Field Hospitals During the COVID-19 Pandemic in Vietnam: Practical Lessons for Rapid Establishment, Health-System Integration, Patient Flow, and Mortuary Preparedness

IN A NUTSHELL
Author's Note 
…field hospitals for pandemic response should be rapidly deployable, temporary, modular, indoor-based, clinically safe and fully integrated with the existing health system. They differ from traditional disaster field hospitals because they must operate for weeks or months under conditions of high infection risk, tropical climate, large patient volumes and possible high mortality. The most appropriate model is not always an open-air camp, but a rapidly converted existing structure with clear zoning, adequate ventilation, oxygen readiness, infection prevention and control, staff protection, clean and infectious routes, safe mortuary management, refrigerated body storage, safe transfer systems and strong referral links. Moreover, field hospitals must be connected to existing health-care facilities for logistics, human resources and technical support; without such integration, they risk functioning only as isolated bed spaces rather than effective treatment facilities.

 By Tham Chi Dung, MD., PhD.

Deputy Director

Research Institute for Health Sciences (RIHS), Hanoi city, Vietnam

Email: thamchidung@icloud.com
Link: ResearchGate

Field Hospitals During the COVID-19 Pandemic in Vietnam

Practical Lessons for Rapid Establishment, Health-System Integration, Patient Flow, and Mortuary Preparedness

Dr. Tham Chi Dung is a medical doctor and public health professional with extensive experience in health policy and pandemic preparedness and response in Vietnam. He has served in official public health and policy-making roles in the Ministry of Health, contributed to the development of strategies, technical guidance and operational policies for pandemic control. During the COVID-19 pandemic, he was involved as one of the key technical contributors to the design and organization of field hospitals in Vietnam. His practical lessons are drawn from policy development, field implementation and real-world response activities, contributing to overall efforts to control the pandemic and strengthen emergency health-system preparedness.

 

Vietnam’s COVID-19 experience demonstrated how a pandemic can rapidly evolve from localized outbreaks into a national health-system emergency. By 30 September 2023, Vietnam had reported 11,623,698 confirmed COVID-19 cases and 43,206 deaths across all 63 provinces and cities, corresponding to a reported case fatality proportion of approximately 0.4%. More than 266 million vaccine doses had also been administered nationally [1]. Although the initial phases of the pandemic were relatively well controlled, the large epidemic wave beginning in 2021 placed substantial pressure on hospital bed capacity, oxygen supply, intensive care services, health workforce availability and referral systems. This situation required rapid expansion of treatment capacity through field hospitals, tiered models of care and strengthened coordination between emergency response structures and the existing health system [2].

Field hospitals are a critical surge-capacity mechanism when the number of patients exceeds the capacity of existing health-care facilities. In the Vietnam context, the COVID-19 response showed that field hospitals should be designed as temporary, rapidly deployable, modular and infection-prevention-oriented facilities, rather than as permanent hospitals or conventional open-air disaster-response camps. Their primary functions are to expand treatment capacity, isolate infectious patients from routine hospital services, reduce the risk of nosocomial transmission, and maintain essential clinical care for patients with mild, moderate, severe and critical disease. The World Health Organization’s manual on severe acute respiratory infection treatment centres provides practical guidance for establishing and operating screening and treatment facilities during COVID-19 and other respiratory infection emergencies [3].

A practical field hospital in Vietnam did prioritize the rapid conversion of existing infrastructure, such as schools, dormitories, sports centres, exhibition halls, military facilities, unused hospital buildings or other large public buildings. This approach is more feasible than new construction because pandemic response requires operational readiness within days or weeks. Core functional areas should include hospital administration, reception and triage, diagnostic imaging, laboratory services, emergency and intensive care, treatment areas for mild and moderate cases, isolation areas before discharge, pharmacy and medical supplies, laundry and equipment processing, food services, staff rest areas, mortuary management, infection prevention and control, security and signage.

