Medicine of the Future in America

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

The ultimate aim of the Task Force was to provide recommendations for the management of all adults and children critically ill because of a disaster or pandemic, regardless of where the care is provided. However, in the case of disaster response, no high-quality evidence exists from which to develop recommendations. Disaster response is rapid, large scale, and nonstandardized, and thus, the ability to develop real-time studies is extremely difficult. Evidence, therefore, is largely restricted to retrospective case series, provider experience, and expert opinion. To bridge this gap, the Task Force convened an unprecedented group of experts, from bedside physicians with deployment experience to medical societies to government representatives, to offer the best suggestions. Using a modified Delphi process, the Task Force approached all aspects of care, from the bedside to policy development to provider education, in both a resource-intensive and a resource-limited setting (the developing world). Although the Task Force’s 14 articles span many areas, their suggestions cover five main levels of disaster response and planning: patient care, disaster providers and responders, health-care systems and hospitals, local and regional governments, and community and society.
High-quality care of the critically ill is the foundation of all disaster response efforts. However, a disaster alters basic care delivery to the critically ill, and if preparedness is inadequate, this foundation can crumble, with adverse patient outcomes. The inability to respond to an increase in patients and resource demand has been directly linked to poor outcomes in a number of disasters. Therefore, the management of medications, medical supplies, oxygen therapy, mechanical ventilation, specialized services (eg, dialysis), and ICU location is detailed extensively over these 14 articles. Methods of conservation (particularly with scarce medication and oxygen therapy), substitution, and triage are a particular focus, with the goal of optimizing patient outcomes in mass critical care. These principles are very relevant today, where the resource limitations in West Africa are hindering both patient care and outbreak management. For example, minimal ventilator requirements are described to ensure both lung-protective strategies and that high positive end-expiratory pressure can be delivered in cases of ARDS. Antibiotic and antiviral substitutions for certain disease states are suggested, along with the minimal resources needed to manage a highly contagious disease among the critically ill. With this process, the Task Force suggestions create the strongest foundation of care delivery for the individual critically ill patient during a mass critical care.

This entry was posted in Care and tagged critical care, critically ill patients, health care.
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