Definitive Care for the Critically Ill During a Disaster: Medical Resources for Surge Capacity: From a Task Force for Mass Critical Care Summit Meeting, January 26–27, 2007, Chicago, IL
University of Washington, Harborview Medical Center, Campus Box 359762, 325 Ninth Ave, Seattle, WA 98104, USA. Chest
(Impact Factor: 7.48).
05/2008; 133(5 Suppl):32S-50S. DOI: 10.1378/chest.07-2691
Mass numbers of critically ill disaster victims will stress the abilities of health-care systems to maintain usual critical care services for all in need. To enhance the number of patients who can receive life-sustaining interventions, the Task Force on Mass Critical Care (hereafter termed the Task Force) has suggested a framework for providing limited, essential critical care, termed emergency mass critical care (EMCC). This article suggests medical equipment, concepts to expand treatment spaces, and staffing models for EMCC.
Consensus suggestions for EMCC were derived from published clinical practice guidelines and medical resource utilization data for the everyday critical care conditions that are anticipated to predominate during mass critical care events. When necessary, expert opinion was used. TASK FORCE MAJOR SUGGESTIONS: The Task Force makes the following suggestions: (1) one mechanical ventilator that meets specific characteristics, as well as a set of consumable and durable medical equipment, should be provided for each EMCC patient; (2) EMCC should be provided in hospitals or similarly equipped structures; after ICUs, postanesthesia care units, and emergency departments all reach capacity, hospital locations should be repurposed for EMCC in the following order: (A) step-down units and large procedure suites, (B) telemetry units, and (C) hospital wards; and (3) hospitals can extend the provision of critical care using non-critical care personnel via a deliberate model of delegation to match staff competencies with patient needs.
By using the Task Force suggestions for adequate supplies of medical equipment, appropriate treatment space, and trained staff, communities may better prepare to deliver augmented essential critical care in response to disasters.
Available from: Randy D. Kearns
- "The emergence of a novel H5N1 influenza virus that was particularly deadly, without a proven vaccination compounded the anxiety. These real world events served as the impetus for a 2007 series of meetings focused on how to leverage staff, equipment, and treatment areas to assure emergency mass critical care (EMCC) was available for patients in a medical surge (10). "
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ABSTRACT: Disasters which include countless killed and many more injured, have occurred throughout recorded history. Many of the same reports of disaster also include numerous accounts of individuals attempting to rescue those in great peril and render aid to the injured and infirmed. The purpose of this paper is to briefly discuss the transition through several periods of time with managing a surge of many patients. This review will focus on the triggering event, injury and illness, location where the care is provided and specifically discuss where the science is today.
Available from: Nicholas E Kman
- "While much of our knowledge regarding medical support for natural disasters comes from earthquake support and the general military experience, there have been recent experiences with hurricanes Andrew, Katrina, tropical storms (such as Allison in Texas), and various tornados which have added to our knowledge of WD medical support. National taskforces have come together and produced recommendations for mass disasters, but much of these supportive recommendations have been in response to the potential of bioterrorism or viral/influenza pandemics. "
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ABSTRACT: Wind disasters are responsible for tremendous physical destruction, injury, loss of life and economic damage. In this review, we discuss disaster preparedness and effective medical response to wind disasters. The epidemiology of disease and injury patterns observed in the early and late phases of wind disasters are reviewed. The authors highlight the importance of advance planning and adequate preparation as well as prompt and well-organized response to potential damage involving healthcare infrastructure and the associated consequences to the medical response system. Ways to minimize both the extent of infrastructure damage and its effects on the healthcare system are discussed, focusing on lessons learned from recent major wind disasters around the globe. Finally, aspects of healthcare delivery in disaster zones are reviewed.
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To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on manpower.
Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including manpower.
Key recommendations include: (1) plan to access, coordinate and increase labor resources for continued and expanded ICU care including increasing critical care specialists and expanded practice for non-critical care personnel; (2) develop an education, awareness, preparation and communication program to ensure a well-protected and prepared workforce with coordinated rapid manpower expansion; (3) maintain a central inventory of all clinical and non-clinical staff with their current roles along with possible emergency re-training possibilities; (4) coordinate all clinical and non-clinical staffing requirements and determine the hospital’s daily needs including a sick and no-show list together with ICU requirements; (5) provide clinical care to patients only with clinical staff and not with non-clinical staff; (6) delegate duties not within the scope of workers’ practice under crisis conditions with proper supervision and support from experienced clinicians to ensure patient safety; (7) intensivists should supervise nonintensivist physicians to expand the workforce if patient surge exceeds the number of available ICU-trained specialists.
Judicious planning and adoption of protocols for providing adequate manpower are necessary to optimize outcomes during a pandemic.
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