Objective To explore the paths of driving factor combinations leading to the emergence of medical surge scenarios in the future crisis environment of "disease X" outbreak, thus providing references for enhancing the overall resilience of the medical and health service system.

Methods From July to September 2024, 144 members of front-line medical staff in Heilongjiang province who had participated in the prevention and control of the COVID-19 epidemic were selected through the Questionnaire Star platform by the purposive sampling method. Seven variables–the transmission capacity of the infectious disease, the pathogenicity of pathogens, the immunity of residents, the number of medical staff, the reserve of emergency materials, the frequency of emergency rescue and skill training, and the effectiveness of patient triage and referral mechanisms–were selected based on the public safety triangle theoretical model. The fuzzy-set qualitative comparative analysis was performed to explore the configuration path.

Results The results of necessity analysis showed that the consistency of the transmission capacity of the infectious disease, pathogenicity of pathogens, the immunity of residents, the number of medical staff, the reserve of emergency materials, the frequency of emergency rescue and skill training, and the effectiveness of patient triage and referral mechanisms were 0.546, 0.578, 0.485, 0.562, 0.491, 0.530, and 0.563, respectively (all < 0.9). There were no necessary conditions for a medical surge scenario in a future crisis environment of "disease X" outbreak. The conditional configuration analysis produced a total of 5 paths and 2 configurations, i.e., the weak epidemic-low bearing-weak response interweave driving surge type and the strong epidemic surge type with relatively sufficient preparation, with the overall consistency of 0.886 and the overall coverage of 0.532.

Conclusions The occurrence of medical surge scenarios is the result of a combination of complex factors, and medical institutions must improve their response capabilities in all aspects such as personnel reserve and allocation, triage and referral, and material reserve.