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American Journal of  Physical Education 
and Health Science (AJPEHS)

Fostering Mobile Field Hospitals Collaboration During Disaster Response for Seamless 
Continuity of  Care: A Mini Review

Lawan Mohammed Isa1*, Nimisingha Jacob Amakama1, Gilles Dusserre1, Alina Petrica1, Luc Vechot2, Danladi Ayuba Job1

Thawbaan Adam1, Yusuf  Muritala Kolade1

Volume 2 Issue 2, Year 2024
ISSN: 2992-9679 (Online) 

DOI: https://doi.org/10.54536/ajpehs.v2i2.3441
https://journals.e-palli.com/home/index.php/ajpehs

Article Information ABSTRACT

Received: July 11, 2024

Accepted: August 15, 2024

Published: November 25, 2024

When mobile field hospitals are deployed in response to a disaster, they may sometimes 
face unprecedented challenges that require collaboration either with other mobile 
field hospitals or with existing regional hospitals to maintain continuity of  care for the 
impacted populations. This article explores the pivotal role of  enhancing healthcare team 
collaboration to ensure seamless care continuity during disaster response in an austere 
disaster-stricken environment. To improve patient outcomes during disasters, this study aims 
to investigate the barriers to care continuity in disaster response and highlight frameworks 
that can enhance healthcare team collaboration during sudden onset of  disasters. Several 
bibliographical databases, including Pub Med, Science Direct, Web of  Science, and Google 
Scholar were utilized. Articles examined from the databases were focused on state-of-the-
art healthcare collaboration frameworks. To shed light on the difficulties and the necessity 
of  implementing a collaborative healthcare disaster response framework, a case study of  an 
American mobile field hospital deployed during the 2010 Haiti earthquake was examined. 
The literature review highlighted several factors that are responsible for lack of  coordination 
during disaster response especially in an austere setting like Haiti. The review further 
highlights some frameworks that have the potential to improve care continuity in such an 
environment. In the event of  a disaster, especially in austere settings like Haiti where the 
usual coordination mechanisms with regional or local government is difficult, deployed 
mobile hospitals must find alternative frameworks to enable them to work in tandem among 
themselves and with the local hospitals to improve the affected population’s continuity of  
care. The five frameworks highlighted have the potential to facilitate care coordination and 
hence continuity of  care in such settings.

Keywords
Care Continuity, Disaster 
Response, Emergency Medicine, 
Healthcare collaboration, Mobile 
Field Hospital, Regional Hospital

INTRODUCTION
Disasters, both man-made and natural, are becoming 
major global problems. Numerous disasters appear to 
be occurring more frequently and with greater intensity, 
including earthquakes, tsunamis, hurricanes, floods, 
explosions, epidemics (such as influenza, Ebola, SARS, 
and COVID-19), and terrorist attacks (Chen et al., 2020). 
For the management of  large numbers of  casualties, 
prompt medical response to a disaster is essential. Mobile 
field hospitals are used to treat the impacted populations 
with emergency care following a disaster’s immediate 
impact, they frequently replace or enhance the services 
provided by regional and local hospitals that have been 
damaged or not operating optimally (Yang et al., 2018). 
Even though mobile field hospitals are made to function 
independently while on missions, there are times when 
working in tandem with regional hospitals is required 
to meet the population’s healthcare needs. The lessons 
from an American field hospital deployed to Haiti 
following the earthquake in 2010 serves as one example 
of  this requirement for the need for collaboration. In this 
instance, the responding team experienced shortage in 
supplies of  critical medical materials, including oxygen 

tanks (Neyem et al., 2016). Sadly, this setback resulted 
in one fatality, with two other patients suffering critical 
conditions before being sent to the closest regional 
hospital that administered oxygen. In 2010, a comparable 
incident occurred in an Israeli mobile hospital, where 
patients undergoing orthopedic treatments were not 
sure how and where  to received continued care with the 
retrieval of  the mobile field hospital (Dehghani Tafti et 
al., 2023). The difficulties seen in these cases highlighted 
the need for a structure that will make it easier for mobile 
field hospitals and regional hospitals to collaborate in 
times of  disaster to guarantee continuity of  care and 
positive patient outcomes. 

Continuity of  Care
Care continuity, or continuity of  care (COC) according 
to the World Health Organization (2018) is the extent 
to which people experience a series of  discrete health 
care events as coherent and interconnected over time 
and consistent with their health needs and preferences 
(Gulliford et al., 2006). Prior to 2000, the idea of  care 
continuity was centered on patients’ interactions with their 
doctors or continuous medical care. The multidimensional 

1 Department of  Disaster Management and Environmental Impact, IMT Mines Ales, France
2 MKOPSC, Texas A&M University, USA
* Corresponding author’s e-mail: mohadamagum71@yahoo.com



