Arizona Surge Line: An emergent statewide COVID-19 transfer service with equity as an outcome

Lisa Villarroel, Erin Tams, Luke Smith, Jessica Rigler, Dena Wilson, Chengcheng Hu, Marilyn K. Glassberg

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Introduction: The Arizona Surge Line was an emergent initiative during the COVID-19 pandemic to facilitate COVID-19 patient transfers and load-level hospitals on a statewide level. It was designed and implemented by the Arizona Department of Health Services in preparation for the first hospital surge due to COVID-19, recognizing the disproportionate impact that hospital surge would have on rural and tribal populations. Methods: We analyzed the Arizona Surge Line transfer data for the state's first two COVID-19 surges (4/16/2020–3/6/2021). Transfer data included transfer request characteristics, patient demographics and participating hospital characteristics. When applicable, we compared this data with Arizona census data, COVID-19 case data, and the CDC/ATSDR Social Vulnerability Index. The primary outcomes studied were the proportion of COVID-19 patient requests being successfully transferred, the median transfer time, and the proportion of vulnerable populations impacted. Results: During the period of study, 160 hospitals in Arizona made 6,732 requests for transfer of COVID-19 patients. The majority of these patients (84%, 95% CI: 83–85%) were placed successfully with a median transfer time of 59 min (inter-quartile range 33–116). Of all transfer requests, 58% originated from rural hospitals, 53% were for patients of American Indian/Alaska Native ethnicity, and 73% of patients originated from highly vulnerable areas. The majority (98%) of receiving facilities were in urban areas. The Arizona Surge Line matched the number of transfers with licensed market shares during the period of study. Conclusions: The Arizona Surge Line is an equity-enhancing initiative that disproportionately benefited vulnerable populations. This statewide transfer infrastructure could become a standard public health mechanism to manage hospital surges and enhance access to care during a health emergency.

Original languageEnglish (US)
Article number1028353
JournalFrontiers in Public Health
StatePublished - Jan 25 2023


  • access to care
  • equity
  • load-leveling
  • surge
  • transfer center

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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