A key operational lesson is that pandemic field hospitals should not be designed primarily as open-air facilities. Traditional disaster-response models often use tents or outdoor temporary structures; however, respiratory pandemics require a different model. Transmission risk, prolonged operational duration, climatic conditions and staff fatigue must all be considered. In Vietnam, pandemics may occur not only during cooler seasons but also during periods of intense heat, strong sunlight, high humidity and heavy rainfall. Open-air facilities may therefore compromise patient comfort, staff safety, infection control and continuity of clinical care. Indoor or semi-permanent facilities with roofing, ventilation, electricity, water supply, sanitation, waste management and cooling systems are more appropriate. Ventilation remains essential, but it should be achieved through controlled indoor airflow, natural ventilation where feasible, mechanical exhaust systems and clear separation between clean and contaminated zones [3].

The physical structure of a field hospital should be based on zoning, separation of risk areas and unidirectional movement flows. At minimum, the hospital should include a clean zone, buffer zone and contaminated or infectious zone. The clean route should be reserved for hospital leadership, administrative functions, staff entry before exposure, clean medicines, sterile and non-contaminated medical supplies, food delivery, information technology systems and other clean logistics. The infectious route should be used for suspected or confirmed patients, contaminated equipment, used linen, infectious medical waste, wastewater-related activities and movement of deceased bodies. These routes must be physically separated and should not intersect. Clear signage, security control, physical barriers, colour coding, access restrictions and supervision are necessary to prevent accidental crossover between clean and infectious flows.

Field hospitals should not function as isolated facilities. They must be formally integrated with the existing health-care system, particularly provincial hospitals, central hospitals, district health centres, emergency medical services, laboratories and public health authorities. Such integration enables field hospitals to receive technical support, specialist consultation, staff rotation, oxygen supply, essential medicines, laboratory testing, imaging support, waste treatment, ambulance referral and emergency equipment. During the COVID-19 response in Ho Chi Minh city, specialist teams from Cho Ray Hospital supported treatment activities in multiple field hospitals, while the Ministry of Health organized field warehouses for medical equipment and transferred ventilators, infusion pumps and patient monitors to COVID-19 treatment facilities [5]. This experience highlights the importance of a hub-and-spoke model, in which existing hospitals serve as technical and logistical hubs, while field hospitals provide surge capacity, isolation, early treatment and step-down care.

The reception and triage area should be located at the controlled entry point of the infectious zone. Patients should be rapidly classified into suspected, confirmed, mild, moderate, severe or critical categories. Mild and moderate cases may be managed in large treatment wards with adequate bed spacing, routine clinical monitoring and access to oxygen when required. Severe and critical cases require a high-dependency or emergency stabilization area equipped with oxygen supply, pulse oximeters, patient monitors, emergency medicines, high-flow oxygen, non-invasive ventilation, mechanical ventilators and trained clinical staff. Strong referral links with higher-level hospitals are essential so that patients with clinical deterioration can be transferred rapidly when field-hospital capacity or technical capability is exceeded. WHO’s Emergency Medical Teams approach similarly emphasizes coordination with national health systems, referral mechanisms, triage, infection prevention and logistics support during outbreaks and emergencies [6].

Because severe pandemics may be associated with high mortality, field hospitals must include a safe, dignified and infection-controlled mortuary and body-management system. The temporary mortuary should be located at the terminal end of the infectious route, away from the kitchen, pharmacy, staff rest areas, administrative offices, public entrance and clean supply routes. When deaths exceed indoor storage capacity, refrigerated vehicles or refrigerated containers should be placed in a controlled service zone close to the final infectious exit. These units should have temperature monitoring, backup power or fuel, restricted access, body identification records and handover logs. Deceased patients should be treated as potentially infectious, handled by trained staff using appropriate personal protective equipment, placed in leak-proof body bags, externally disinfected, labelled, documented and transferred only through the infectious route. Standard operating procedures should cover death certification, family notification, temporary cold storage, release of bodies, transport, burial or cremation, and cleaning and disinfection of mortuary areas and transport vehicles. WHO guidance emphasizes infection prevention, safe handling, staff protection, dignity and respect in the management of bodies of persons who died from suspected or confirmed COVID-19 [4].