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concept of  continuity of  care was rarely used in studies. 
After 2000, nevertheless, the idea of  care continuity was 
given a multifaceted approach.
During disaster scenarios, people suffering from 
already existing chronic conditions need their care to be 
maintained. This will have to go along with the ongoing 
treatment of  injured victims. Research indicates that COC 
is highly correlated with outcomes for patients and the 
health system, including better health, patient satisfaction, 
and quality of  life; lower rates of  hospitalization and death; 
higher patient self-efficacy and treatment adherence; 
and lower health costs. Continuity of  care has also been 
shown to be strongly correlated with lower complication 
rates and health service consumption among patients  
(Dehghani Tafti et al., 2023). These results helped make 
team-based care and other chronic care management 
models more important (Goodwin, 2021).
Longitudinal continuity, informational continuity, and 
interpersonal/relational continuity are the three categories 
of  continuity of  care that have been recognized(Panteli et 
al., 2015). Patients who receive most of  their care from a 
single physician or group of  providers over an extended 
period are said to have longitudinal continuity. Physicians 
can become familiar with patients’ medical histories and 
present conditions thanks to the ongoing contact that 
exists between patients and healthcare professionals. 
Informational continuity is the transfer of  a patient’s 
information from one episode of  treatment to the next, 
both between the patient and the providers and among the 
providers, using both an organized database of  medical 
records and the collective memory of  the doctors with 
whom the patient develops a relationship with patient (such 
as being aware of  their preferences) (Chen et al., 2020). 
Chen et al. (2020), maintained that researchers have 

proposed that the concept of  care continuity should 
emphasize care coordination among multiple physicians 
in various care settings, such as cross-border continuity 
and managerial continuity, in addition to the ongoing 
interpersonal continuity between patients and their 
doctors when patients see multiple providers. Hence, 
when mobile field hospitals are deployed for instance, 
it is necessary to establish collaboration between their 
staff  and those of  the nearby regional hospitals to ensure 
continuity of  care for the impacted populations.

Mobile Field Hospitals (MFH)
A mobile field hospital is defined as mobile, self-contained, 
self-sufficient medical facility that is capable of  rapid 
deployment, expansion or contraction to meet immediate 
emergency requirement for a specified period of  time 
(Rossodivita, 2011).The conditions involved before a field 
hospital can be dispatched  include: (a) written request by 
the country in need, (b) work with the local healthcare 
systems (c) Clear definition of  their roles, responsibilities 
and operational attainment . The main purpose of  a field 
hospital is to compliment or substitute local hospitals 
in advent of  sudden impact events that produce a 
disaster(Malone et al., 2020). Depending on the situation, 
there are different types of  deployable mobile field hospital.

Types of  Mobile Field Hospital
Different types of  mobile hospitals are deployed 
depending on what is needed to perform a rescue at 
the catastrophe site while dealing with a difficult natural 
environment and a high number of  fatalities. Currently, 
there are three types of  mobile hospitals that may be 
distinguished based on the variations in transportation 
media: floating, flying, and terrestrial (Skang, 2023).

Figure 1: Rescue Material Delivery Vehicle of  National Emergency Medical Rescue Team of  the Second People’s 
Hospital of  Guangdong Province (Chen et al., 2020)

The most prevalent kind of  mobile hospital is the 
terrestrial kind, which comprises shelter, car, tent, and 
so on. The mobile hospital on land is modular. As 
needed, the number of  units, the layout, and the care 

options might be changed. A floating mobile hospital is 
a standalone medical institution that is situated on the 
sea. Floating hospitals are limited to locations close to 
water and need a significant amount of  space to dock 



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and allow boats to carry patients and workers. The flying 
hospital has been embraced by numerous governments, 
non-profits, and air forces worldwide. In times of  crisis, 
flying hospitals might offer surgical hospital services, 
emergency medical attention, as well as humanitarian 

help. Additionally, aeromedical evacuation allowed for the 
quick transfer of  injured people from disaster locations 
to hospitals. Mobile field hospitals of  whatever type 
must collaborate with regional hospitals during a disaster 
response to achieve continuity to the affected population.

Figure 2: A Tent mobile fielded hospital used by a Chinese medical team during Earthquake in Nepal

Although there is a wealth of  literature on hospital 
collaboration, they are mainly focusing on larger stationary 
hospitals, therefore, a framework is essential specifically 
for the purpose of  collaboration between local hospitals 
and deployed mobile field hospitals. The objective of  this 
research is to answer two questions: 

(1) What are the barriers to continuity of  care in 
disaster response? And 

(2) What are the current frameworks that can enhance 
collaboration between a mobile and regional hospitals for 
better disaster response?

LITERATURE REVIEW
Challenges of  Providing Care Continuity During 
Disasters
Research conducted by Hamis et al. (2023), on Covid-19 
field hospitals shows a considerable number of  challenges 
faced by these hospitals when responding to  Covid 19 
pandemic. The main challenges include paucity of  electronic 
medical record that is applicable in all the hospitals, poor 
communication between staffs and that of  patient-family, 
lack of  supply and resources, shortage of  staffs, difficulty 
in mobilizing enormous number of  qualified professionals 
with diver’s clinic background and experience in field 
hospitals and poor patient number anticipation (Hamdani 
et al., 2023, Amakama, 2024a, Amakama et al., 2024b). 
These factors can have negative impact on the quality of  
healthcare delivered and hence care continuity.
During high impact disasters, the challenges of  continuity 
of  care is another issue that needs to be addressed. For 
example, during the Israeli EMT3 mission in Nepal 
(2015), patients who had orthopedic surgery, were 
sent home with instructions to have the cast or sutures 
taken out, but it was not obvious where this would be 

