Policy brief on healthcare surge capacity and medical supply chain resilience for island communities.
Policy brief on healthcare surge capacity and medical supply chain resilience for island communities. Free under Creative Commons Attribution 4.0 — no registration required.
Summary of the paper
"The Last Hospital on the Island" is an ISPI policy brief on public health emergency infrastructure for geographically isolated island communities. It argues that reliance on a single hospital creates a hard ceiling on surge capacity that cannot be eased by moving patients to nearby facilities, as continental health systems can.
The brief uses Maui Memorial Medical Center, the only hospital on Maui, to show how a surge on an island becomes a medical airlift problem limited by the number of evacuation flights available.
What the paper finds
- Sole-provider dependence has no continental equivalent. When the island's only hospital reaches capacity, there is no regional network to absorb the overflow.
- Post-COVID investment missed the core gap. Investment has focused on supply chains and stockpiles rather than on the physical and workforce capacity limits of island hospitals.
- Pacific territory systems are particularly exposed. The brief describes facility age, staffing and equipment in territory health systems as documented to be inadequate for surge scenarios, in places where the federal government has a unique responsibility.
What it recommends
- Fund island hospital surge capacity, including physical expansion, mobile surge capacity and telemedicine, through HHS and FEMA programs designed for sole-provider island facilities.
- Develop island-specific public health emergency preparedness standards for shelter-in-care, pre-positioned pharmaceutical and equipment reserves, and medical evacuation capacity.
- Commission comprehensive public health emergency infrastructure assessments of Pacific Island territory health systems to guide HHS investment and appropriations.
Who it's for
Hospital and health system leaders, state and territorial health departments, emergency managers, HHS and FEMA program staff, and legislators in Hawaii and the Pacific Island territories.
This research connects to the 39 Small Island Developing States worldwide through the Samoa Pathway and BPOA+30 framework. Every ISPI research product carries a mandatory SIDS global bridge per the ISPI Research Architecture.
Cite as
Pulley, Warren (2026). The Last Hospital on the Island: Public Health Emergency Infrastructure Policy for Geographically Isolated Island Communities (ISPI PB-19). Island Security Policy Institute, Honolulu. https://ispiglobal.com/papers-landing/pb19-public-health-emergency https://doi.org/10.5281/zenodo.23450039
BibTeX
@techreport{ispipb192026,
author = {Pulley, Warren},
title = {The Last Hospital on the Island: Public Health Emergency Infrastructure Policy for Geographically Isolated Island Communities},
institution = {Island Security Policy Institute},
address = {Honolulu, HI},
number = {ISPI PB-19},
year = {2026},
url = {https://ispiglobal.com/papers-landing/pb19-public-health-emergency},
doi = {10.5281/zenodo.23450039}
}Related analysis
AnalysisHow to Apply an Island Emergency Management Framework to Your Organization →AnalysisWhat Is Island Emergency Management? Why Continental Frameworks Don't Apply →AnalysisContinuity of Operations (COOP) for Island Local Government: A Step-by-Step Guide and Checklist →PaperPB-18 — Democratic Resilience in Small Island States — Policy Brief →GuideIsland Emergency Management & Preparedness: Research and FAQ →Pulley, Warren. "Public Health Emergency Infrastructure in Island Communities." Island Security Policy Institute, 2026. https://ispiglobal.com/papers-landing/pb19-public-health-emergency
