We qualitatively examined the impact of the permanent closure of St. Vincent's Hospital in New York City on the remaining hospitals in the area and analyzed how these hospitals responded to this event. We conducted a descriptive survey consisting of interviews with clinical (n = 24) and administrative (n = 11) staff from 4 hospitals in lower Manhattan after the sudden closure of St. Vincent's Hospital. These hospitals experienced a sudden and sustained increase in patient volume. Each was faced with specific constraints (eg, finances, physical plant, bureaucracy), but they developed similar strategic responses. Generally applicable principles included: soliciting innovative ideas from clinical staff, reexamining previous proposals to improve efficiency, fast-tracking stalled capacity-building projects, and focusing on improving patient care and flow. Three broad tactical themes were apparent: increases in staff and staff hours, use of alternative sites of care, and implementing novel ways of operating. The impact on hospital operations resulting from the closure of St. Vincent's Hospital is a surrogate medical surge event and met thresholds for activating emergency operations plans. Novel operating methods used in response to this surge event offer practical and broadly applicable principles that might improve medical surge management in other hospitals.