done. Also, the EMT3 mission in Haiti 2010 highlighted 
another challenge in continuity of  care which is lack of  
electronic medical record that can be shared between 
MFH and the regional hospital during follow ups (Alpert 
& Merin, 2024). 
Feizolahzadeh et al. (2019), classified the barriers to 
care continuity in disaster  into seven primary class and 
eighteen subsidiary categories: the absence of  a disaster 
paradigm (comprising of  two subcategories pertaining 
to solely emergency approaches and cultural, social, 
and political matters); the difficulties in the pre-hospital 
system (comprising of  three subcategories pertaining to 
inadequate risk communication, pre-hospital measures, 
and poor distribution of  injured individuals); the lack 
of  coordination and cooperation (comprising of  two 
subcategories pertaining to intra-organizational and inter-
organizational coordination); poor hospital preparedness 
(comprising of  three subcategories comprising of  a 
deficient all hazards approach plan, a failure to learn from 
disasters, and substandard physician collaboration); the 
lack of  utilization of  available resources and capacities 
(comprising of  poor management of  volunteers, lack of  
using home care centers and lack of  financial resources. 
Inadequate planning (with three subcategories: poor early 
discharge plans, following up of  patients after discharge, 
and inadequate design of  special needs shelters) and finally 
inadequate patient knowledge (with two subcategories: 
patients and their family lacking pre-disaster education 
plans and inadequate self-care knowledge). From the 
forgoing, it is evident that lack of  coordination and 
collaboration stands out as the main concern to providing 
care continuity during disaster response. In this article, 
we focused on this barrier and try to look for possible 
solutions that are applicable to mobile field hospitals.



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Review of  Some Existing Frameworks with Potential 
for Disaster Response Coordination
In order to provide effective continuity of  care during 
disaster response, different healthcare systems must work 
together for the patients best interest (Huber, 2022). 
Lack of  collaboration between healthcare can have great 
negative effect on response phase during disaster and in 
return affect the healthcare of  the people (Yousefian et 
al., 2021). Feizolahzadeh et al. (2019) proposed solutions 
to diverse barriers to continuity of  care during disaster 
situations but did not focus them to favour mobile field 
hospitals operations. Due to the paucity of  information 
focusing specifically on collaboration between mobile 
hospitals and regional hospitals, we will look at different 

healthcare literatures on collaboration and try to find a 
solution that can be considered applicable and with the 
potential to improve collaboration and continuity of  care 
between mobile field and regional hospitals:

Sunnybrook Framework
The six core competencies that make up the Sunnybrook 
framework for interprofessional team cooperation are 
intentionally formulated as collective competencies and 
are intended to be applied to teams. The framework also 
includes 19 related behaviors and definitions for each 
core competency (McLaney et al., 2022). The primary 
goal of  the framework is to facilitate interprofessional 
collaboration, as seen in the figure’s center below.

Figure 3: The Sunnybrook framework of  the core competencies for interprofessional team collaboration (McLaney 
et al., 2022)

The competencies cover the four domains shown in the 
picture as encircling interprofessional collaboration: 

(1) Approach to leadership, 
(2) Research and quality improvement, 
(3) Education, and 
(4) Clinical and professional practice and care. 

The competence framework defines interprofessional 
education as “learning about, from, and with each other,” 
and interprofessional care as “working together to deliver 
the highest quality of  care.” When two or more professions 
collaborate to integrate knowledge and scientific viewpoints 
to address a quality issue or answer a common research 
question. Interprofessional leadership is defined by the 
framework as utilizing the skills and abilities of  team 
members across all roles and professions. In a complex 
setting, interprofessional leadership acknowledges the value 
of  a variety of  voices and viewpoints in bringing about 
organizational and cultural change (McLaney et al., 2022).

Conceptual Structure for How Interdisciplinary 
Team Members at Home Based Medical Care 
Access and Share Patient Data
The figure below shows the conceptual structure for how 
interdisciplinary team(IDT) members at home based 
medical care (HBMC) access and share patient data 
(Fathi et al., 2016). The framework’s first definition of  
the general context of  HBMC procedures was to draw 
attention to the difficulties in obtaining and disseminating 
patient data in this context.
The framework then emphasized four process elements 
that were found in the literature study results and 
described the ways in which IDT members in the 
HBMC environment exchange and obtain patient data. 
Using electronic medical records (EMRs), holding IDT 
meetings, standardizing patient assessments, and using 
secure e-messaging were among them.



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Electronic medical record (EMR) use was found to be a 
frequent method among IDT members for sharing patient 
information through the literature search. Frequent team 
meetings were another crucial tool for enhancing IDT 
communication and guaranteeing that every team member 
had access to critical patient data. IDT meetings resulted 
in enhanced collaboration between team members, 
according to experiences recorded by IDT participants 
from a variety of  specialties. Meetings enhanced team 
effectiveness, enhanced patient satisfaction, and enhanced 
the standard of  treatment. Another frequently mentioned 
method for IDT members to send patient medical 
information in a quick and easy-to-understand format is 
secure electronic messaging. Better communication, easier 
access to patient data, and an increased capacity to cut 
down on errors were all made possible via e-messaging. In 
a similar vein, improved patient information transmission 
resulted from the implementation of  standardized 
patient evaluation forms that were readily available to 
all IDT members and routinely updated. These kinds 
of  documents were especially helpful when patients 
were being transferred from one type of  care facility to 
another, or when members of  the IDT were providing 
care for difficult patients in nursing homes, inpatient and 
outpatient palliative care teams.

