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Paediatric patients in mass casualty incidents: a comprehensive review and call to action. Br J Anaesth 2021; 128:e109-e119. [PMID: 34862001 DOI: 10.1016/j.bja.2021.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 12/16/2022] Open
Abstract
The paediatric population is disproportionately affected during mass casualty incidents (MCIs). Several unique characteristics of children merit special attention during natural and man-made disasters because of their age, physiology, and vulnerability. Paediatric anaesthesiologists play a critical part of MCI care for this population, yet there is a deficit of publications within the anaesthesia literature addressing paediatric-specific MCI concerns. This narrative review article analyses paediatric MCI considerations and compares differing aspects between care provision in Australia, the UK, and the USA. We integrate some of the potential roles for anaesthesiologists with paediatric experience, which include preparation, command consultation, in-field care, pre-hospital transport duties, and emergency department, operating theatre, and ICU opportunities. Finally, we propose several methods by which anaesthesiologists can improve their contribution to paediatric MCI care through personal education, training, and institutional involvement.
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Gallagher JJ, Adamski J. Mass Casualties and Disaster Implications for the Critical Care Team. AACN Adv Crit Care 2021; 32:76-88. [PMID: 33725109 DOI: 10.4037/aacnacc2021235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Preparing for disasters both natural and anthropogenic requires assessment of risk through hazard vulnerability analysis and formulation of facility and critical care-specific disaster plans. Disaster surge conditions often require movement from conventional to contingency or crisis-level operations to meet the needs of the many under our care. Predisaster planning for modification of critical care space, staffing, and supplies is essential to successful execution of operations during a surge. Expansion of intensive care unit beds to nonconventional units such as perioperative areas, general care units, and even external temporary units may be necessary. Creative, tiered staffing models as well as just-in-time education of noncritical care clinicians and support staff are important to multiply capable personnel under surge conditions. Finally, anticipation of demand for key equipment and supplies is essential to maintain stockpiles, establish supply chains, and sustain operations under prolonged disaster scenarios.
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Affiliation(s)
- John J Gallagher
- John J. Gallagher is Professor, Department of Acute & Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15213
| | - Jennifer Adamski
- Jennifer Adamski is Adult-Gerontology Acute Care Nurse Practitioner Program Director and Assistant Professor, Emory University, Atlanta, GA; and Critical Care Nurse Practitioner, Critical Care Flight Team, Cleveland Clinic, Cleveland, Ohio
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3
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Tujjar O, Simonelli M. Absenteeism of Frontline Healthcare Workers During Covid-19: the Need for a Framework of Support. ACTA ACUST UNITED AC 2020; 2:2715-2717. [PMID: 33134848 PMCID: PMC7592146 DOI: 10.1007/s42399-020-00609-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Omar Tujjar
- Department of Anaesthesia, Intensive Care and Pain Medicine, Sligo University Hospital, The Mall, Sligo, Ireland
| | - Martina Simonelli
- Department of Anaesthesia, Intensive Care and Pain Medicine, Sligo University Hospital, The Mall, Sligo, Ireland
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4
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Aziz S, Arabi YM, Alhazzani W, Evans L, Citerio G, Fischkoff K, Salluh J, Meyfroidt G, Alshamsi F, Oczkowski S, Azoulay E, Price A, Burry L, Dzierba A, Benintende A, Morgan J, Grasselli G, Rhodes A, Møller MH, Chu L, Schwedhelm S, Lowe JJ, Bin D, Christian MD. Managing ICU surge during the COVID-19 crisis: rapid guidelines. Intensive Care Med 2020; 46:1303-1325. [PMID: 32514598 PMCID: PMC7276667 DOI: 10.1007/s00134-020-06092-5] [Citation(s) in RCA: 234] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management of intensive care units caring for patients with COVID-19 including: planning a crisis surge response; crisis surge response strategies; triage, supporting families, and staff.
