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Surge Capacity Principles: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement.
Chest. 2014 Aug 21;
Authors: Hick JL, Einav S, Hanfling D, Kissoon N, Dichter JR, Devereaux AV, Christian MD
Abstract
ABSTRACT: Background:This paper provides consensus suggestions for expanding critical care surge capacity and extension of critical care service capabilities in disaster or pandemics. It focuses on the principles and frameworks for expansion of intensive care services in hospitals in the developed world. A companion paper addresses surge logistics, those elements that provide the capability to deliver mass critical care in disaster events. [See Surge Capacity Logistics article in this supplement]. The suggestions in this chapter are important for all who are involved in large-scale disasters or pandemics with multiple critically ill or injured patients including front line clinicians, hospital administrators, and public health or government officials. Methods:The Surge Capacity panel developed 23 key questions focused on the following domains: systems issues; equipment, supplies and pharmaceuticals; staffing; and informatics. Literature searches were conducted to identify evidence on which to base key suggestions. Most reports were small-scale, observational, or used flawed modeling and hence the level of evidence on which to base recommendations was poor, therefore not permitting the development of evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process. Suggestions from the previous task force were also included for validation by the expert panel. Results:This paper presents 10 suggestions pertaining to the principles that should guide surge capacity and capability planning for mass critical care including: the role of critical care in disaster planning; the surge continuum; targets of surge response; situational awareness and information sharing; mitigating the impact on critical care; planning for the care of special populations; and service de-escalation (also considered as "engineered failure"). Conclusions:Future reports of critical care surge should emphasize population-based outcomes as well as logistical details. Planning should be based on the projected number of critically ill or injured patients resulting from specific scenarios. This should include consideration of ICU patient care requirements over time and must factor in resource constraints that may limit the ability to provide care. Standard ICU management forms and patient data forms to assess ICU surge capacity impacts should be created and utilized in disaster events.
Background: This paper provides consensus suggestions for expanding critical care surge capacity and extension of critical care service capabilities in disaster or pandemics. It focuses on the principles and frameworks for expansion of intensive care services in hospitals in the developed world. A companion paper addresses surge logistics, those elements that provide the capability to deliver mass critical care in disaster events. [See Surge Capacity Logistics article in this supplement]. The suggestions in this chapter are important for all who are involved in large-scale disasters or pandemics with multiple critically ill or injured patients including front line clinicians, hospital administrators, and public health or government officials.
Methods: The Surge Capacity panel developed 23 key questions focused on the following domains: systems issues; equipment, supplies and pharmaceuticals; staffing; and informatics. Literature searches were conducted to identify evidence on which to base key suggestions. Most reports were small-scale, observational, or used flawed modeling and hence the level of evidence on which to base recommendations was poor, therefore not permitting the development of evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process. Suggestions from the previous task force were also included for validation by the expert panel.
Results: This paper presents 10 suggestions pertaining to the principles that should guide surge capacity and capability planning for mass critical care including: the role of critical care in disaster planning; the surge continuum; targets of surge response; situational awareness and information sharing; mitigating the impact on critical care; planning for the care of special populations; and service de-escalation (also considered as "engineered failure").
Conclusions: Future reports of critical care surge should emphasize population-based outcomes as well as logistical details. Planning should be based on the projected number of critically ill or injured patients resulting from specific scenarios. This should include consideration of ICU patient care requirements over time and must factor in resource constraints that may limit the ability to provide care. Standard ICU management forms and patient data forms to assess ICU surge capacity impacts should be created and utilized in disaster events.
PMID: 25144334 [PubMed - as supplied by publisher]