Healthcare Team Collaboration in Hospital 
Transfers through Cloud-Based Mobile Systems
Collaborative systems encompass mobile applications 
that are cloud-based and offer continuous monitoring 
features and recommendations for healthcare (Neyem et 
al., 2016). Implementing these software applications can 
be especially difficult because of  front-end and back-end 
mobility-related constraints. For most apps, mobile front-
end needs remain consistent and are linked to the inherent 

constraints of  communicating with the device. However, 
the requirements for the application back-end are 
distinct and specific to platforms used for collaboration 
and monitoring. These include needs for performance 
(battery life, storage, and bandwidth), security (reliability 
and privacy), and environment (interoperability, 
heterogeneity, scalability, and availability).To address 
these constraints, (Neyem et al., 2016) invented a  
technology which leverages mobile cloud computing 
(mcc) concepts to enhance the capabilities of  mobile 
devices. MCC architectures aim to increase performance 
and battery life by utilizing the capabilities of  external 
resource-rich nodes. Therefore, the approach merely uses 
a smartphone as a hub and display for wirelessly sent data 
from several sensors; whenever a network connection is 
available, it transmits the data to a server that does all 
the computer-intensive processing. This keeps the mobile 
device’s battery from being overtaxed by allowing the 
server to examine and analyze incoming data in real time 
to gather statistics and contextual information. Based on 
the overall architecture displayed below, the suggested 
platform functions as follows. An in-office medical 
practitioner uses the Web system to allocate the transfer 
to an ambulance prior to starting the transfer. The mobile 
system notifies the assigned ambulance’s paramedics. The 
transfer begins as soon as the patient is prepared, and the 
sensors are attached to him. The embedded sensors take 
some vital signs during the transfer and transmit the data 
to the mobile device. The mobile device transfers the data 
to the cloud, computes the REMS, and shows the results 
graphically. Afterwards, real-time observation of  all 
patient data by healthcare experts in the office facilitates 
improved teamwork amongst participating parties. In this 
way healthcare systems can collaborate effectively using 
cloud-based technology.

Figure 4: Conceptual framework for how IDT members access and communicate patient information in HBMC 
practices (Fathi et al., 2016)



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Onsite Incident Command System 
Due to staffing constraints and concerns about infection 
control, nursing facilities in Boston were forced to close 
during the peak of  COVID-19 pandemic in March and 
April 2020. Using the incident command system, the 
military, local administration, and medical professionals 
worked together to quickly create a 1000-bed field 
hospital for COVID-19 patients, including 500 respite 
beds for undomiciled patients and 500 post-acute care 
(PAC) beds in just 9 days. Using the Incident Command 
System, which was divided into the areas of  clinical care 
and operations, human resources, facilities/logistics, 

finance, data management, and information technology. 
Three people provided support to the military general 
incident commander: one military deputy commander 
and two clinical co-directors. Clinical teams and ancillary 
services were incorporated in the leadership structure 
for clinical care and operations, which was adjusted in 
response to changing demands. All around the region, 
patient recommendations were accepted and subjected 
to stringent admissions screening procedures.(Baughman 
et al., 2020). This approach provided a system for an 
effective collaboration between the military, local and 
other healthcare facilities during the pandemic.

Figure 5: General architecture of  the proposed cloud-based mobile system (Neyem et al., 2016)

Figure 6: Incident Command System-ICS (Baughman et al., 2020)



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WIISARD (Wireless internet information system for 
medical response in disaster)
When the Israel defense force sent a mobile field hospital 
to Haiti following the devastating earthquake in 2010, 
they used a specially designed technology solution called 

WIISARD which combine the hospital administration 
system and electronic medical record (EMR) of  the 
patients. It can collects and display information in a 
disaster response scenario associated with mass casualty 
(Demchak et al., 2007). Its basic design is shown below.

Figure 7: Diagram illustrating the basic system architecture of  WIISARD (Levy et al., 2010)

The primary application was an administrative dashboard 
with textual, numerical, and graphical data that was 
updated every minute. This includes records of  triage 
and patients’ medical condition, the record of  possible 
discharge, records of  hospital deaths, surgical procedures, 
imaging tests, births, and patient distribution by 
department all summarized on the dashboard. Along with 
keeping track of  patient movements across the hospital, 
the system also recorded the dates and times that patients 
entered each department. From the dashboard panel, the 
overall data could be narrowed down to the level of  a 
single patient. An electronic patient record was one of  
the application’s second modules. The patients’ personal 
details, admission notes, treatments received, laboratory 
and imaging results were all included in the medical 
record, which was arranged as tabs on the application 
screen. The application also featured specific modules 
for ordering and reporting imaging and laboratory study 
findings. The hospital included a digital x-ray machine 
in its imaging department. Consequently, there was a 
requirement for an image distribution solution. For this 
assignment, K-PACS open source PACS workstations 
were selected (Levy et al., 2010).
The implementation of  an EMR in a disaster response 
scenario helps to assure the appropriateness of  care in 
a multiple caregiver environment, allowing for faster 
patient transfers across hospital departments while 
minimizing the danger of  missing critical medical records 
of  patients. This was especially important in Haiti due 
to language barriers between patients and caregivers and 
a lack of  translators. Furthermore, such system facilitate  
easy  patient discharge by generating a concise discharge 
statement that is critical for the continuity of  care (Levy 
et al., 2010).

