Medical device availability under system degradation: a dependency-based framework for adaptive responses and risk-informed decision-making

The availability of medical devices (MDs) is commonly viewed as a challenge related to procurement, logistics, or reprocessing. However, recent conflicts, disasters, pandemics, and attacks on healthcare systems have shown that the availability of MDs depends on a broader network of interdependent resources. Disruption to these dependencies may not only compromise the acquisition of new MDs, but also the continued use and reprocessing of existing ones. This recommendation conceptualises MD availability as a system-dependent healthcare capability. Five key dependency domains are proposed to describe the resources and functions required to maintain device availability in degraded conditions. Based on these dependencies, a seven-component adaptive response framework (7R) is presented: Relocate, Rebuy, Rebuild, Rethink, Reduce, Reuse, and Reprocess. Adaptive reprocessing is examined as a representative high-dependency response strategy because it necessitates the coordinated interaction of multiple dependency domains while simultaneously introducing risks relating to infection prevention, functionality, operations, and governance. Rather than eliminating risk, adaptive measures redistribute risk across domains. The proposed framework links dependencies, adaptive response options, reprocessing functions and residual risk, supporting preparedness planning and operational decision-making when conventional standards can no longer be fully maintained.