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Affiliation(s)
- Shadman Aziz
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, Whitechapel Rd, Whitechapel, London, E1 1FR, England, UK
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Alhazzani
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Master University, Ontario, Canada
| | - Laura Evans
- Department of Pulmonary and Critical Care Medicine, University of Washington, Seattle, USA
| | | | | | - Jorge Salluh
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | | | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, UAE
| | - Simon Oczkowski
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Master University, Ontario, Canada
| | - Elie Azoulay
- Assistance publique - Hôpitaux de Paris, Paris, France
| | - Amy Price
- Anaesthesia and Informatics Lab, Stanford University, Stanford, USA
| | - Lisa Burry
- Sinai Health System, University of Toronto, Toronto, Canada
| | - Amy Dzierba
- New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | | | | | - Giacomo Grasselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Andrew Rhodes
- St Georges Hospitals NHS Foundation Trust, London, UK
| | - Morten H Møller
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Larry Chu
- Anaesthesia and Informatics Lab, Stanford University, Stanford, USA
| | | | - John J Lowe
- Department of Environmental and Occupational Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Du Bin
- Peking Union Medical College Hospital, Beijing, China
| | - Michael D Christian
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, Whitechapel Rd, Whitechapel, London, E1 1FR, England, UK.
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5
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Patel L, Elliott A, Storlie E, Kethireddy R, Goodman K, Dickey W. Ethical and Legal Challenges During the COVID-19 Pandemic: Are We Thinking About Rural Hospitals? J Rural Health 2020; 37:175-178. [PMID: 32282953 PMCID: PMC7262323 DOI: 10.1111/jrh.12447] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Love Patel
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Amy Elliott
- Allina Faribault Hospital and Clinic, Faribault, Minnesota
| | - Erik Storlie
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Rajesh Kethireddy
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Kim Goodman
- Clinical Ethics and Value Program, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - William Dickey
- Interim Vice President, Medical Affairs, Abbott Northwestern Hospital, Minneapolis, Minnesota
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6
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Koonin LM, Pillai S, Kahn EB, Moulia D, Patel A. Strategies to Inform Allocation of Stockpiled Ventilators to Healthcare Facilities During a Pandemic. Health Secur 2020; 18:69-74. [PMID: 32196387 PMCID: PMC7194315 DOI: 10.1089/hs.2020.0028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During a severe pandemic, especially one causing respiratory illness, many people may require mechanical ventilation. Depending on the extent of the outbreak, there may be insufficient capacity to provide ventilator support to all of those in need. As part of a larger conceptual framework for determining need for and allocation of ventilators during a public health emergency, this article focuses on the strategies to assist state and local planners to allocate stockpiled ventilators to healthcare facilities during a pandemic, accounting for critical factors in facilities' ability to make use of additional ventilators. These strategies include actions both in the pre-pandemic and intra-pandemic stages. As a part of pandemic preparedness, public health officials should identify and query healthcare facilities in their jurisdiction that currently care for critically ill patients on mechanical ventilation to determine existing inventory of these devices and facilities' ability to absorb additional ventilators. Facilities must have sufficient staff, space, equipment, and supplies to utilize allocated ventilators adequately. At the time of an event, jurisdictions will need to verify and update information on facilities' capacity prior to making allocation decisions. Allocation of scarce life-saving resources during a pandemic should consider ethical principles to inform state and local plans for allocation of ventilators. In addition to ethical principles, decisions should be informed by assessment of need, determination of facilities' ability to use additional ventilators, and facilities' capacity to ensure access to ventilators for vulnerable populations (eg, rural, inner city, and uninsured and underinsured individuals) or high-risk populations that may be more susceptible to illness.
