Specialties:
Comprehensive Trauma Care and General Trauma Management; Chest Wall Trauma and Surgical Fixation of Rib Fractures; Minimally Invasive Thoracic Surgery for Lung Tumors, Pneumothorax, Empyema, and Lung Volume Reduction Surgery; Mediastinal Disorders, including Mediastinal Tumors, Infections, Foreign Bodies, Myasthenia Gravis, and Diaphragmatic Weakness or Hernia.

When major disasters, public safety incidents, or sudden mass-casualty incidents (MCIs) occur, hospitals are often confronted with two simultaneous challenges. On one hand, multiple patients with severe traumatic injuries require immediate, life-saving intervention. On the other, the hospital itself may experience functional degradation of surgical capacity, as operating rooms, personnel, or equipment become constrained by overwhelming demand or disaster-related disruption.

Ensuring that essential trauma surgical services can continue when hospital capacity is compromised has become a defining responsibility of modern medical centers.

In response to these risks, the Ministry of Health and Welfare has promoted the Resilient Healthcare Program, emphasizing that medical centers must maintain continuity of critical healthcare functions during disasters or extraordinary conditions. Within this framework, the Backup Operation Room Project (BORP) has been developed as a key strategy to preserve emergency trauma surgical capability when standard systems are under stress.

Why Do We Need the Backup Operation Room Project (BORP)?

During disasters or MCIs, hospital surgical capacity may be affected at the same time that critically injured patients arrive. Operating rooms may be unavailable due to space limitations, equipment damage, or staffing shortages, yet trauma patients still require urgent interventions such as hemorrhage control, decompression, or damage-control surgery. Reliance solely on conventional operating rooms and routine workflows may therefore result in dangerous delays during the most critical window for survival.

The Backup Operation Room Project (BORP) was established to address this gap. When hospital surgical capacity is compromised, BORP enables the extension of damage control surgical capability beyond conventional operating rooms, allowing care to be delivered in non-conventional medical spaces or austere environments that can be rapidly adapted for emergency use. Within predefined safety boundaries, essential life-saving procedures can be initiated without delay.

BORP is not intended to replace standard operating rooms. Rather, it functions as a continuity-of-operations strategy, ensuring that essential damage control surgery remain available when routine hospital infrastructure cannot function fully. In this way, BORP represents the hospital’s last line of defense for life-saving surgical care under disaster conditions.

Modular Organization and Rapid Mobilization Under BORP

Under BORP, Far Eastern Memorial Hospital employs a compact, modular operational design. Each BORP unit consists of 10 members, including trauma and orthopedic surgeons, emergency physicians, emergency nurses, anesthesiologists or nurse anesthetists, operating room nurses, and logistics support personnel. This structure allows for rapid mobilization and independent execution of emergency trauma surgery when conventional operating rooms are unavailable.

Currently, the hospital has established two fully operational BORP units, with an additional three reserve units planned to support surge capacity. Depending on the scale and duration of an incident, units may be activated sequentially or rotated to sustain surgical capacity over time while minimizing staff fatigue.

Dedicated Equipment as a Core Component of BORP

BORP is not solely a staffing model; it is a system-level capability supported by dedicated resources. With funding support from the Ministry of Health and Welfare, Far Eastern Memorial Hospital has established exclusive BORP equipment sets, including trauma surgical instrument kits, hemorrhage control and fixation devices, surgical lighting, power saws, and essential surgical and anesthesia supplies. These resources are not shared with routine surgical services, preventing competition for equipment during emergencies.

All BORP equipment is managed through an electronic tracking system that monitors expiration dates, sterilization status, and replenishment processes. This ensures that equipment is immediately deployable when needed—not merely listed on paper.

Emphasizing Training, Team-Based Coordination, and Advanced Trauma Capability

Effective disaster response depends not only on individual technical expertise, but on system performance under pressure. Training within BORP therefore places strong emphasis on team-based coordination and the development of advanced trauma capability.

Team training is structured around trauma resource management (TRM) principles, focusing on clear role definition, closed-loop communication, and mutual support in environments where time, manpower, and resources are limited. Through competency-based courses, scenario-driven simulations, and field exercises—including training conducted in non-conventional spaces such as underground parking areas—participants learn to maintain shared situational awareness and coordinated action under high stress.

In parallel, Far Eastern Memorial Hospital places strong emphasis on the long-term development of physicians’ advanced trauma surgical skills. Surgeons involved in BORP are systematically supported to complete internationally recognized training programs such as ASSET (Advanced Surgical Skills for Exposure in Trauma) and DSTC (Definitive Surgical Trauma Care). These programs focus on life-saving operative techniques, rapid hemorrhage control, and critical surgical decision-making—competencies essential for disaster settings and austere surgical environments.

By integrating team-based coordination with advanced trauma expertise, BORP represents not merely a policy framework, but a deployable surgical capability—one that can adapt to compromised infrastructure while maintaining patient safety and clinical effectiveness.

An Investment in Life

The Backup Surgical Room Project (BORP) represents Far Eastern Memorial Hospital’s long-term commitment to public safety. This initiative is not simply an investment in equipment or manpower, but a deliberate choice to invest in the capacity to save lives at critical moments.

Looking ahead, the hospital will continue to integrate BORP with its emergency response systems, including the Doctor-in-Car (physician-staffed rapid response vehicle). This allows physicians to assess injuries earlier at the scene, initiate clinical decision-making sooner, and activate in-hospital surgical resources in advance—reducing the time from injury to definitive trauma care.

In an era defined by uncertainty, Far Eastern Memorial Hospital stands firm as a critical pillar of emergency and disaster care. Through the Backup Surgical Room Project (BORP), the hospital ensures that when people need help the most, surgical capability remains available—protecting every precious life.

Author Information

Hu-Lin Christina Wang, MD, MSc
Ward Director, Division of Trauma, Far Eastern Memorial Hospital
Executive Lead, Backup Surgical Room Project (BORP)
Deputy Secretary General, Formosa Association for the Surgery of Trauma (FAST)
Joint Lecturer, Yuan Ze University, Department of Computer Science and Engineering

Picture 1： Triage and assessment of wounded patients during BORP drill

Picture 2:  Damage control surgery in a medical tent set up during BORP drill

Picture 3： Postoperative care during BORP drill