Triage: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement.

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Triage: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement.

Chest. 2014 Aug 21;

Authors: Christian MD, Sprung CL, King MA, Dichter JR, Kissoon N, Devereaux AV, Gomersall CD

Abstract
ABSTRACT: Background:Disasters and pandemics can result in large numbers of critically ill or injured patients that may overwhelm available resources despite implementing surge response strategies. If this occurs, critical care triage, which includes both prioritizing patients for care and rationing scarce resources, will be required. 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 triage work group reviewed previous task force suggestions and the literature to identify 17 key questions for which specific literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process. Suggestions from the previous task force that were not being updated were also included for validation by the expert panel. Results:The suggestions from the task force outline the key principles upon which critical care triage should be based as well as a path for the development of the plans, processes, and infrastructure required. This chapter provides eleven suggestions regarding the principles upon which critical care triage should be based and policies to guide critical care triage. Conclusions:Ethical and efficient critical care triage is a complex process that requires significant planning and preparation. At present, the prognostic tools required to produce an effective decision support system (triage protocol) as well as the infrastructure, processes, legal protections, and training are largely lacking in most jurisdictions. Therefore, critical care triage should be a last resort after mass critical care surge strategies.
Background: Disasters and pandemics can result in large numbers of critically ill or injured patients that may overwhelm available resources despite implementing surge response strategies. If this occurs, critical care triage, which includes both prioritizing patients for care and rationing scarce resources, will be required. 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 triage work group reviewed previous task force suggestions and the literature to identify 17 key questions for which specific literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process. Suggestions from the previous task force that were not being updated were also included for validation by the expert panel.
Results: The suggestions from the task force outline the key principles upon which critical care triage should be based as well as a path for the development of the plans, processes, and infrastructure required. This chapter provides eleven suggestions regarding the principles upon which critical care triage should be based and policies to guide critical care triage.
Conclusions: Ethical and efficient critical care triage is a complex process that requires significant planning and preparation. At present, the prognostic tools required to produce an effective decision support system (triage protocol) as well as the infrastructure, processes, legal protections, and training are largely lacking in most jurisdictions. Therefore, critical care triage should be a last resort after mass critical care surge strategies.

PMID: 25144591 [PubMed - as supplied by publisher]

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