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Affiliation(s)
- Lisa M Koonin
- Lisa M. Koonin, DrPH, MN, MPH, is with Health Preparedness Partners, LLC, a subcontractor of General Dynamics Information Technology (GDIT); Danielle Moulia, MPH, is a Public Health Scientist with General Dynamics Information Technology (GDIT); and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; all in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish Pillai, MD, MPH, MS, is CDR, US Public Health Service, and Deputy Director, Division of Preparedness and Emerging Infections; and Emily B. Kahn, PhD, MPH, MA, is Senior Epidemiologist/Modeler, Division of Preparedness and Emerging Infections; both in the National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Satish Pillai
- Lisa M. Koonin, DrPH, MN, MPH, is with Health Preparedness Partners, LLC, a subcontractor of General Dynamics Information Technology (GDIT); Danielle Moulia, MPH, is a Public Health Scientist with General Dynamics Information Technology (GDIT); and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; all in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish Pillai, MD, MPH, MS, is CDR, US Public Health Service, and Deputy Director, Division of Preparedness and Emerging Infections; and Emily B. Kahn, PhD, MPH, MA, is Senior Epidemiologist/Modeler, Division of Preparedness and Emerging Infections; both in the National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Emily B Kahn
- Lisa M. Koonin, DrPH, MN, MPH, is with Health Preparedness Partners, LLC, a subcontractor of General Dynamics Information Technology (GDIT); Danielle Moulia, MPH, is a Public Health Scientist with General Dynamics Information Technology (GDIT); and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; all in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish Pillai, MD, MPH, MS, is CDR, US Public Health Service, and Deputy Director, Division of Preparedness and Emerging Infections; and Emily B. Kahn, PhD, MPH, MA, is Senior Epidemiologist/Modeler, Division of Preparedness and Emerging Infections; both in the National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Danielle Moulia
- Lisa M. Koonin, DrPH, MN, MPH, is with Health Preparedness Partners, LLC, a subcontractor of General Dynamics Information Technology (GDIT); Danielle Moulia, MPH, is a Public Health Scientist with General Dynamics Information Technology (GDIT); and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; all in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish Pillai, MD, MPH, MS, is CDR, US Public Health Service, and Deputy Director, Division of Preparedness and Emerging Infections; and Emily B. Kahn, PhD, MPH, MA, is Senior Epidemiologist/Modeler, Division of Preparedness and Emerging Infections; both in the National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Anita Patel
- Lisa M. Koonin, DrPH, MN, MPH, is with Health Preparedness Partners, LLC, a subcontractor of General Dynamics Information Technology (GDIT); Danielle Moulia, MPH, is a Public Health Scientist with General Dynamics Information Technology (GDIT); and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; all in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish Pillai, MD, MPH, MS, is CDR, US Public Health Service, and Deputy Director, Division of Preparedness and Emerging Infections; and Emily B. Kahn, PhD, MPH, MA, is Senior Epidemiologist/Modeler, Division of Preparedness and Emerging Infections; both in the National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
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Hick JL, Hanfling D, Wynia MK, Pavia AT. Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2. NAM Perspect 2020; 2020:202003b. [PMID: 34532682 DOI: 10.31478/202003b] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- John L Hick
- Hennepin Healthcare and University of Minnesota
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Abstract
This review provides an overview of triaging critically ill or injured patients during mass casualty incidents due to events such as disasters, pandemics, or terrorist incidents. Questions clinicians commonly have, including "what is triage?," "when to triage?," "what are the types of disaster triage?," "how to triage?," "what are the ethics of triage?," "how to govern triage?," and "what research is required on triage?," are addressed.
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9
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Altman RL, Santucci KA, Anderson MR, McDonnell WM, Fanaroff JM, Bondi SA, Narang SK, Oken RL, Rusher JW, Scibilia JP, Scott SM, Sigman LJ. Understanding Liability Risks and Protections for Pediatric Providers During Disasters. Pediatrics 2019; 143:peds.2018-3893. [PMID: 30804075 DOI: 10.1542/peds.2018-3893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although most health care providers will go through their careers without experiencing a major disaster in their local communities, if one does occur, it can be life and career altering. The American Academy of Pediatrics has been in the forefront of providing education and advocacy on the critical importance of disaster preparedness. From experiences over the past decade, new evidence and analysis have broadened our understanding that the concept of preparedness is also applicable to addressing the unique professional liability risks that can occur when caring for patients and families during a disaster. Concepts explored in this technical report will help to inform pediatric health care providers, advocates, and policy makers about the complexities of how providers are currently protected, with a focus on areas of unappreciated liability. The timeliness of this technical report is emphasized by the fact that during the time of its development (ie, late summer and early fall of 2017), the United States went through an extraordinary period of multiple, successive, and overlapping disasters within a concentrated period of time of both natural and man-made causes. In a companion policy statement (www.pediatrics.org/cgi/doi/10.1542/peds.2018-3892), recommendations are offered on how individuals, institutions, and governments can work together to strengthen the system of liability protections during disasters so that appropriate and timely care can be delivered with minimal fear of legal reprisal or confusion.
