Care of the Critically Ill and Injured During Pandemics and Disasters

Groundbreaking Results from the Task Force on Mass Critical Care
  • Christian E. Sandrock
    Correspondence
    Intensive Care Unit, Division of Pulmonary and Critical Care, Division of Infectious Diseases, University of California, Davis School of Medicine, 4150 V St #3400, Sacramento, CA 95817
    Affiliations
    Intensive Care Unit, Division of Pulmonary and Critical Care, Division of Infectious Diseases, University of California, Davis School of Medicine, Sacramento, CA
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      The critically ill are a unique group of patients in a disaster response setting because they require resource-intensive care, advanced and costly therapies, and specialized settings and providers to deliver this care.
      • Devereaux A
      • Christian MD
      • Dichter JR
      • Geiling JA
      • Rubinson L
      Task Force for Mass Critical Care. Summary of suggestions from the Task Force for Mass Critical Care summit, January 26-27, 2007.
      • Hick JL
      • Christian MD
      • Sprung CL
      European Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.
      They can present as a sudden surge of patients over a short period of time, pushing the limits of the health-care facility, or they can present over a sustained period of time, such as was the case of the 2009 influenza A(H1N1) pandemic, straining the larger regional health system. In many disasters, such as the London bombings, the critically ill can present as both an immediate surge and as a sustained intensive response, thus presenting varying response needs throughout the disaster.
      • Hick JL
      • Christian MD
      • Sprung CL
      European Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.
      • Aylwin CJ
      • König TC
      • Brennan NW
      • et al.
      Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005.
      This variability with the most critically ill creates uncertainty in health-care response because local, regional, and national health-care systems may have resource limitations, a paucity of medical expertise, and structural compromise of health-care clinics and hospitals at any given moment. The current Ebola outbreak in West Africa best highlights the difficulties surrounding critically ill patients in a very resource-limited environment. However, regardless of the type of disaster and the extent of the critically ill, planning for this uncertainty in mass critical care is paramount to ensuring good patient outcomes.
      • Aylwin CJ
      • König TC
      • Brennan NW
      • et al.
      Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005.
      • Gabriel LE
      • Webb SA
      Preparing ICUs for pandemics.
      • Westall GP
      • Paraskeva M
      H1N1 influenza: critical care aspects.
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      References

        • Devereaux A
        • Christian MD
        • Dichter JR
        • Geiling JA
        • Rubinson L
        Task Force for Mass Critical Care. Summary of suggestions from the Task Force for Mass Critical Care summit, January 26-27, 2007.
        Chest. 2008; 133: 1S-7S
        • Hick JL
        • Christian MD
        • Sprung CL
        European Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.
        Intensive Care Med. 2010; 36: S11-S20
        • Aylwin CJ
        • König TC
        • Brennan NW
        • et al.
        Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005.
        Lancet. 2006; 368: 2219-2225
        • Gabriel LE
        • Webb SA
        Preparing ICUs for pandemics.
        Curr Opin Crit Care. 2013; 19: 467-473
        • Westall GP
        • Paraskeva M
        H1N1 influenza: critical care aspects.
        Semin Respir Crit Care Med. 2011; 32: 400-408
        • White DB
        • Angus DC
        Preparing for the sickest patients with 2009 influenza A(H1N1).
        JAMA. 2009; 302: 1905-1906
        • Dulski TM
        • Basavaraju SV
        • Hotz GA
        • et al.
        Factors associated with inpatient mortality in a field hospital following the Haiti earthquake, January-May 2010.
        Am J Disaster Med. 2011; 6: 275-284
        • Christian MD
        • Devereaux AV
        • Dichter JR
        • Rubinson L
        • Kissoon N
        on behalf of the Task Force for Mass Critical Care. Introduction and executive summary: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.
        Chest. 2014; 146: 8S-34S
        • Memoli MJ
        Pandemic research in the ICU: always be prepared.
        Crit Care Med. 2013; 41: 1147-1148
        • Altevogt BM
        • Stroud C
        • Hanson SL
        • Hanfling D
        • Gostin LO
        Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations; Institute of Medicine. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report, Washington, DC.
        National Academy Press. 2009;
        • Moszynski P
        Death toll climbs and healthcare needs escalate in Japan.
        BMJ. 2011; 342: d1859
        • Raiter Y
        • Farfel A
        • Lehavi O
        • et al.
        Mass casualty incident management, triage, injury distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a suicide bomber attack in downtown Tel Aviv.
        Emerg Med J. 2008; 25: 225-229
        • Powell T
        • Hanfling D
        • Gostin LO
        Emergency preparedness and public health: the lessons of Hurricane Sandy.
        JAMA. 2012; 308: 2569-2570
        • Zack N
        Philosophy and disaster.
        Homeland Security Affairs. 2006; 2: 1-13
        • Rawls J
        >A Theory of Justice Rev. ed. Boston, MA.
        Belknap Press of Harvard University Press. 1999;