Download eBook for Free

Full Document

FormatFile SizeNotes
PDF file 1.2 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

استراتيجيات الاستجابة لتلبية الاحتياجات المفاجئة للرعاية الحرجة بسبب تفشي فيروس كورونا ( COVID-19 ) لعام 2020 في الولايات المتحدة

Arabic language version

FormatFile SizeNotes
PDF file 1.3 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Research Questions

  1. How can hospitals meet the need for critical care capacity using available staff and resources?
  2. Where are the bottlenecks in critical care resources that might create a mismatch with the projected demand posed by the COVID-19 pandemic?

The coronavirus disease 2019 (COVID-19) virus is creating unprecedented stresses on hospital and critical care systems. Hospitals, health care systems, states, and regions urgently need to assess their resources, identify potential bottlenecks, and create strategies for increasing critical care surge capacity, which refers to the resources needed to care for the sickest patients with the novel coronavirus.

In this report, the authors present a list of strategies for creating critical care surge capacity and estimate the number of patients accommodated, given the number of available critical care doctors and nurses, respiratory therapists, ventilators, and hospital beds. They also document the development of a user-friendly, Microsoft Excel–based tool that allows decisionmakers at all levels — hospitals, health care systems, states, regions — to estimate current critical care capacity and rapidly explore strategies for increasing it.

The strategies are organized into two tiers. Tier 1 includes contingency capacity strategies: adaptations to medical care spaces, staffing constraints, and supply shortages in a way that can increase capacities without significant impact on medical care delivery. Tier 2 includes crisis capacity strategies: changes that likely will have significant impact on routine care delivery and operations.

Key Findings

The number of ventilators is the most common limiting factor for the United States

  • To function appropriately, intensive care units (ICUs) need space (ICU beds), staff (nurses, physicians, and respiratory therapists), and stuff (ventilators). For hospitals and communities to effectively respond to the anticipated surge in the critical care needs for COVID-19 patients, the balance between space, staff, and stuff (i.e., resources) needs to be maximized.
  • Strategies for creating space capacity include repurposing existing space and expanding telemedicine to allow ICU physicians to advise non-ICU physicians in community hospitals.
  • Strategies for creating staff capacity include using physician extenders to provide critical care under the supervision of ICU doctors and expanding staff through recruitment from outside organizations.
  • Strategies for creating stuff capacity include reusing personal protective equipment and regional sharing of available ventilators.
  • The overall number of patients who can be cared for is limited by whichever resource is most limited. In the majority of estimates for the United States, ventilators are the limiting factor. In a few instances, doctors are the limiting factor, but in no case is the number of nurses, respiratory therapists, or beds the limiting factor.


  • Hospitals should consider using the RAND Critical Care Surge Response Tool or similar resources to assess critical care bottlenecks in space, staff, and stuff and identify the most-effective surge strategies to address those bottlenecks.
  • Hospitals should consider having tiered critical care surge capacity plans in place ahead of time so that critical care surge capacity efforts can be escalated as indicated.
  • Hospitals should consider canceling elective procedures to free up critical care space, staff, and stuff.
  • Hospitals should consider developing an inventory of staff who might play unconventional roles in their COVID-19 response.
  • State, regional, and federal entities should consider facilitating communication and coordination among hospitals, health care systems, and public health entities.
  • State, regional, and federal entities should consider developing regional resource-sharing protocols to facilitate proportional distribution according to needs.
  • State, regional, and federal entities should consider instituting emergency credentialing policies for health care worker volunteers (e.g., waivers).
  • State, regional, and federal entities should consider instituting policies to combat price-gouging by suppliers of PPE, ventilators, and other critical care resources.

Research conducted by

Funding for this independent research was provided by gifts from RAND supporters and income from operations. This research was conducted by RAND Health Care.

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.