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

Abstract

Background: 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.

Methods: 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.

Discussion: 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.

Figure 1.

Initial expansion of critical care treatment space during disasters. Hospital facilities are the preferred location for the provision of critical care during a disaster. Expanding available critical space therefore becomes a priority that requires the repurposing of current bed utilization. The least sick patients (pts) should be discharged or transferred to community care facilities. This has the downstream effect of permitting the movement of intermediate care/telemetry patients to general practice wards and critical care capabilities expanding into IMCU/telemetry space.

Figure 2.

Critical care expansion during sustained catastrophies will require further expansion of critical care capabilities. All remaining IMCU/telemetry patients (from Fig 1) still in the medical ICU will be transferred to general hospital wards. Most, if not all, lower-acuity patients on the wards will also now need to move out of the hospital. Critical care patients will now occupy most of the hospital, including some of the general hospital wards. See Figure 1 legend for expansion of abbreviations.