MATERIALS AND METHODS
Several bibliographical databases were examined, 
including Pub Med, Science Direct, Web of  Science, 
and google scholar. Articles published on the cutting 
edge of  healthcare collaboration frameworks were 
among the databases reviewed. This made it easier to 
comprehend their shortcomings, advantages, and chances 
for development and use in emergency situations. The 
reviews played a pivotal role in portraying a suitable 
methodological framework that possesses the necessary 
features and capabilities to tackle the typical obstacles 
associated with healthcare team collaboration during 
sudden onset disasters. Specifically, the framework aims 
to improve care continuity and patient outcomes in 
disaster situations.

Used Case: Mobile Hospital Experience During the 
Haiti Earthquake 2010
Goodman et al. (2015) described the experiences faced by 
the United States medical disaster teams when they arrived 
in Haiti following the earthquake on January 12, 2010. 48 
hours after the earthquake, the team deployed consisting 
of  11 doctors, 3 pharmacists, 18 security personnel and 
logisticians, 29 nurses, and 2 respiratory therapists arrived 
in a devastated area of  Port Au Prince. They set up the 
mobile medical unit on the site of  the destroyed Gheskio 
hospital. A small procedure tent for wound dressings 
and debridement, a surgical theater room, an intensive 
care unit and a pediatric ward as well as two general 
medicine tents were set up. A maximum of  35 people 
can be housed at once for triage, treatment, and release. 
In the first two weeks of  operation, they experienced 
little supply of  food, medication, and supplies due to 
the extensive damage to the airport and the continual 



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airlifting of  individuals out of  the country. As a result, 
they resorted to the use of  improvised resources and 
means to cope with the current situation. For example, 
even though complicated fractures of  the arms, legs, and 
hips were the most common injury, external fixators were 
not made available until the second week. One inventive 
way to straighten the fractures was to employ traction by 
connecting bits of  stone from the debris to ropes that 
were swung over the army cot poles.
After one week, three seriously ill patients arrived at the 
Gheskio Field Hospital simultaneously:

• N.S., a middle-aged woman with underlying congestive 
heart failure was brought with serious breathing problem 
and was immediately put on oxygen and diuretics

• The second patient was JP, a man in his mid-twenties 
who was under the rubble for three days before he was 
saved by his family members and brought with severe 
crush injuries. He was immediately intubated and put on 
a respirator.

• The last patient was a baby suffering from  
pneumonia who also required manual ventilation and 
intubation and the field hospital only had one mechanical 
respirator(Goodman et al., 2015)
The field hospital was running low on gasoline and oxygen 
when the three patients arrived. The logistician was worried 
that the gasoline needed to fuel the generators would run 
out. Although requests for these goods had been made, 
it was unclear when they would receive them due to the 
unstable circumstances at the airport. Other medical 
supplies that were sufficient included antibiotics, heart 
medicines, and pain relievers. It was evident by that evening 
that oxygen supplies were running short, but no meeting 
had been held to discuss how to handle the situation.
The medical officer decided to try rationing the oxygen 

by turning down the low rate in the tent where N.S. was 
receiving treatment. More diuretics and morphine were 
administered to her to relieve her respiratory distress 
while her nurse spent the night attempting to keep her 
comfortable.
When the communications liaison discovered the 
availability of  oxygen and other medications at the 
University teaching hospital, NS was transported there by 
pickup truck, but no oxygen was given during the journey. 
Although the team’s doctor accompanied her there while 
attempting to relieve her pain with inhalers, she had to 
contend with the lack of  oxygen and suffered before 
finally reaching the destination. She survived and was 
discharged after a few days.
In the ICU tent, J.P. and the baby were being attended 
to. When the baby’s oxygen tank ran out, room air was 
used to manually ventilate her. For a full day, the two 
respiratory therapists and one pediatrician alternated 
in ventilating the patients using the Ambu bag. When 
the baby started experiencing respiratory difficulty, the 
pediatrician providing ventilatory care recommended 
that J.P. be left to die instead of  being put into conscious 
sleep. Refusing, the other doctor in the tent intubated him 
and J.P. received the last oxygen tank that was left. Lastly, 
the infant and J.P. were flown to the Comfort Hospital 
Ship, which was berthed in the harbor, via helicopter. J.P. 
passed away enroute, but the infant made it through.

RESULTS AND DISCUSSION
The table below summarizes and compares the various 
frameworks. The strengths and weaknesses also 
highlighted to give some insight into each framework and 
its suitability for adoption by emergency healthcare teams 
for optimum continuity of  care.

Table 2: Table of  comparative analysis
Author Framework Strength Weakness Opportunity Threats

M
cL

an
ey

 
et 

al.
 

