaries.
		• Identification of best-practice triage procedures under surge conditions.
		• Case study analyses drawing on academic literature, national and international appraisals and reports, key-informant interviews, and “survivor” surveys and interviews to identify procedural barriers to effective (and equitable) application of a health system's resources in past surge events.
		• Analysis of written procedures and plans and of practical exercises and “drills” identifying potential obstacles to an effective future response.
		• Surveys and interviews identifying public expectations and potential obstacles to compliance with health advice in the event of a surge event.