WEDNESDAY, May 7 (HealthDay News) -- A series of papers in a supplement to the May issue of the journal Chest offers guidance for health authorities to respond to disasters in which hundreds or thousands of individuals require critical care. Though created with a flu pandemic in mind, the suggestions -- prepared by the Task Force for Mass Critical Care -- are intended to apply to other events creating surges in critically ill patients.
Factors that are likely to limit the number of victims who can receive critical medical interventions include shortages of staff (with poorly prepared physicians and potential staff absenteeism), medical supplies (such as ventilators and oxygen supplies), and treatment space (expanding into non-critical-care areas in hospital areas faces limitations). In another paper, the Task Force lays out components for emergency mass critical care (EMCC), which should include mechanical ventilation, IV fluid resuscitation, vasopressor administration, medications such as antimicrobials and antidotes, and sedation and analgesia.
In terms of rationing scarce critical-care resources, another paper's recommendations include an equitable triage process that includes use of the Sequential Organ Failure Assessment score; legal and ethical rationale supporting the allocation of resources; and a process for revising the triage plans for future use. Finally, another article offers another set of recommendations, including a mechanical ventilator for each EMCC patient, and a system of care locations expanding from ICUs, post-anesthesia care units, and emergency departments to step-down units, telemetry units and hospital wards.
"We must be prepared to implement surge strategies based on contemporary knowledge, experience and expert opinion," Lewis Rubinson, M.D., Ph.D., of the University of Washington in Seattle, and colleagues conclude.
Rubinson disclosed financial relationships with the U.S. Centers for Disease Control and Prevention.
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