Resource-poor settings: infrastructure and capacity building: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

Abstract

Background: Planning for mass critical care (MCC) in resource-poor or constrained settings has been largely ignored, despite their large populations that are prone to suffer disproportionately from natural disasters. Addressing MCC in these settings has the potential to help vast numbers of people and also to inform planning for better-resourced areas.

Methods: The Resource-Poor Settings panel developed five key question domains; defining the term resource poor and using the traditional phases of disaster (mitigation/preparedness/response/recovery), literature searches were conducted to identify evidence on which to answer the key questions in these areas. Given a lack of data upon which to develop evidence-based recommendations, expert-opinion suggestions were developed, and consensus was achieved using a modified Delphi process.

Results: The five key questions were then separated as follows: definition, infrastructure and capacity building, resources, response, and reconstitution/recovery of host nation critical care capabilities and research. Addressing these questions led the panel to offer 33 suggestions. Because of the large number of suggestions, the results have been separated into two sections: part 1, Infrastructure/Capacity in this article, and part 2, Response/Recovery/Research in the accompanying article.

Conclusions: Lack of, or presence of, rudimentary ICU resources and limited capacity to enhance services further challenge resource-poor and constrained settings. Hence, capacity building entails preventative strategies and strengthening of primary health services. Assistance from other countries and organizations is needed to mount a surge response. Moreover, planning should include when to disengage and how the host nation can provide capacity beyond the mass casualty care event.

Figure 1 -

Accurate numbers of critical care centers and services worldwide are unknown. Membership in the World Federation of Societies in Intensive and Critical Care Medicine is used as an extrapolation of possible services worldwide, with countries illustrated where membership Societies are fully developed (blue), those where existing membership is developing a professional Society (gray), and countries without Federation members (white). (Adapted with permission from World Federation of Societies of Intensive and Critical Care Medicine.)

Figure 2 -

A, Progression of care in developed countries leading from established community level public health and emergency services in support of both secondary and tertiary level critical care services. B, The reality of conditions in many resource-poor countries, where basic emergency and protective public health services are lacking or nonexistent. Where critical care services are available, they are limited primarily to urban academic medical centers. ACLS = Advanced Cardiac Life Support; APLS = Advanced Pediatric Life Support; ATLS = Advanced Trauma Life Support; PALS = Pediatric Advanced Life Support; PICU = pediatric ICU; WHO = World Health Organization.