(2
02

2)

Su
nn

y 
br

oo
ks

 
fr

am
ew

or
k Have been successfully 

applied to different 
healthcare systems

Does not 
explicitly address 
emergency related 
challenges

Can be adaptable to 
different scenarios

Must be customized 
if  considered for 
application in case 
of  emergency

Fa
th

i e
t a

l. 
(2

01
6)

C
on

ce
pt

ua
l 

fr
am

ew
or

k 
fo

r I
D

T 
m

em
be

rs

Provides practical 
and process-oriented 
approach focusing 
on important tools 
necessary for effective 
collaboration during an 
emergency

Reliance on 
electronic 
methods may 
pose challenges in 
a digital deficient 
environment

Its principle can 
be easily applied 
to an emergency 
healthcare setting

Require robust 
cybersecurity when 
sharing vital patient 
data via e-messaging

N
ey

em
 et

 a
l. 

(2
01

6)

C
lo

ud
 b

as
ed

 sy
st

em

The inclusion of  
continuous monitoring 
features allows for real-
time data collection, 
providing healthcare 
professionals with 
up-to-date information 
during hospital 
transfers

Relies heavily on 
the availability 
and reliability 
of  technology, 
which may 
pose challenges 
in areas with 
limited network 
connectivity or 
infrastructure.

The continuous 
monitoring features 
open opportunities 
for remote patient 
monitoring beyond 
hospital transfers, 
contributing to 
proactive healthcare 
management.

The framework may 
encounter technical 
limitations, such as 
delays or errors in 
data transmission, 
which could impact 
the real-time nature 
of  healthcare 
collaboration during 
transfers.



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Discussion
The three patients discussed in the case study suffered 
due to lack of  available resources in the mobile field 
hospital. However, if  a collaboration protocol was initially 
implemented between the mobile hospital or any close 
by regional or local hospitals, such occurrences could 
have been curtailed. Table 2 shows summary of  some 
frameworks with the potential to improve collaboration 
and cooperation between mobile field hospitals and 
regional hospital during such situation to aid in providing 
continuity of  care to affected individuals in a similar 
disaster response scenario. The intention is to advice 
emergency medical teams to explore beyond the box for 
alternative options, particularly in a nation such as Haiti 
where the typical humanitarian aid command system 
framework might appear unworkable due to the absence 
of  an operational government that could support the 
division of  labor and needs assessment for disaster 
response.
The “Incident Command System” Is an easy to use and 
can be implemented within the shortest possible time 
as depicted in case of  Boston covid 19 responses. Its 
effectiveness lies in the leadership and division of  labor 
enabling easy resource allocation where needed. This is 
a very good approach for healthcare teams responding 
to disasters especially in austere situation like the case of  
Haiti where a functioning government may be difficult. 
The “Healthcare Team Collaboration in Hospital 
Transfers through Cloud-Based Mobile Systems,” can 
be used in conjunction with or embedded in any of  the 
framework to facilitate patient transfer from one mobile 
field hospital to another, or to a regional hospital with 
available resources that could save the patient’s life. This 
is because it could provide real time patient status and 

the need for immediate intervention whenever needed 
during transfer. The “Sunnybrook Framework for 
Interprofessional Team Collaboration” can be adapted 
by teams when responding to emergencies but must be 
customized to fit a disaster scenario. The flexibility of  
this framework could be utilized by deploying mobile 
field hospitals to facilitate coordination during disaster 
response. The “Conceptual Structure for How IDT 
Members at HBMC Access and Share Patient Data” has 
already been used by heterogenous healthcare teams to 
organize and divide tasks to provide adequate continuity 
of  care to patients. This is why it can effectively be adopted 
in any disaster situation, especially by international 
heterogenous healthcare teams responding to disaster. 
The “WIISARD (Wireless internet information system 
for medical response in disaster)” can also be used in 
conjunction with other frameworks like the cloud based 
mobile systems. This is because it keeps patients’ records 
and treatment histories which can be transferred to any 
nearby hospital whenever a patient is transferred. This 
facilitates the continuity of  care for the patients. 
After the incidence of  Haiti earthquake and Pakistan 
floods in 2010, several mobile healthcare teams were 
sent by international organizations, but they did not 
make significant impact due to their lack of  planning and 
coordination. As a result, the world health organization 
(WHO) sets up a minimum standard for all international 
healthcare teams responding to sudden onset disasters. 
These teams are meant to be guided by the WHO 
Emergency Response Framework (ERF) which ensures 
that deployed teams can provide quality and standard care 
to the affected populations. The Incident Management 
System (IMS) of  the WHO is like the Incident Command 
System (ICS)approach mentioned in the case of  Boston 

Ba
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ite
 in

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nt
 c

om
m

an
d 

sy
st

em

The system 
demonstrated 
adaptability by 
adjusting the 
leadership structure in 
response to changing 
demands, highlighting 
its flexibility in 
managing dynamic 
situations.

Implementing and 
maintaining an 
incident command 
system can be 
resource-intensive, 
requiring skilled 
personnel and 
the allocation of  
significant time 
and resources.

The incident 
command system 
can be integrated 
with existing 
healthcare systems 
and emergency 
response protocols, 
enhancing overall 
preparedness and 
coordination

The success of  the 
system in creating 
a 1000-bed field 
hospital may not 
directly translate 
to other settings 
or scales, posing 
limitations to its 
scalability.

