Neonatal and pediatric regionalized systems in pediatric emergency mass critical care
ABSTRACT Improved health outcomes are associated with neonatal and pediatric critical care in well-organized, cohesive, regionalized systems that are prepared to support and rehabilitate critically ill victims of a mass casualty event. However, present systems lack adequate surge capacity for neonatal and pediatric mass critical care. In this document, we outline the present reality and suggest alternative approaches.
In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations.Steering Committee members established subcommittees by topic area and performed literature reviews of MEDLINE and Ovid databases. The Steering Committee produced draft outlines through consensus-based study of the literature and convened October 6-7, 2009, in New York, NY, to review and revise each outline. Eight draft documents were subsequently developed from the revised outlines as well as through searches of MEDLINE updated through March 2010.The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. Feedback on each manuscript was compiled and the Steering Committee revised each document to reflect expert input in addition to the most current medical literature.
States and regions (facilitated by federal partners) should review current emergency operations and devise appropriate plans to address the population-based needs of infants and children in large-scale disasters. Action at the state, regional, and federal levels should address legal, operational, and information systems to provide effective pediatric mass critical care through: 1) predisaster/mass casualty planning, management, and assessment with input from child health professionals; 2) close cooperation, agreements, public-private partnerships, and unique delivery systems; and 3) use of existing public health data to assess pediatric populations at risk and to model graded response plans based on increasing patient volume and acuity.
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ABSTRACT: Background:Engagement and education of Intensive Care Unit (ICU) clinicians in disaster preparedness is fragmented by time constraints, institutional barriers and frequently occurs during a disaster.1 We reviewed the existing literature from 2007 to April 2013 and expert opinions concerning clinician engagement and education for critical care during a disaster or pandemic and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this chapter are important for all of those involved in a large-scale disaster or pandemic with multiple critically ill or injured patients including front line clinicians, hospital administrators, and public health or government officials. Methodology:A systematic literature review was performed and suggestions were formulated according to the American College of Chest Physicians' Consensus Statement development methodology. We assessed articles, documents, reports, and grey literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process. Results:Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: 1. Situational awareness, 2. Clinician roles and responsibilities, 3. Education, and 4. Community engagement. Together these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. Conclusions:The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a disaster or pandemic will require a departure from the routine independent systems operating in hospitals routinely. An effective response will require robust information systems, coordination between clinicians, hospitals, and governmental organizations, pre-event engagement of relevant stakeholders, and standardized core competencies for the education and training of critical care clinicians.Chest 08/2014; 146(4). DOI:10.1378/chest.14-0740 · 7.13 Impact Factor
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ABSTRACT: Background:This paper provides consensus suggestions for expanding critical care surge capacity and extension of critical care service capabilities in disaster or pandemics. It focuses on the principles and frameworks for expansion of intensive care services in hospitals in the developed world. A companion paper addresses surge logistics, those elements that provide the capability to deliver mass critical care in disaster events. [See Surge Capacity Logistics article in this supplement]. The suggestions in this chapter are important for all who are involved in large-scale disasters or pandemics with multiple critically ill or injured patients including front line clinicians, hospital administrators, and public health or government officials. Methods:The Surge Capacity panel developed 23 key questions focused on the following domains: systems issues; equipment, supplies and pharmaceuticals; staffing; and informatics. Literature searches were conducted to identify evidence on which to base key suggestions. Most reports were small-scale, observational, or used flawed modeling and hence the level of evidence on which to base recommendations was poor, therefore not permitting the development of evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process. Suggestions from the previous task force were also included for validation by the expert panel. Results:This paper presents 10 suggestions pertaining to the principles that should guide surge capacity and capability planning for mass critical care including: the role of critical care in disaster planning; the surge continuum; targets of surge response; situational awareness and information sharing; mitigating the impact on critical care; planning for the care of special populations; and service de-escalation (also considered as "engineered failure"). Conclusions:Future reports of critical care surge should emphasize population-based outcomes as well as logistical details. Planning should be based on the projected number of critically ill or injured patients resulting from specific scenarios. This should include consideration of ICU patient care requirements over time and must factor in resource constraints that may limit the ability to provide care. Standard ICU management forms and patient data forms to assess ICU surge capacity impacts should be created and utilized in disaster events.Chest 08/2014; 146(4). DOI:10.1378/chest.14-0733 · 7.13 Impact Factor
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ABSTRACT: The Great East Japan earthquake was one of the most devastating natural disasters ever to hit Japan. We present features of the disaster and the radioactive accident in Fukushima. About 19,000 are dead or remain missing mainly due to the tsunami, but children accounted for only 6.5 % of the deaths. The Japanese Society of Pediatric Surgeons set up the Committee of Aid for Disaster, and collaborated with the Japanese Society of Emergency Pediatrics to share information and provide pediatric medical care in the disaster area. Based on the lessons learned from the experiences, the role of pediatric surgeons and physicians in natural disasters is discussed.Pediatric Surgery International 08/2013; 29(10). DOI:10.1007/s00383-013-3405-6 · 1.06 Impact Factor