Augmentation of hospital critical care capacity after bioterrorist attacks or epidemics: Recommendations of the Working Group on Emergency Mass Critical Care‡

Abstract

The Working Group on Emergency Mass Critical Care was convened by the Center for Biosecurity of the University of Pittsburgh Medical Center and the Society of Critical Care Medicine to provide recommendations to hospital and clinical leaders regarding the delivery of critical care services in the wake of a bioterrorist attack resulting in hundreds or thousands of critically ill patients. In these conditions, traditional hospital and clinical care standards in general, and critical care standards in particular, likely could no longer be maintained, and clinical guidelines for U.S. hospitals facing these situations have not been developed. The Working Group offers recommendations for this situation.

Cost-Effectiveness Comparison of Response Strategies to a Large-Scale Anthrax Attack on the Chicago Metropolitan Area: Impact of Timing and Surge Capacity

“…In addition, response strategies should include significant augmentation of the number of ICU beds and the personnel to provide critical care to large numbers of severely ill victims. 59 However, our findings clearly indicate that expanding critical care capacity is not as effective as instituting a more rapid public health KYRIACOU ET AL.…”

“…[55][56][57][58][59] Because no published information exists on ICU bed availability under the assumption of large-scale mass anthrax attack circumstances, we assumed 50% of the 2,655 ICU beds in the Chicago metropolitan area would be available to provide critical care to fulminant victims based on our clinical and administrative experience. Remaining ICU beds would continue to provide critical care for patients with other serious medical conditions.…”

“…[36][37][38] However, it is probable that only a limited number of fulminant victims of a large-scale anthrax attack would receive this type of care because individual hospital surge capacity for severely ill patients is limited. [55][56][57][58][59] For example, on average there are only 17.7 mechanical ventilators and 28.9 critical care beds per urban hospital in the US. 56 In addition, most hospitals (93.6%) have a surge capacity of fewer than 11 patients who would require mechanical ventilation.…”

Development of a triage protocol for critical care during an influenza pandemic

“…Nor does this model factor in the availability of human resources. Surge response strategies 10 (e.g., scaling back elective procedures, opening additional critical care areas and implementing the use of "mass critical care" 11,12 ) will partially mitigate the sudden demand for medical care during an influenza pandemic; however, these strategies will be inadequate to fully address the demands on the health care system.…”

Community Engagement: Leadership Tool for Catastrophic Health Events

“…111,112 At the peak of the pandemic, hospitals will need to cancel elective surgeries and discharge the least ill to recover elsewhere. Today's so-called "elective" procedures, however, include cancer surgeries, angioplasties, and aneurysm surgeries without which many patients may die.…”