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Definitive Care for the Critically Ill During a Disaster: Current Capabilities and Limitations^*

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

Michael D. Christian, MD, FRCPC; Asha V. Devereaux, MD, MPH, FCCP; Jeffrey R. Dichter, MD; James A. Geiling, MD, FCCP and Lewis Rubinson, MD, PhD

^* From the Mount Sinai Hospital/University Health Network (Dr. Christian), Toronto, ON, Canada; Sharp Coronado Hospital (Dr. Devereaux), Coronado, CA; Presbyterian Hospital (Dr. Dichter), Albuquerque, NM; White River Junction VA Medical Center and Dartmouth Medical School (Dr. Geiling), White River Junction, VT; and University of Washington (Dr. Rubinson), Seattle, WA. A list of Task Force members is given in the ^Appendix.

Correspondence to: Michael D. Christian, MD, FRCPC, Mount Sinai Hospital, 600 University Ave, Suite 18-206, Toronto, ON, Canada M5G 1X5; e-mail: michael.christian{at}utoronto.ca

In the twentieth century, rarely have mass casualty events yielded hundreds or thousands of critically ill patients requiring definitive critical care. However, future catastrophic natural disasters, epidemics or pandemics, nuclear device detonations, or large chemical exposures may change usual disaster epidemiology and require a large critical care response. This article reviews the existing state of emergency preparedness for mass critical illness and presents an analysis of limitations to support the suggestions of the Task Force on Mass Casualty Critical Care, which are presented in subsequent articles. Baseline shortages of specialized resources such as critical care staff, medical supplies, and treatment spaces are likely to limit the number of critically ill victims who can receive life-sustaining interventions. The deficiency in critical care surge capacity is exacerbated by lack of a sufficient framework to integrate critical care within the overall institutional response and coordination of critical care across local institutions and broader geographic areas.

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