Human resources are another determinant of field-hospital performance. A field hospital requires a lean but complete management and staffing structure, including leadership, clinical teams, nursing teams, infection prevention and control staff, pharmacists, laboratory and imaging technicians, logistics personnel, information technology staff, cleaners, security personnel, transport teams and mortuary staff. Staff rotation is essential because pandemic response work is physically demanding and psychologically stressful. Field hospitals therefore require a pre-agreed mechanism for mobilizing health workers from existing hospitals, medical universities, military medical units, private providers and retired health professionals. Rapid training, clinical supervision, occupational protection, mental health support and adequate rest arrangements should be planned from the outset.

Logistics are central to the effectiveness and safety of field hospitals. Stable supply chains are required for oxygen, medicines, personal protective equipment, disinfectants, consumables, food, water, electricity, internet connectivity, laundry, waste treatment, body bags, refrigerated storage and ambulance referral. These functions should be supported by existing hospitals and local health authorities rather than being developed separately for each field hospital. Digital information systems should be used to monitor admissions, discharges, bed occupancy, oxygen demand, mortality, stock levels, body storage capacity and daily situation reports. During severe pandemic conditions, daily coordination meetings should review patient load, oxygen demand, referral delays, deaths, mortuary capacity, refrigerated-vehicle availability, staffing gaps, stock levels and funeral-service capacity.

In summary, field hospitals for pandemic response should be rapidly deployable, temporary, modular, indoor-based, clinically safe and fully integrated with the existing health system. They differ from traditional disaster field hospitals because they must operate for weeks or months under conditions of high infection risk, tropical climate, large patient volumes and possible high mortality. The most appropriate model is not always an open-air camp, but a rapidly converted existing structure with clear zoning, adequate ventilation, oxygen readiness, infection prevention and control, staff protection, clean and infectious routes, safe mortuary management, refrigerated body storage, safe transfer systems and strong referral links. Moreover, field hospitals must be connected to existing health-care facilities for logistics, human resources and technical support; without such integration, they risk functioning only as isolated bed spaces rather than effective treatment facilities.

 

References

  1. Ministry of Health of Vietnam, World Health Organization. Viet Nam COVID-19 Situation Report No. 110, September 2023. Hanoi: Ministry of Health and WHO; 2023. Available from: https://cdn.who.int/media/docs/default-source/wpro—documents/countries/viet-nam/covid-19/viet-nam-moh-who-covid-19–110_sep2023.pdf?sfvrsn=a2c6b1c4_1
  2. Thai PQ, Rabaa MA, Luong DH, Tan DQ, Quach HL, Hoang L, et al. Country case study: Viet Nam — COVID-19 health system response. Washington, DC: World Bank; 2023. Available from: https://thedocs.worldbank.org/en/doc/8ca3f9bfda06e5c061ef3affd92fb551-0070012023/original/Vietnam-case-study.pdf
  3. World Health Organization. Severe acute respiratory infections treatment centre: practical manual to set up and manage a SARI treatment centre and a SARI screening facility in health care facilities. Geneva: World Health Organization; 2020. Available from: https://www.who.int/publications/i/item/10665-331603
  4. World Health Organization. Infection prevention and control for the safe management of a dead body in the context of COVID-19: interim guidance. Geneva: World Health Organization; 2020. Available from: https://www.who.int/publications/i/item/infection-prevention-and-control-for-the-safe-management-of-a-dead-body-in-the-context-of-covid-19-interim-guidance
  5. Viet Nam News. “Four-level” hospital strategy helps HCM City battle coronavirus pandemic. Viet Nam News. 2021 Jul 23. Available from: https://vietnamnews.vn/society/996263/four-level-hospital-strategy-helps-hcm-city-battle-coronavirus-pandemic.html
  6. World Health Organization. WHO’s Emergency Medical Teams inspire countries and colleagues during COVID-19 pandemic. ReliefWeb. 2020 Nov 25. Available from: https://reliefweb.int/report/world/who-s-emergency-medical-teams-inspire-countries-and-colleagues-during-covid-19-pandemic