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Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement Online Only ArticlesSurge Capacity Logistics: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement
Section snippets
Stockpiling of Equipment, Supplies, and Pharmaceuticals
1. We suggest hospital support services, including pharmacy, laboratory, radiology, respiratory therapy, and nutrition services, also be included in the planning of critical care surge.
2. We suggest equipment, supplies, and pharmaceutical stockpiles specific to the delivery of mass critical care (MCC) be interoperable and compatible at the regional level and ideally at the state/provincial level, so as to ensure uniformity of response capabilities, coordinated training, and a mechanism for
Materials and Methods
The Surge Capacity topic group met in June 2012 and developed 23 key questions focused on the following domains: systems issues; equipment, supplies, and pharmaceuticals; staffing; and informatics. Four literature searches were conducted to identify studies upon which evidence-based recommendations could be made. Searches were limited to between January 1995 and October 2012; English-language articles were included and non-English-language articles excluded (e-Appendix 1). A total of 1,440
Stockpiling of Equipment, Supplies, and Pharmaceuticals
1. We suggest hospital support services, including pharmacy, laboratory, radiology, respiratory therapy, and nutrition services, also be included in the planning of critical care surge.
2. We suggest equipment, supplies, and pharmaceutical stockpiles specific to the delivery of MCC be interoperable and compatible at the regional level, and ideally at the state/provincial level, so as to ensure uniformity of response capabilities, coordinated training, and a mechanism for exchange of material
Areas for Research
Demographic data of critical care requirements based on the overall population served, specific caseloads, and ICU cases and needs over time is an area that needs to be explored. Methodological assessment of achieved vs required surge would rely on standard ICU management report forms and data forms per patient. At the ICU management and institutional levels, forms based on the framework proposed for critical incident reporting could be used to study the events post hoc.108 For the individual
Conclusions
The critical care response to a disaster is more prolonged than the response in other sections of the hospital, which necessitates preplanning and training for staff augmentation and redistribution of resources. The limits of effective nurse-to-critical patient ratios in a disaster setting have yet to be elucidated, but lower ratios are clearly beneficial. Critical care physician oversight is crucial whether through direct or long-distance consult (eg, telemetry, telephone), particularly, but
Acknowledgments
Author contributions: S. E. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. S. E., J. L. H., D. H., B. L. E., E. S. T., R. D. B., R. K. K., N. K., J. R. D., A. V. D. and M. D. C. contributed to the development of PICO questions; S. E., J. L. H., D. H., B. L. E., E. S. T., R. D. B., and R. K. K. conducted the literature review; S. E., J. L. H., D. H., B. L. E., E. S. T., R. D. B., R. K. K., N. K., J. R.
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FUNDING/SUPPORT: This publication was supported by the Cooperative Agreement Number 1U90TP00591-01 from the Centers of Disease Control and Prevention, and through a research sub award agreement through the Department of Health and Human Services [Grant 1 - HFPEP070013-01-00] from the Office of Preparedness of Emergency Operations. In addition, this publication was supported by a grant from the University of California–Davis.
COI grids reflecting the conflicts of interest that were current as of the date of the conference and voting are posted in the online supplementary materials.
DISCLAIMER: American College of Chest Physicians guidelines and consensus statements are intended for general information only, are not medical advice, and do not replace professional care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this consensus statement can be accessed at http://dx.doi.org/10.1378/chest.1464S1.
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