Medicine of the Future in America

Care of the Critically ill and Injured During Pandemics and Disasters: Discussion

In a disaster, the health-care system can deliver optimal critical care for a limited time, but eventually, regional and national governments must provide support. With mass critical care, the response system is stretched immediately, with resources, staffing, and patient flow impacted at the regional level. The suggestions of the Task Force, most notably the coordination of patient flow and resources, have not been described elsewhere in the literature or in other disaster planning documents. In a disaster, the traditional method of directly transferring a critically ill patient from a smaller, more remote hospital to a larger, tertiary center cannot occur independently of local and regional governments. If a tertiary center is impacted, public health and government officials must have the ability to triage patients and coordinate flow to a less impacted area. This process will require local and regional providers to understand the needs of mass critical care, including the ability to triage and recommend care substitutions, rather than to rely on local providers in the field to make these decisions. buy yasmin online
In addition, the Task Force outlines these issues in more resource-limited settings, such as the developing world and areas without government support (nongovernmental organizations). Thus, during a spectrum of response by a government and health-care system, the progression of triage from conventional to conservation and contingency to crisis care has been fully aligned with this work. The Task Force’s vision of a large, central coordination of patient flow, resources, and critical care expertise sets a high but necessary benchmark for public health and government officials.
However, the most important aspect of the Task Force’s suggestions concerns the community and society. A large-scale disaster can leave both small and large populations without structure and government, and in the absence of a planned and timely response, healthcare inequities can expand rapidly. These inequities can undermine any government or nongovernmental organization response, particularly within the populations most displaced and at risk, thus directly impacting patient outcomes. Perhaps the Task Force’s greatest contribution in these 14 manuscripts is when it discusses complex care delivery in an ethical and equal fashion to critically ill patients.

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