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Affiliation(s)
- Robin L. Altman
- Department of Pediatrics, New York Medical College of Touro University and Maria Fareri Children's Hospital of Westchester Medical Center Health Network, Valhalla, New York
| | - Karen A. Santucci
- Department of Pediatrics, School of Medicine, Yale University and Children’s Emergency Department, Yale-New Haven Hospital, New Haven, Connecticut
| | | | - William M. McDonnell
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
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Blancher M, Albasini F, Elsensohn F, Zafren K, Hölzl N, McLaughlin K, Wheeler AR, Roy S, Brugger H, Greene M, Paal P. Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol 2018; 19:131-140. [PMID: 29446647 PMCID: PMC6014052 DOI: 10.1089/ham.2017.0143] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131–140, 2018. Introduction: Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Materials and Methods: Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. Results: We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. Discussion: General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. Conclusions: Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.
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Affiliation(s)
- Marc Blancher
- 1 Department of Emergency Medicine, University Hospital of Grenoble-Alps , Grenoble, France .,2 The French Mountain Rescue Association (ANMSM) , Grenoble, France
| | - François Albasini
- 2 The French Mountain Rescue Association (ANMSM) , Grenoble, France .,3 Department of Emergency Medicine, St. Jean de Maurienne Hospital , St. Jean de Maurienne, France
| | | | - Ken Zafren
- 4 ICAR MedCom , Roethis, Austria .,5 Department of Emergency Medicine, Stanford University Medical Center , Stanford, California.,6 Alaska Mountain Rescue Group , Anchorage, Alaska
| | - Natalie Hölzl
- 7 Department of Anesthesiology and Intensive Care Medicine, Klinikum Kempten, Germany
| | - Kyle McLaughlin
- 8 Department of Emergency Medicine, Canmore, Canada .,9 Department of Emergency Medicine, University of Calgary , Calgary, Canada
| | - Albert R Wheeler
- 10 Department of Emergency Medicine, St John's Medical Center , Jackson, Wyoming.,11 Search and Rescue Medical Director, Grand Teton National Park , Jackson, Wyoming
| | - Steven Roy
- 12 Quebec Secours SAR, Resident Physician Elective in Wilderness Medicine, McGill University , Montreal, Canada
| | - Hermann Brugger
- 13 Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy
| | - Mike Greene
- 14 Emergency Medicine Physician, Medical Officer Mountain Rescue England and Wales , Whitehaven, England
| | - Peter Paal
- 15 Department of Anesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University , Salzburg, Austria
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Cohen O, Feder-Bubis P, Bar-Dayan Y, Adini B. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis. Glob Health Action 2015; 8:28871. [PMID: 26449204 PMCID: PMC4598337 DOI: 10.3402/gha.v8.28871] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/09/2015] [Accepted: 09/01/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Public health legal preparedness (PHLP) for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC) and developed countries. OBJECTIVE This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak. DESIGN A rigorous literature review was conducted using eight electronic databases as well as Google Scholar. The results encompassed peer-reviewed English articles, reports, theses, and position papers dating from 2011 to 2014. Earlier articles concerning regulatory actions were also examined. RESULTS The importance of PHLP has grown during the past decade and focuses mainly on infection-disease scenarios. Amid LMICs, it mostly refers to application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Among developed countries, the United States' utilisation of health legal preparedness is the most advanced, including the creation of a model comprising four elements: law, competencies, information, and coordination. Only limited research has been conducted in this field to date. Nevertheless, in both developed and developing states, studies that focused on regulations and laws activated in health systems during emergencies, identified inconsistency and incoherence. The Ebola outbreak plaguing West Africa since 2014 has global implications, challenges and paralleling results, that were identified in this review. CONCLUSIONS The review has shown the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended.
