Medicine of the Future in America

Care of the Critically ill and Injured During Pandemics and Disasters

Care of the Critically ill and Injured During Pandemics and DisastersThe critically ill are a unique group of patients in a disaster response setting because they require resourceintensive care, advanced and costly therapies, and specialized settings and providers to deliver this care. They can present as a sudden surge of patients over a short period of time, pushing the limits of the healthcare facility, or they can present over a sustained period of time, such as was the case of the 2009 influenza A(H1N1) pandemic, straining the larger regional health system. In many disasters, such as the London bombings, the critically ill can present as both an immediate surge and as a sustained intensive response, thus presenting varying response needs throughout the disaster. This variability with the most critically ill creates uncertainty in health-care response because local, regional, and national health-care systems may have resource limitations, a paucity of medical expertise, and structural compromise of health-care clinics and hospitals at any given moment. The current Ebola outbreak in West Africa best highlights the difficulties surrounding critically ill patients in a very resource-limited environment. However, regardless of the type of disaster and the extent of the critically ill, planning for this uncertainty in mass critical care is paramount to ensuring good patient outcomes. generic zoloft
In 2008, the American College of Chest Physicians (CHEST) Task Force for Mass Critical Care published a series of suggestions with the aim of providing resource, logistic, and patient-flow planning for mass critical care in a disaster. Since the release of these documents, disasters and pandemics, most notably the 2009 influenza A(H1N1) pandemic the Haiti earthquake, and most recently the Ebola outbreak in West Africa, have provided additional learning experiences in mass critical care. Because the 2008 documents were limited in scope, without discussion of pediatrics, trauma, critical care in the developing world, and subspecialty critical care, the Task Force for Mass Critical Care was reconvened to provide a rigorously developed set of suggestions with an expanded scope and expertise to support critical care providers, hospital administrators, public health officials, and government planners. The result, published in CHEST, is an unparalleled, detailed series of 14 articles that lays the strongest foundation for disaster planning and response to date.

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