Evaluating the operational effectiveness of Emergency Medical Team field hospitals: A novel tool for measuring surge capacity performance

As the frequency and complexity of disasters increase, Emergency Medical Teams (EMTs) and their field hospitals have become essential to delivering medical care in crisis settings. Despite their critical role, no validated tool currently exists to evaluate EMT field hospital performance in real time. To develop, validate, and pilot a real-time evaluation tool to assess the operational effectiveness of EMT field hospitals. A mixed-methods approach was used to construct the tool. Initial Key Performance Indicator (KPI) domains were derived from an extensive literature review and refined through 20 expert interviews and a modified Delphi process. KPI domains meeting a ≥75% consensus threshold were included. The finalized tool, composed of six KPI domains, was developed into a digital application with real-time dashboard functionality. The tool was piloted in a full-scale simulation of a Type 1 mobile EMT deployment responding to a simulated outbreak. Seventeen EMT personnel participated. Quantitative data were analyzed using descriptive statistics, one-sample t-tests, and Pearson correlations. Qualitative feedback was also collected. Six validated KPI domains formed the tool’s core: Deployment & Operational Readiness, Clinical Service Delivery, Needs & Capacity Assessment, Staffing & Human Resources, Equipment & Logistics, and Coordination & Communication. The pilot yielded a high overall performance score (4.52/5), with the highest ratings in deployment readiness and clinical services. The lowest score was identified in coordination and communication. Perceived elements (e.g., safety, teamwork, wellbeing) correlated strongly with perceived effectiveness but showed a statistically significant gap when compared to objective performance scores (p < 0.05). Qualitative feedback highlighted the tool's utility but raised concerns over data collection burden during real-time deployment. The tool provides a structured yet flexible framework for monitoring EMT field hospital performance. While promising, future field validation and streamlining are needed to balance comprehensiveness with operational feasibility.