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Category Archives: Care

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

Care of the Critically ill and Injured During Pandemics and Disasters: ConclusionPolitical careers have failed and governments have fallen when response to a disaster has been inadequate. If one resource is limited with adverse patient outcomes in one region while it is freely available in another region, patient care will be grossly inequitable. Despite excellent care delivery in these settings, population mistrust of health-care providers will occur and the high-quality response of front-line critical care providers will be greatly undermined. This mistrust will herald a larger collapse of the health system and eventually of the community. These principles are currently prevalent in West Africa, where the health-care community is seen as the source of the Ebola spread, and governments and health-care institutions are deemed inept, ineffectual, and a hindrance to good care. Thus, patients avoid the health-care system, further carrying and spreading disease. The effort of the Task Force to address inequity during disaster response, from resource allocation triage to care of special, vulnerable populations, is a massive step toward correcting these inequities at times of greatest stress on the health-care system.
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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
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Care of the Critically ill and Injured During Pandemics and Disasters: High-Quality Care

Care of the Critically ill and Injured During Pandemics and Disasters: High-Quality CareWith a strong foundation of patient care established, health-care providers for the critically ill need additional support to ensure adequate, high-quality care. As disasters evolve, treatments may change, thus requiring rapid education of providers. When resources are scarce, staff may need to triage those limited resources among many patients, therefore requiring an ethical system to determine resource use. An ICU subspecialist, such as a burn surgeon, may have a limited ability to cover large geographic areas. The Task Force suggestions place a particular emphasis on the use of technology and telemedicine, particularly surrounding an expanded scope of practice in some specialist-limited areas (eg, burns and trauma). Baseline education and just-in-time training, along with mental health support during difficult decision-making, is also designed to allow providers to deliver the best care without the impact larger resource decisions would have. With these suggestions, the health-care worker will be fully supported to deliver the best care possible at the bedside, with a structured framework for triage and clinical decision support, specialist support, and just-in-time education for difficult-to-treat illnesses. buy zoloft online
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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.
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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
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