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Affiliation(s)
- Odeya Cohen
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel;
| | - Paula Feder-Bubis
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Health Systems Management, Faculty of Health Sciences & Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaron Bar-Dayan
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Bruria Adini
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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12
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Hick JL, Einav S, Hanfling D, Kissoon N, Dichter JR, Devereaux AV, Christian MD. Surge capacity principles: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2015; 146:e1S-e16S. [PMID: 25144334 DOI: 10.1378/chest.14-0733] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This article provides consensus suggestions for expanding critical care surge capacity and extension of critical care service capabilities in disasters or pandemics. It focuses on the principles and frameworks for expansion of intensive care services in hospitals in the developed world. A companion article addresses surge logistics, those elements that provide the capability to deliver mass critical care in disaster events. The suggestions in this article are important for all who are involved in large-scale disasters or pandemics with injured or critically ill multiple patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS The Surge Capacity topic panel developed 23 key questions focused on the following domains: systems issues; equipment, supplies, and pharmaceuticals; staffing; and informatics. Literature searches were conducted to identify evidence on which to base key suggestions. Most reports were small scale, were observational, or used flawed modeling; hence, the level of evidence on which to base recommendations was poor and did not permit the development of evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions from the previous task force were also included for validation by the expert panel. RESULTS This article presents 10 suggestions pertaining to the principles that should guide surge capacity and capability planning for mass critical care, including the role of critical care in disaster planning; the surge continuum; targets of surge response; situational awareness and information sharing; mitigating the impact on critical care; planning for the care of special populations; and service deescalation/cessation (also considered as engineered failure). CONCLUSIONS Future reports on critical care surge should emphasize population-based outcomes as well as logistical details. Planning should be based on the projected number of critically ill or injured patients resulting from specific scenarios. This should include a consideration of ICU patient care requirements over time and must factor in resource constraints that may limit the ability to provide care. Standard ICU management forms and patient data forms to assess ICU surge capacity impacts should be created and used in disaster events.
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13
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Christian MD, Sprung CL, King MA, Dichter JR, Kissoon N, Devereaux AV, Gomersall CD. Triage: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2015; 146:e61S-74S. [PMID: 25144591 PMCID: PMC7127536 DOI: 10.1378/chest.14-0736] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pandemics and disasters can result in large numbers of critically ill or injured patients who 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 pandemics or disasters with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS The Triage topic panel 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 using 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 article provides 11 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.
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Affiliation(s)
- Michael D. Christian
- Royal Canadian Medical Service, Canadian Armed Forces and Mount Sinai Hospital, Toronto, ON, Canada
- Critical Care and Infectious Diseases, Mount Sinai Hospital, 600 University Ave, Room 18-232-1, Toronto, ON, M5G 1X5, Canada
| | | | - Mary A. King
- University of Washington, Harborview Medical Center, Seattle, WA
| | | | - Niranjan Kissoon
- BC Children's Hospital and Sunny Hill Health Centre, University of British Columbia, Vancouver, BC, Canada
| | | | - Charles D. Gomersall
- The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Dichter JR, Kanter RK, Dries D, Luyckx V, Lim ML, Wilgis J, Anderson MR, Sarani B, Hupert N, Mutter R, Devereaux AV, Christian MD, Kissoon N. System-level planning, coordination, and communication: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2015; 146:e87S-e102S. [PMID: 25144713 DOI: 10.1378/chest.14-0738] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, coordination, communication, and response. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS The American College of Chest Physicians (CHEST) consensus statement development process was followed in developing suggestions. Task Force members met in person to develop nine key questions believed to be most relevant for system-planning, coordination, and communication. A systematic literature review was then performed for relevant articles and documents, reports, and other publications reported since 1993. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS Suggestions were developed and grouped according to the following thematic elements: (1) national government support of health-care coalitions/regional health authorities (HC/RHAs), (2) teamwork within HC/RHAs, (3) system-level communication, (4) system-level surge capacity and capability, (5) pediatric patients and special populations, (6) HC/RHAs and networks, (7) models of advanced regional care systems, and (8) the use of simulation for preparedness and planning. CONCLUSIONS System-level planning is essential to provide care for large numbers of critically ill patients because of disaster or pandemic. It also entails a departure from the routine, independent system and involves all levels from health-care institutions to regional health authorities. National government support is critical, as are robust communication systems and advanced planning supported by realistic exercises.
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