Indonesia has recently completed a large-scale national simulation exercise designed to test and strengthen the readiness of hospitals, health offices, and emergency medical teams for a potential megathrust earthquake scenario affecting West Sumatra and other high‑risk regions of the country.[6] The exercise, which brought together more than five hundred participants from multiple districts and sectors, focused heavily on how hospitals would manage mass casualties, maintain critical services, and coordinate with other parts of the health system during a complex disaster situation.[6] While the primary emphasis of the activity was on broader health system preparedness, the scenario planning and operational drills placed hospitals at the center of emergency care, triage, referral pathways, and continuity of essential services, making it a significant management‑focused event for the hospital sector.[6]

Under the simulated megathrust earthquake scenario, participating hospitals were required to test their emergency care pathways, including casualty reception, triage, stabilization, and referral to higher‑level facilities when local capacity was exceeded.[6] This involved reviewing and stress‑testing protocols for critical care units, operating theatres, diagnostics and imaging services, blood banking, and laboratory support, all of which are vital for the management of trauma and complex medical cases in a disaster.[6] Hospital managers and clinical leaders examined how to allocate limited intensive care beds, ensure availability of anaesthesia teams for emergency surgeries, and keep essential consumables and pharmaceuticals flowing despite damage to infrastructure and supply chains.[6]

The simulation also highlighted the importance of robust infection control and patient flow management in disaster conditions, especially when hospitals may need to expand surge capacity into non‑traditional spaces such as corridors, temporary tents, or repurposed wards.[6] Participants worked through procedures for isolating patients with communicable diseases, maintaining hygiene standards in crowded environments, and protecting both staff and patients while still delivering life‑saving interventions.[6] This focus on infection prevention is particularly relevant for facilities that still face routine outbreaks of infectious diseases and must be ready to handle overlapping emergencies such as earthquakes and epidemics.[6]

Healthcare information technology and data management were key components of the exercise, as coordinators identified gaps in data flow between field teams, hospital emergency operations centers, and national command structures.[6] Hospitals practiced using digital tools and standardized reporting templates to track bed availability, critical stock levels, and patient transfers in near real time, allowing decision‑makers to prioritize resources where they were most needed.[6] The exercise findings pointed to the need for more integrated health information systems that can connect emergency departments, intensive care units, laboratories, and radiology services to external coordination platforms in a secure and reliable way.[6]

From a hospital management perspective, the national drill underscored the central role of leadership, governance, and cross‑sector coordination in disaster preparedness.[6] Hospital executives and department heads had to test their internal chain of command, clarify roles and responsibilities, and ensure that staff understood escalation procedures for activating emergency operation plans.[6] The exercise also required close collaboration with local health offices, emergency medical teams, and non‑health actors such as disaster management agencies, which is critical when hospitals depend on external support for logistics, telecommunications, and security during large‑scale crises.[6]

Clinical specialties and support services central to hospital operations were woven throughout the scenario, even when they were not explicitly labeled in exercise documents.[6] For example, cardiology and respiratory care units needed to prepare for patients with heart attacks, arrhythmias, and respiratory distress triggered by physical trauma, stress, or environmental exposures after the earthquake.[6] Orthopaedics teams were expected to manage fractures, crush injuries, and spinal trauma, while rehabilitation and mobility services had to plan for early physiotherapy and assistive devices for patients recovering from serious injuries.[6]

Diagnostics and imaging departments, including radiology and point‑of‑care ultrasound, played a vital role in rapidly assessing internal injuries and guiding surgical decision‑making during the simulation.[6] Laboratory equipment and blood banking services were tested for their ability to handle sudden spikes in demand for blood products, cross‑matching, and urgent laboratory tests needed to stabilize critically ill patients.[6] Hospital managers reviewed contingency plans to ensure back‑up power for imaging equipment, protect sensitive devices from damage, and maintain sufficient stocks of reagents and consumables in case of supply interruptions.[6]

The exercise findings also highlighted the need to strengthen facilities management and physical infrastructure resilience in hospitals across high‑risk districts.[6] Participants discussed structural and non‑structural measures to protect operating rooms, intensive care units, and critical equipment from earthquake damage, along with strategies for maintaining water, power, and medical gas supplies under extreme conditions.[6] These discussions are expected to feed into future investment plans for hospital upgrades, retrofitting, and the design of new facilities that can better withstand seismic events while continuing to provide essential services.[6]

Another cross‑cutting theme was the importance of well‑trained staff and regular drills for sustaining hospital readiness over time.[6] The national simulation demonstrated that emergency plans must be more than documents stored on shelves; they need to be practiced, refined, and understood by multi‑disciplinary teams from emergency departments, critical care, surgery, nursing, pharmacy, and support services.[6] Organizers emphasized that lessons from this exercise will inform updated training modules, tabletop exercises, and hospital‑level simulations aimed at embedding a culture of preparedness in daily operations rather than treating it as an occasional checklist activity.[6]

Telemedicine and remote support also emerged as areas with potential to strengthen hospital response capacity, particularly for facilities in remote or resource‑limited districts that may struggle to access specialized expertise during a major disaster.[6] While the current exercise focused primarily on in‑person operations, stakeholders discussed how virtual consultations, remote diagnostics, and centralized command centers could help connect smaller hospitals and field teams to tertiary centers and national experts in real time.[6] Such approaches could enhance decision‑making for complex cases in cardiology, neurology, surgery, and critical care when local teams are under severe pressure.[6]

National health authorities and partners view this megathrust earthquake simulation as a crucial step toward building a more resilient hospital network and health system in Indonesia, particularly in regions with high seismic risk.[6] Officials noted that the presence of diverse stakeholders from multiple districts signals a strong commitment to upgrading emergency care, coordination mechanisms, and hospital management capabilities in the face of increasing disaster threats.[6] Recommendations from the exercise, including improvements in data systems, clarification of sub‑cluster roles, and targeted investments in hospital infrastructure and training, are expected to guide future policy decisions and resource allocation for health‑sector disaster preparedness.[6]