On 11 June 2009 the World Health Organization raised the pandemic alert level to Phase 6 and declared that a global pandemic was underway. The causative pathogen, an H1N1 influenza A virus, was a triple-reassortant combination of swine, avian and human influenza that initially appeared in Mexico earlier that year (Cao et al, 2009). In April 2009, the first US cases of H1N1 were confirmed by the Centers for Disease Control and Prevention (CDC) (Jain et al, 2009). Since then, many more clinical cases have been reported to the CDC and to public health authorities.
[Show abstract][Hide abstract] ABSTRACT: Natural disasters, industrial accidents, terrorism attacks, and pandemics all have the capacity to result in large numbers of critically ill or injured patients. This supplement provides suggestions for all of those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administrators, professional societies, and public health or government officials. The current Task Force included a total of 100 participants from nine countries, comprised of clinicians and experts from a wide variety of disciplines. Comprehensive literature searches were conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert-opinion-based suggestions that are presented in this supplement using a modified Delphi process. The ultimate aim of the supplement is to expand the focus beyond the walls of ICUs to provide recommendations for the management of all critically ill or injured adults and children resulting from a pandemic or disaster wherever that care may be provided. Considerations for the management of critically ill patients include clinical priorities and logistics (supplies, evacuation, and triage) as well as the key enablers (systems planning, business continuity, legal framework, and ethical considerations) that facilitate the provision of this care. The supplement also aims to illustrate how the concepts of mass critical care are integrated across the spectrum of surge events from conventional through contingency to crisis standards of care.
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