Detailed studies of U.S. disaster preparedness offer recommendations

Anticipating that a terrorist attack, influenza pandemic, or natural disaster will someday exhaust regional or national critical care systems, an expert task force recently issued a comprehensive series of reports that takes stock of current capabilities and recommends a surge framework that would care for as many patients as possible but would necessarily exclude some. The series, from the Critical Care Collaborative Initiative’s January 2007 Mass Critical Care Summit, appeared recently in a May supplement issue of the journal Chest. The five articles from the 37-member task force of American and Canadian experts include an executive summary and individual papers on current capabilities, a framework to optimize surge capacity, medical resource guidance, and recommendations for allocating scarce critical care resources in a mass critical care setting. Task force member John Hick, MD, told Lisa Schnirring and Robert Roos of CIDRAP News that, although initial mainstream media focus was patient exclusion issues surrounding the task force’s ventilator triage criteria, the guidelines are so far receiving good support in the medical community. “It [the series] provides both a systems and facility-based approach to resource-poor situations,” he said. “Whether the goals are reasonable or not, we’ll have to see,” added Hick, medical director of bioterrorism and disaster preparedness and an emergency medicine physician at Hennepin County Medical Center in Minneapolis and coauthor on three of the five articles.

Though the group covered an expansive array of controversial ethics and resource topics related to critical care in a disaster scenario, they had few disagreements on about 90 percent of the materials, Hick said. Not surprisingly, the critical care inclusion-exclusion generated the most discussion and required a great deal of compromise, he said. “It’s not exactly what we would do as individuals, but it’s a good framework nonetheless,” Hick said. Perhaps the biggest sticking point was the group’s recommendation for intensive care unit (ICU) expansion, he said, adding that the group settled on 200 percent because of pandemic concerns, though many advocated 100 percent ICU expansion as a more achievable goal. “My only fear is that people will see that as unrealistic and not aim for what they can achieve, and I think we tried to be clear to do at least what you can,” Hick said.

In an assessment of current U.S. and Canadian capabilities for critical care during a disaster, including equipment and supplies, staff, and space, the task force points to the likelihood of