Le
vy

 et
 a

l. 
(2

01
0)

A
pp

lic
at

io
n 

of
 in

fo
rm

at
io

n 
te

ch
no

lo
gy

 w
ith

in
 a

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el

d 
ho

sp
ita

l 
de

pl
oy

m
en

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ol

lo
w

in
g 

th
e 

Ja
nu

ar
y 

20
10

 H
ai

ti 
ea

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hq

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ke

The presence of  
electronic medical 
record facilitates and 
enhances continuity 
of  care in multiple 
hospitals

One notable 
weakness is 
dependency on 
technology. If  
the technology 
fails, the response 
mission fails

Implementing 
similar technology 
in regional or other 
field hospitals 
will enhance 
information 
exchange and 
coordination

Regional hospitals 
may find it 
difficult to ensure 
compatibility and 
integration of  such 
systems; careful 
planning and 
collaboration are 
necessary to reduce 
data silos and 
promote constant 
information flow.



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Am. J. Phys. Educ. Health Sci. 2(2) 86-96, 2024

from our literature review. This approach is very 
effective because it provides a system of  leadership, 
coordination and planning among responding teams. It 
facilitates partner coordination and engagement as well 
as operational logistics and support. It should however be 
noted that WHO’s IMS is more effective in a country with 
a functioning government where an in-country incident 
manager will oversee the affairs between the government 
and the responding healthcare teams.
Although each of  the framework may have a few gaps, 
however, they each have a great deal of  potential and 
opportunity that, if  thoroughly thought through, may 
help to improve care continuity by facilitating cooperation 
between mobile field hospitals and regional hospitals 
during disaster response.

CONCLUSION
In the event of  a disaster, there is need for the deployed 
mobile hospitals to collaborate with the nearby hospital to 
enhance the continuity of  care for the affected population. 
Numerous scholarly works exist regarding enhancing 
healthcare collaboration; however, they primarily 
concentrate on institutionalized healthcare systems. We 
can demonstrate that the highlighted frameworks offer a 
potential resolution that can be used in disaster response 
collaboration between regional hospitals and deployed 
mobile field hospitals. The frameworks could solve 
healthcare team collaboration issues and improve patient’s 
outcomes during disaster response. The difficulties faced 
by the American field hospital which led to death of  one 
patient and suffering of  two others further emphasize 
the need to utilize the function of  these frameworks for 
effective healthcare collaboration and continuity of  care.

LIMITATIONS
The limitation of  our research lies in the literature review, 
as we only obtained data from open access publication. 
This could mask some other important frameworks or 
work that may have similar  results as our findings.

REFERENCES
Alpert, E. A., & Merin, O. (2024). Global Disaster 

Response and Emergency Medical Teams. In Ciottone’s 
Non declared Disaster Medicine (pp. 120–125). Elsevier. 
https://doi.org/10.1016/B978-0-323-80932-
0.00020-3

Amakama, N. J. (2024a) Design and Implementation of  an 
Interoperable Solution of  a Mobile Field Hospital Dedicated 
to the Oil and Gas Industry. (Doctoral dissertation, 
IMT-MINES ALES-IMT-Mines Alès Ecole Mines-
Télécom). https//theses.hal.science/tel-04728704

Amakama, N. J., Dusserre, G., Cadiere, A., Schuette, R. 
W., & Zacharewicz, G. (2024b). “in press”.  An agent-
based simulation study on the effect of  ambulance 
dispatch policies on patient mortality in hospital 
systems: a disaster response test case. International 
Journal of  Emergency Management, 19(1). https://doi.
org/10.1504/IJEM.2024.10067639

Baughman, A. W., Hirschberg, R. E., Lucas, L. J., Suarez, 
E. D., Stockmann, D., Hutton Johnson, S., Hutter, 
M. M., Murphy, D. J., Marsh, R. H., Thompson, R. 
W., Boland, G. W., Ives Erickson, J., & Palamara, 
K. (2020). Pandemic Care Through Collaboration: 
Lessons From a COVID-19 Field Hospital. Journal of  
the American Medical Directors Association, 21(11), 1563–
1567. https://doi.org/10.1016/j.jamda.2020.09.003

Chen, X., Lu, L., Shi, J., Zhang, X., Fan, H., Fan, B., Qu, 
B., Lv, Q., & Hou, S. (2020). Application and Prospect 
of  a Mobile Hospital in Disaster Response. Disaster 
Medicine and Public Health Preparedness, 14(3), 377–383. 
https://doi.org/10.1017/dmp.2020.113

Dehghani Tafti, A., Fatehpanah, A., Salmani, I., Bahrami, 
M. A., Tavangar, H., Fallahzadeh, H., Tehrani, A. A., 
Bahariniya, S., & Tehrani, G. A. (2023). COVID-19 
pandemic has disrupted the continuity of  care for 
chronic patients: Evidence from a cross-sectional 
retrospective study in a developing country. BMC 
Primary Care, 24(1), 137. https://doi.org/10.1186/
s12875-023-02086-6

Demchak, B., Griswold, W. G., & Lenert, L. A. (2007). 
Data quality for situational awareness during mass-
casualty events. AMIA Annual Symposium proceedings. 
AMIA Symposium, 2007, 176–180.

