This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rubinson, L. Articles by Geiling, J. A. Search for Related Content PubMed PubMed Citation Articles by Rubinson, L. Articles by Geiling, J. A.

Definitive Care for the Critically Ill During a Disaster: A Framework for Optimizing Critical Care Surge Capacity

From a Task Force for Mass Critical Care Summit Meeting, January 26–27, 2007, Chicago, IL

Lewis Rubinson, MD, PhD; John L. Hick, MD; Dan G. Hanfling, MD; Asha V. Devereaux, MD, MPH, FCCP; Jeffrey R. Dichter, MD; Michael D. Christian, MD; Daniel Talmor, MD, MPH, FCCP; Justine Medina, RN, MS; J. Randall Curtis, MD, MPH, FCCP and James A. Geiling, MD, FCCP

^* From the University of Washington (Dr. Rubinson), Seattle, WA; Hennepin County Medical Center (Dr. Hick), Minneapolis, MN; Inova Fairfax Hospital (Dr. Hanfling), Falls Church, VA; Sharp Coronado Hospital (Dr. Devereaux), Coronado, CA; Presbyterian Hospital (Dr. Dichter), Albuquerque, NM; Mount Sinai Hospital/University Health Network (Dr. Christian), Toronto, ON, Canada; Beth Israel Deaconess Medical Center (Dr. Talmor), Boston, MA; American Association of Critical Care Nurses (J. Medina), Aliso Viejo, CA; Harbor View Medical Center (Dr. Curtis), Seattle, WA; White River Junction VA Medical Center and Dartmouth Medical School (Dr. Geiling), Hanover NH. A list of Task Force members is given in the ^Appendix.

Correspondence to: Lewis Rubinson, MD, PhD, University of Washington, Harborview Medical Center, Campus Box 359762, 325 Ninth Ave, Seattle, WA 98104; e-mail: rubinson{at}u.washington.edu

Background: Plausible disasters may yield hundreds or thousands of critically ill victims. However, most countries, including those with widely available critical care services, lack sufficient specialized staff, medical equipment, and ICU space to provide timely, usual critical care for a large influx of additional patients. Shifting critical care disaster preparedness efforts to augment limited, essential critical care (emergency mass critical care [EMCC]), rather than to marginally increase unrestricted, individual-focused critical care may provide many additional people with access to life-sustaining interventions. In 2007, in response to the increasing concern over a severe influenza pandemic, the Task Force on Mass Critical Care (hereafter called the Task Force) convened to suggest the essential critical care therapeutics and interventions for EMCC.

Task Force suggestions: EMCC should include the following: (1) mechanical ventilation, (2) IV fluid resuscitation, (3) vasopressor administration, (4) medication administration for specific disease states (eg, antimicrobials and antidotes), (5) sedation and analgesia, and (6) select practices to reduce adverse consequences of critical illness and critical care delivery. Also, all hospitals with ICUs should prepare to deliver EMCC for a daily critical care census at three times their usual ICU capacity for up to 10 days.

Discussion: By using the Task Force suggestions for EMCC, communities may better prepare to deliver augmented critical care in response to disasters. In light of current mass critical care data limitations, the Task Force suggestions were developed to guide preparedness but are not intended as strict policy mandates. Additional research is required to evaluate EMCC and revise the strategy as warranted.

Key Words: critical care surge capacity • disaster medicine • influenza pandemic • mass casualty medical care • medical surge capacity