At the time this article was written, the World Health Organization had declared a global pandemic due to the novel coronavirus disease 2019, the first pandemic since 2009 H1N1 influenza A. Emerging respiratory pathogens are a common trigger of acute surge events-the extreme end of the healthcare capacity strain spectrum in which there is a dramatic increase in care demands and/or decreases in care resources that trigger deviations from normal care delivery processes, reliance on contingencies and external resources, and, in the most extreme cases, nonroutine decisions about resource allocation. This article provides as follows: 1) a conceptual introduction and approach to healthcare capacity strain including the etiologies of patient volume, patient acuity, special patient care demands, and resource reduction; 2) a framework for considering key resources during an acute surge event-the "four Ss" of preparedness: space (beds), staff (clinicians and operations), stuff (physical equipment), and system (coordination); and 3) an adaptable approach to and discussion of the most common domains that should be addressed during preparation for and response to acute surge events, with an eye toward combating novel respiratory viral pathogens.
