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Definitive Care for the Critically Ill During a Disaster: Medical Resources for 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; J. Randall Curtis, MD, MPH, FCCP; Richard D. Branson, MS, RRT; Suzi Burns, RN, MSN, RRT; Michael D. Christian, MD; Asha V. Devereaux, MD, MPH, FCCP; Jeffrey R. Dichter, MD; Daniel Talmor, MD, MPH, FCCP; Brian Erstad, PharmD; Justine Medina, RN, MS and James A. Geiling, MD, FCCP

^* From the University of Washington (Dr. Rubinson), Seattle, WA; Hennepin County Medical Center (Dr. Hick), Minneapolis, MN; Harbor View Medical Center (Dr. Curtis), Seattle, WA; University of Cincinnati (Mr. Branson), Cincinnati, OH; University of Virginia (Ms. Burns), Charlottesville, VA; Mount Sinai Hospital/University Health Network (Dr. Christian), Toronto, ON, Canada; Sharp Coronado Hospital (Dr. Devereaux), Coronado, CA; Presbyterian Hospital (Dr. Dichter), Albuquerque, NM; Beth Israel Deaconess Medical Center (Dr. Talmor), Boston, MA; University of Arizona (Dr. Erstad), Tucson, AZ; American Association of Critical Care Nurses (Ms. Medina), Aliso Viejo, CA; 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: Mass numbers of critically ill disaster victims will stress the abilities of health-care systems to maintain usual critical care services for all in need. To enhance the number of patients who can receive life-sustaining interventions, the Task Force on Mass Critical Care (hereafter termed the Task Force) has suggested a framework for providing limited, essential critical care, termed emergency mass critical care (EMCC). This article suggests medical equipment, concepts to expand treatment spaces, and staffing models for EMCC.

Methods: Consensus suggestions for EMCC were derived from published clinical practice guidelines and medical resource utilization data for the everyday critical care conditions that are anticipated to predominate during mass critical care events. When necessary, expert opinion was used.

Task Force major suggestions: The Task Force makes the following suggestions: (1) one mechanical ventilator that meets specific characteristics, as well as a set of consumable and durable medical equipment, should be provided for each EMCC patient; (2) EMCC should be provided in hospitals or similarly equipped structures; after ICUs, postanesthesia care units, and emergency departments all reach capacity, hospital locations should be repurposed for EMCC in the following order: (A) step-down units and large procedure suites, (B) telemetry units, and (C) hospital wards; and (3) hospitals can extend the provision of critical care using non-critical care personnel via a deliberate model of delegation to match staff competencies with patient needs.

Discussion: By using the Task Force suggestions for adequate supplies of medical equipment, appropriate treatment space, and trained staff, communities may better prepare to deliver augmented essential critical care in response to disasters.

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