Strengthening Public Health Preparedness Through Simulation: Experience From a Multi-Agency Field Hospital in Island Malaysia

During Malaysia's Delta wave in 2021, the island of Labuan faced a surge of COVID-19 cases that overwhelmed its only hospital. In response, a 100-bed field hospital with four transit ICU beds was rapidly established through multi-agency collaboration. Prior to patient admission, seven simulation exercises were conducted with 98 personnel to prepare workflows and identify system vulnerabilities. Scenarios included oxygen outages, patient collapse, fire drills, intubation, specimen transport, and portable x-ray deployment. The simulations revealed gaps in logistics, communication, and role clarity, leading to immediate corrective measures. Over 4 weeks, the hospital admitted 243 patients, 30% aged 60 years or older. Twelve required advanced respiratory support, yet no in-hospital deaths or cardiopulmonary arrests occurred. Staff debriefings highlighted improvements in teamwork, communication, preparedness, and workflow efficiency. This experience demonstrates how low-resource simulation can function as a strategic public health intervention to enhance preparedness in resource-limited settings.