Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic or mass disaster

Abstract

Purpose: To provide recommendations and standard operating procedures for intensive care units and hospital preparedness for an influenza pandemic.

Methods: Based on a literature review and expert opinion, a Delphi process was used to define the essential topics.

Results: Key recommendations include: Hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas. Hospitals should have appropriate beds and monitors for these expansion areas. Establish a management system with control groups at facility, local, regional and/or national levels to exercise authority over resources. Establish a system of communication, coordination and collaboration between the ICU and key interface departments. A plan to access, coordinate and increase labor resources is required with a central inventory of all clinical and non-clinical staff. Delegate duties not within the usual scope of workers' practice. Ensure that adequate essential medical equipment, pharmaceuticals and supplies are available. Protect patients and staff with infection control practices and supporting occupational health policies. Maintain staff confidence with reassurance plans for legal protection and assistance. Have objective, ethical, transparent triage criteria that are applied equitably and publically disclosed. ICU triage of patients should be based on the likelihood for patients to benefit most or a 'first come, first served' basis. Develop protocols for safe performance of high-risk procedures. Train and educate staff.

Conclusions: Mortality, although inevitable during a severe influenza outbreak or disaster, can be reduced by adequate preparation.

Fig. 1

Schematic algorithm describing key lines of authority (command chain) and information flow (bi-directional) during a MCE/crisis. The Hospital Emergency Executive Control Group (HEECG) is the central operations center with “command and control” responsibility for the overall management of the crisis. It should consist of the hospital chief, heads of all major clinical and support departments, and key supply and logistic divisions. The Hospital EECG should determine whether to open new wards, re-deploy staff, suspend or redirect services (e.g., elective operations), prioritize the allocation of hospital supplies (including personal protective equipment), endorse triage policies, and formalize infection control and occupational health policies. The ICU EECG provides the Hospital EECG with information such as ICU functionality, capacity, projected staff and supply requirements, and preferred triage and discharge policies. The ICU EECG ensures that relevant policies agreed upon and endorsed by the HEECG are implemented within the ICU. It is made up of at least the ICU director, a deputy, the head nurse and deputy, and one or more triage officers. In the case of multiple ICUs in a hospital under different administrative authorities, each ICU should have an independent ICU EECG. An additional combined ICUEECG may be considered desirable. Other potentially important interfaces are shown

Fig. 2

Coordination with interface units: Dashed lines indicate the continuity of the lines of authority for triage from the CTC down through the IMS levels. Two-way communication should flow through this chain. This is not meant to indicate lines of command and control. The dashed and dotted lines indicate the direct data inputs that will flow between (bi-directional) the local triage officer and the CTC