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U.S. Department of Health and Human Services

Health Care Coalition Surge Test

A tool designed to help Health Care Coalitions identify gaps in surge and response readiness

The Coalition Surge Test (CST) is designed to help health care coalitions (HCCs) identify gaps in their surge planning through a low- to no-notice exercise. The exercise’s foundation comes from a real-world health care system disaster challenge—the evacuation of a hospital or other patient care facility. Further, the tool incorporates lessons-learned from pilot tests with HCCs in South Dakota, Texas, Michigan, and Wyoming that contributed significantly to the tool’s development. The tool is available and free for all to use in their health care disaster preparedness and planning.


The CST tests a coalition’s ability to work in a coordinated way to find appropriate destinations for patients using a simulated evacuation of at least 20 percent of a coalition’s staffed acute-care bed capacity. The entire CST takes approximately four hours to complete and includes the two following phases:


  • Phase 1: Table Top Exercise with Functional Elements and Facilitated Discussion. The exercise starts 60 minutes after the assessment team notifies one or more hospitals or other patient-care facilities that they need to stand up their facility command centers. The exercise ends when all patients are placed or after 90 minutes, whichever comes first, after which participants will join a facilitated discussion that explores issues raised during the exercise. The facilitated discussion may include: patient transportation planning, receiving health care facility capacity, patient tracking and public information, the needs of vulnerable patients, and continuity of operations.
  • Phase 2: After Action Review. An after action review concludes the CST and consists of an assessment of strengths and weaknesses and corrective action planning. Ideally, this should occur immediately after Phase 1, but it can be scheduled for a later date to maximize health care executive participation; however, it must occur within 30 days of Phase 1.

The CST includes a low- to no-notice exercise. Low- to no-notice exercising is important in ensuring that HCCs can transition quickly and efficiently into “disaster mode” and provide a more realistic picture of readiness than pre-announced exercises. At least one month in advance, a trusted insider will identify the assessment team and inform HCC members that the CST will occur within a two-week window. HCC members will not know the exact date and time, and they will not know whether they are playing the role of “evacuating” or “receiving” facility until 60 minutes before the start of the exercise.

The CST is designed to be challenging. Struggling with a challenging exercise may be more helpful in the long run than succeeding with an easier one. Within 90 minutes, an HCC should be able to identify the beds it can make available, determine the patient placements necessary, match patients to those beds, and identify transportation resources appropriate for each patient. While no patients will be moved during the exercise, the actual movement of patients during a real evacuation event may not happen in 90-minutes.  Some HCCs may not be able to complete the exercise within 90 minutes.

The CST is intended to improve health care system response readiness. HCCs will select their own peer assessors who can provide exacting, but constructive, feedback to improve response.

The CST tests the overall health care system response. Although the exercise simulates health facility evacuation, it can reveal preparedness capabilities needed for a number of different scenarios. These capabilities may include emergency operations coordination, information sharing, and medical surge capacity.

To learn more about the tool and how it works, see the Coalition Surge Test manual. For additional questions or to discuss this tool further please contact your HPP Field Project Officer or email your questions to the Hospital Preparedness Program.

Interested in conducting an exercise at an individual hospital?  Check out the Hospital Surge Test. ​

  • This page last reviewed: April 23, 2018