Fathi, R., Sheehan, O. C., Garrigues, S. K., Saliba, D., 
Leff, B., & Ritchie, C. S. (2016). Development 
of  an Interdisciplinary Team Communication 
Framework and Quality Metrics for Home-Based 
Medical Care Practices. Journal of  the American Medical 
Directors Association, 17(8), 725-729.e10. https://doi.
org/10.1016/j.jamda.2016.03.018

Feizolahzadeh, S., Vaezi, A., Mirzaei, M., Khankeh, 
H., Taheriniya, A., Vafaeenasab, M., & Khorasani-
Zavareh, D. (2019). Barriers and facilitators to 
provide continuity of  care to dischargeable patients 
in disasters: A qualitative study. Injury, 50(4), 869–876. 
https://doi.org/10.1016/j.injury.2019.03.024

Goodman, A., & Black, L. (2015). The challenge of  
allocating scarce medical resources during a disaster 
in a low income country: a case study from the 2010 
Haitian earthquake. Palliat. Med. Hosp. Care. Open. J., 
1(1), 24-29.

Goodwin, J. S. (2021). Continuity of  Care Matters 
in All Health Care Settings. JAMA Network 
Open, 4(3), e213842. https://doi.org/10.1001/
jamanetworkopen.2021.3842

Gulliford, M., Naithani, S., & Morgan, M. (2006). What 
is “continuity of  care”? Journal of  Health Services 
Research & Policy, 11(4), 248–250. https://doi.
org/10.1258/135581906778476490

Hamdanieh, L. A., Marzaleh, M. E. A., Ostadtaghizadeh, 
A. Y., & Soltani, A. I. (2023). Challenges of  Emergency 
Medical Teams and Deploying a Field Hospital in the 
Aftermath of  the Beirut Blast: A Qualitative Study. 
Disaster Medicine and Public Health Preparedness, 17, e114. 
https://doi.org/10.1017/dmp.2022.19

Hamis, A. A., Md Bukhori, A. B., Heng, P. P., Jane Ling, M. 



Pa
ge

 
96

https://journals.e-palli.com/home/index.php/ajpehs

Am. J. Phys. Educ. Health Sci. 2(2) 86-96, 2024

Y., Shaharuddin, M. A.-A., A Fauzi, N. A. F., Masdor, 
N. A., Othman, R., & Ismail, A. (2023). Strategies, 
challenges and opportunities in the implementation 
of  COVID-19 field hospitals: A scoping review. 
BMJ Open, 13(3), e067227. https://doi.org/10.1136/
bmjopen-2022-067227

Huber, C. (2022). Interprofessional collaboration 
in health care. Praxis, 110(1), 3–4. https://doi.
org/10.1024/1661-8157/a003808

Levy, G., Blumberg, N., Kreiss, Y., Ash, N., & Merin, O. 
(2010). Application of  information technology within 
a field hospital deployment following the January 
2010 Haiti earthquake disaster. Journal of  the American 
Medical Informatics Association, 17(6), 626–630. https://
doi.org/10.1136/jamia.2010.004937

Malone, N. C., Williams, M. M., Smith Fawzi, M. C., 
Bennet, J., Hill, C., Katz, J. N., & Oriol, N. E. (2020). 
Mobile health clinics in the United States. International 
Journal for Equity in Health, 19(1), 40. https://doi.
org/10.1186/s12939-020-1135-7

McLaney, E., Morassaei, S., Hughes, L., Davies, R., 
Campbell, M., & Di Prospero, L. (2022). A framework 
for interprofessional team collaboration in a hospital 
setting: Advancing team competencies and behaviours. 
Healthcare Management Forum, 35(2), 112–117. https://
doi.org/10.1177/08404704211063584

Neyem, A., Carrillo, M. J., Jerez, C., Valenzuela, G., 
Risso, N., Benedetto, J. I., & Rojas-Riethmuller, J. S. 
(2016). Improving Healthcare Team Collaboration 
in Hospital Transfers through Cloud-Based Mobile 
Systems. Mobile Information Systems, 2016, 1–14. 
https://doi.org/10.1155/2016/2097158

Panteli, D., Wagner, C., Verheyen, F., & Busse, R. (2015). 
Continuity of  care in the cross-border context: 
Insights from a survey of  German patients treated 
abroad. European Journal of  Public Health, 25(4), 557–
563. https://doi.org/10.1093/eurpub/cku251

Rossodivita, A. (2011). (A340) The Role of  Field Hospitals 
in Severe Environments—Guidelines to Prepare and 
Build a Field Hospital during a Disaster. Prehospital 
and Disaster Medicine, 26(S1), s95–s96. https://doi.
org/10.1017/S1049023X11003244

Skang. (2023, February 16). Global health considerations 
in time of  natural disasters. BMJ Case Reports Blog. 
https://blogs.bmj.com/case-reports/2023/02/16/
global-health-considerations-in-time-of-natural-
disasters/

World Health Organization. (2018). Continuity and 
coordination of  care: A practice brief  to support implementation 
of  the WHO Framework on integrated people-centred health 
services. World Health Organization. https://iris.who.
int/handle/10665/274628

Yang, M., Suh, S., & Lee, Y. (2018). A Study on 
the Historical Background and Deployment 
Characteristics of  Mobile Hospital for Disaster—
Focused on Military Mobile Hospitals. Journal of  The 
Korea Institute of  Healthcare Architecture, 24(3), 39–47. 
https://doi.org/10.15682/jkiha.2018.24.3.39

Yousefian, S. (2021). Identifying the components 
affecting intra-organizational collaboration of  health 
sector in disasters: Providing a conceptual framework 
using a systematic review. https://doi.org/10.1016/j.
ijdrr.2021.102146


